medico legal aspect of injury

127
MEDICOLEGAL ASPECT OF INJURY RADHIKA AGARWAL (64) TARAN GGOEL (81)

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Page 1: Medico Legal Aspect of Injury

MEDICOLEGAL ASPECT OF INJURY

RADHIKA AGARWAL

(64)

TARANGGOEL (81)

INJURYbull Medico-legally-injury is defined as breach or

dissolution of natural continuity of any of the tissue of a living body by actual physical violence

bull Legally- trauma or injury may be defined as any harm whatsoever in nature caused illegally to the bodymindreputation or property ( Section 44 IPC)

INJURIESMEDICOLEGAL ASPECT

Some important terms in relation to lsquomedicolegal aspect of injury-bull ASSAULT- An assault is an lsquooffer of threatrsquo or an attempt to apply force to the body of another in a hostile manner COGNISABLE OFFENCE- Cognisable offence means an offence for which a police officer may arrest the offender without a warrant Eg-Murder rape kidnapping HOMICIDE- Homicide means lsquokilling of one individualrsquo as a result of conduct of the other It may be ndash LAWFUL or UNLAWFUL SUICIDE- Suicide means lsquoSelf Murderrsquo Attempted suicide is an unlawful act

INTERPRETATION OF WOUNDS(1) Causative object or weapon

Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument

(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots

(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole

CLASSIFICATION

1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification

(A) Classification of injuries according to causative factors

1) Mechanical or physical injury-

(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration

(b) Those caused by sharp force(iv) Incision(v) Punctured wound

(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 2: Medico Legal Aspect of Injury

INJURYbull Medico-legally-injury is defined as breach or

dissolution of natural continuity of any of the tissue of a living body by actual physical violence

bull Legally- trauma or injury may be defined as any harm whatsoever in nature caused illegally to the bodymindreputation or property ( Section 44 IPC)

INJURIESMEDICOLEGAL ASPECT

Some important terms in relation to lsquomedicolegal aspect of injury-bull ASSAULT- An assault is an lsquooffer of threatrsquo or an attempt to apply force to the body of another in a hostile manner COGNISABLE OFFENCE- Cognisable offence means an offence for which a police officer may arrest the offender without a warrant Eg-Murder rape kidnapping HOMICIDE- Homicide means lsquokilling of one individualrsquo as a result of conduct of the other It may be ndash LAWFUL or UNLAWFUL SUICIDE- Suicide means lsquoSelf Murderrsquo Attempted suicide is an unlawful act

INTERPRETATION OF WOUNDS(1) Causative object or weapon

Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument

(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots

(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole

CLASSIFICATION

1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification

(A) Classification of injuries according to causative factors

1) Mechanical or physical injury-

(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration

(b) Those caused by sharp force(iv) Incision(v) Punctured wound

(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 3: Medico Legal Aspect of Injury

INJURIESMEDICOLEGAL ASPECT

Some important terms in relation to lsquomedicolegal aspect of injury-bull ASSAULT- An assault is an lsquooffer of threatrsquo or an attempt to apply force to the body of another in a hostile manner COGNISABLE OFFENCE- Cognisable offence means an offence for which a police officer may arrest the offender without a warrant Eg-Murder rape kidnapping HOMICIDE- Homicide means lsquokilling of one individualrsquo as a result of conduct of the other It may be ndash LAWFUL or UNLAWFUL SUICIDE- Suicide means lsquoSelf Murderrsquo Attempted suicide is an unlawful act

INTERPRETATION OF WOUNDS(1) Causative object or weapon

Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument

(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots

(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole

CLASSIFICATION

1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification

(A) Classification of injuries according to causative factors

1) Mechanical or physical injury-

(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration

(b) Those caused by sharp force(iv) Incision(v) Punctured wound

(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 4: Medico Legal Aspect of Injury

INTERPRETATION OF WOUNDS(1) Causative object or weapon

Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument

(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots

(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole

CLASSIFICATION

1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification

(A) Classification of injuries according to causative factors

1) Mechanical or physical injury-

(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration

(b) Those caused by sharp force(iv) Incision(v) Punctured wound

(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 5: Medico Legal Aspect of Injury

CLASSIFICATION

1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification

(A) Classification of injuries according to causative factors

1) Mechanical or physical injury-

(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration

(b) Those caused by sharp force(iv) Incision(v) Punctured wound

(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 6: Medico Legal Aspect of Injury

1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification

(A) Classification of injuries according to causative factors

1) Mechanical or physical injury-

(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration

(b) Those caused by sharp force(iv) Incision(v) Punctured wound

(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 7: Medico Legal Aspect of Injury

(2) Thermal injury

(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald

(b) Due to application of cold(i) Generalized effect of cold

Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 8: Medico Legal Aspect of Injury

(3) Chemical injury

(A) corrosions( due to strong acids or alkalis)

(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)

(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury

(B) Classification according to severity of injury

(1) Simple(2) Grievous(3) dangerous

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 9: Medico Legal Aspect of Injury

C Depending upon the time of infection

(a)Ante-mortem(b) Post-mortem

D Depending upon the manner of infliction sustaining

(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 10: Medico Legal Aspect of Injury

Types of wounds

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 11: Medico Legal Aspect of Injury

Types of woundsAbrasions

Bruises

Lacerations

Incised Wounds

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 12: Medico Legal Aspect of Injury

LEGAL CLASSIFICATION

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 13: Medico Legal Aspect of Injury

SIMPLE INJURY

bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 14: Medico Legal Aspect of Injury

GRIEVOUS HURTAny hurt which endangers life

ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain

ORUnable to follow his ordinary pursuits

ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 15: Medico Legal Aspect of Injury

GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or

joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 16: Medico Legal Aspect of Injury

-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo

Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)

EMASCULATION

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 17: Medico Legal Aspect of Injury

CASTRATED MALE

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 18: Medico Legal Aspect of Injury

PERMANENT PRIVATION OF SIGHT OF EITHER EYE

-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt

Example- a) corneal scarring b) retinal detachment etc

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 19: Medico Legal Aspect of Injury

Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 20: Medico Legal Aspect of Injury

PERMANENT PRIVATION OF HEARING OF EITHER EAR

bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear

bull EXAMPLE - Rupture of Tympanic Membrane

bull Cause- Blow to the head even if there is PARTIAL hearing loss

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 21: Medico Legal Aspect of Injury

PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE

bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo

bull It depends on - the nature of the injury on the person associated

bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt

b) cutting of nose ear etc

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 22: Medico Legal Aspect of Injury

Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 23: Medico Legal Aspect of Injury

PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo

bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body

leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a

leg of an individual during to a road traffic accident

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 24: Medico Legal Aspect of Injury

DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT

bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently

bull There may also damage to any other organ or part of the organ leading to loss of its distinct function

bull The damage should be permanent

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 25: Medico Legal Aspect of Injury

FRACTURE DISLOCATION OF A BONE OR TOOTH

bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt

NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 26: Medico Legal Aspect of Injury

LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 27: Medico Legal Aspect of Injury

ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily

pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of

20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc

NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 28: Medico Legal Aspect of Injury

MEDICO-LEGAL CLASSIFICATION

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 29: Medico Legal Aspect of Injury

MECHANICAL INJURY-BY BLUNT FORCE

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 30: Medico Legal Aspect of Injury

ABRASIONIt is defined as destruction or damage of the

superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 31: Medico Legal Aspect of Injury

Types of abrasions

1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 32: Medico Legal Aspect of Injury

The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving

individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused

with burns

^`

MEDICOLEGAL IMPORTANCE OF

ABRASIONS

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 33: Medico Legal Aspect of Injury

DETERMINATION OF AGE OF AN ldquoABRASIONrdquo

TIME CHANGES IN ABRASION

FRESH REDDISH amp SWOLLENNO SCAB

8-12 HOURS REDDISH SCAB

2-3 DAYS BROWN SCAB

4-5 DAYS DARK BROWN SCAB

6 DAYS BLACK SCAB STARTS FALLING

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 34: Medico Legal Aspect of Injury

CAUSATIVE AGENT

Imprint of the muzzle of a shotgun (Abrasion ring)

Imprint of the hilt guard of a knife

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 35: Medico Legal Aspect of Injury

Patterned abrasion

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 36: Medico Legal Aspect of Injury

LIGATURE MARK

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 37: Medico Legal Aspect of Injury

LIGATURE MARK

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 38: Medico Legal Aspect of Injury

LIGATURE MARK

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 39: Medico Legal Aspect of Injury

BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin

subcutaneous tissuesbull It is due to an infiltration or extravasation of

blood into the tissues following rupture of small vessels as a result of application of blunt force

bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 40: Medico Legal Aspect of Injury

The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal

organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection

MEDICOLEGAL ASPECT OF

BRUISES

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 41: Medico Legal Aspect of Injury

DETERMINATION OF ldquoAGE OF A BRUISErdquo

COLOR OF BRUISE PIGMENT TIME

RED HAEMOGLOBIN IMMEDIATE (24 HOURS)

BLUE DE-OXYGENATED HAEMOGLOBIN

1-3 DAYS

BLUISH-BLACK TO BROWN

HAEMOSIDERIN 4 DAYS

GREENISH HAEMOTOIDIN 5-6 DAYS

YELLOW BILIRUBIN 7-12 DAYS

COMPLETELY DISAPPEARS

- 2 WEEKS

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 42: Medico Legal Aspect of Injury

bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA

multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence

CONTUSION INDICATES-

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 43: Medico Legal Aspect of Injury

Patterned contusion

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 44: Medico Legal Aspect of Injury

LACERATIONSbull In laceration there is breach of continuity of

tissue involving depth more than the covering epithelium of the skin or that of an organ

bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 45: Medico Legal Aspect of Injury

LacerationCharacteristics

bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 46: Medico Legal Aspect of Injury

EXTENT OF LACERATIONS

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 47: Medico Legal Aspect of Injury

MEDICOLEGAL IMPORTANCE OF LACERATION

bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found

sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle

bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained

bull It leaves a permanent scar which may link the person with an old injury of long time back

bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 48: Medico Legal Aspect of Injury

bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 49: Medico Legal Aspect of Injury

The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted

The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 50: Medico Legal Aspect of Injury

MECHANICAL INJURY-BY SHARP INSTRUMENT

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 51: Medico Legal Aspect of Injury

INCISED WOUNDbull Incised wounds are cuts or slashes

produced by the sharp edge of aweapon like knife razor sword etc

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 52: Medico Legal Aspect of Injury

MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face

neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed

parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing

and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external

bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the

respiratory passage by blood

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 53: Medico Legal Aspect of Injury

Direction of trauma

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 54: Medico Legal Aspect of Injury

AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS

FRESH HAEMATOMA FORMATION

CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES

12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH

REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE

15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION

24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT

ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM

72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION

4-5 DAYS - FORMATION OF NEW FIBRILS

7 DAYS SCAR FORMATION SCAR FORMATION

AGE OF INCISED WOUND

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 55: Medico Legal Aspect of Injury

STAB WOUND PUNCTURED WOUND

bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body

bull Depth is the greatest dimension ofpunctured wound

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 56: Medico Legal Aspect of Injury

HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more

than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts

bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears

bull Defence wounds and marks ofresistance may be present on the body

bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 57: Medico Legal Aspect of Injury

DEFENCE WOUNDSbull A wound sustained when a victim places a

hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 58: Medico Legal Aspect of Injury

MEDICOLEGAL IMPORTANCE OF

DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles

bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault

bullThe size and shape of the bruises depends upon the attacking object

bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped

bullDefence wounds indicate homicide

bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 59: Medico Legal Aspect of Injury

SUICIDAL STAB WOUNDS Suicidal stab wounds are located

on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 60: Medico Legal Aspect of Injury

MEDICOLEGAL IMPORTANCE

bull In the examination of a stab wound the following essential points are kept into consideration-

1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 61: Medico Legal Aspect of Injury

Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc

Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end

If extremities are attacked amputation

CHOP WOUNDS

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 62: Medico Legal Aspect of Injury

bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed

bullIn case of long bones the bone fragments get loosened on the opposite side of the force

bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities

bullFew are accidental due to machinery

bullVery rarely suicidal

bullSometimes chop wounds are found on bodies recovered from water

MEDICOLEGAL IMPORTANCE OF

CHOP WOUNDS

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 63: Medico Legal Aspect of Injury

Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 64: Medico Legal Aspect of Injury

Self-inflicted injuries

Cuts are usually superficial multiple and parallel

In right handed people most of injuries are on the left side

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 65: Medico Legal Aspect of Injury

MEDICOLEGAL IMPORTANCE OF

SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 66: Medico Legal Aspect of Injury

SELF-INFLICTED WOUND

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 67: Medico Legal Aspect of Injury

PHYSICAL INJURY- FIREARM WEAPONS

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 68: Medico Legal Aspect of Injury

FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma

The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity

Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 69: Medico Legal Aspect of Injury

MEDICOLEGAL ASPECT OF

FIREARM INJURIES

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 70: Medico Legal Aspect of Injury

RECONSTRUCTION SUICIDE ACCIDENT amp MURDER

The questions the doctor will be suspected to answer are

1 Could the wound have been inflicted with that weapon

2 At what range was it fires3 From what direction4 Could it have been self-inflicted

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 71: Medico Legal Aspect of Injury

FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of

temple centre of forehead under the chinover the heart rarely epigastrium

Any area Any area

SHORT DISTANCE Contact or very close range

Close or very close range

Any range Usually distant

DIRECTION Upward or backward

Any direction Usually upwards

NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS

Present Present Absent

WEAPON Found at the scene

Found at the scene

Not found at the scene

SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle

Maybe indoors or outdoors in the marriages or parties

Any place amp there is evidence of disturbed scene and struggle

VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely

with weapon firmly grasped

Not so Not so

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 72: Medico Legal Aspect of Injury

exit inletLarge Small Size

Less More Loss of substance

NO ++++ Powder marks

Everted Inverted Edge

Eternal Internal Beveling

DIFFERENCE BETWEEN INLET amp EXIT

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 73: Medico Legal Aspect of Injury

MEDICOLEGAL ASPECT OF FIREARM WOUNDS

ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound

2) ABRASION COLLAR - indicates the direction of firing

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 74: Medico Legal Aspect of Injury

MEDICOLEGAL ASPECT OF EXIT WOUND

1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 75: Medico Legal Aspect of Injury

Medico legal importance of powder marks

1- Diagnosis of fire arm injuries

2- Differentiation between inlet and exit 3- Identification the type of powder used

4- Estimation the distance of firing 5- Determination the direction of firing

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 76: Medico Legal Aspect of Injury

DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc

The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 77: Medico Legal Aspect of Injury

IMMEDIATE CAUSES OF DEATH FROM WOUNDS-

Haemorrhage

Injury to a vital organ

Neurogenic shock

Combination of any of these

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 78: Medico Legal Aspect of Injury

Haemorrhage

Site of haemorrhage Cause of death

Extradural subdural or subarachnoid

Cerebral compression

Medulla Failure of vital functions

Pericardial sac Cardiac tamponade

Pleural cavity Collapse of lung amp displacement of mediastinum

Respiratory passages eg in cut throat injury or tonsillectomy

asphyxia

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 79: Medico Legal Aspect of Injury

INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal

NOTE- extensive damage to abdominal viscera may be present without visible marks of injury

NEUROGENIC SHOCK-

It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 80: Medico Legal Aspect of Injury

REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection

a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus

bull renal failure( crush syndrome)bull thrombosisbull embolism

a) fat embolism b) air embolism

bull secondary shockbull consumptive( disseminated

intravascular )coagulopathy

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 81: Medico Legal Aspect of Injury

MEDICOLEGAL IMPLICATIONS IN RELATION TO

ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE

Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE

EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 82: Medico Legal Aspect of Injury

MEDICOLEGAL IMPLICATION -

bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-

a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death

bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence

of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-

a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 83: Medico Legal Aspect of Injury

MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo

bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the

guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 84: Medico Legal Aspect of Injury

Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days

HISTOLOGICAL TIMING OF

WOUNDS

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 85: Medico Legal Aspect of Injury

HISTOCHEMICAL TIMING OF

WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 86: Medico Legal Aspect of Injury

CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF

WOUNDING

Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 87: Medico Legal Aspect of Injury

Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death

bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)

DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 88: Medico Legal Aspect of Injury

The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN

In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin

AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in

the wounds inflicted after death

BIOCHEMICAL TIMING OF

WOUND

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 89: Medico Legal Aspect of Injury

TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death

Great increase in the serotonin content and slight increase in the free histamine content

Wound inflicted 5-15 minutes before death

Relatively higher increase in histamine than in serotonin

Wound inflicted 15-60 minutes before death

Higher increase in serotonin content than histamine

In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)

No changes in the serotonin and histamine content of the severe wounds caused by the crash

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 90: Medico Legal Aspect of Injury

DIFFERENTIATING SUICIDAL HOMICIDAL

OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 91: Medico Legal Aspect of Injury

CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important

indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the

victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been

moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has

died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 92: Medico Legal Aspect of Injury

THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 93: Medico Legal Aspect of Injury

THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 94: Medico Legal Aspect of Injury

SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked

bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself

HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-

bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 95: Medico Legal Aspect of Injury

Thank you

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127
Page 96: Medico Legal Aspect of Injury

BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology

bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit

bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk

bullTimes of IndiabullThe Hindustan times

  • Slide 1
  • INJURY
  • INJURIES MEDICOLEGAL ASPECT
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Slide 10
  • Types of wounds
  • Slide 12
  • Slide 13
  • SIMPLE INJURY
  • Slide 15
  • GRIEVOUS INJURY
  • Slide 17
  • Slide 18
  • Slide 19
  • PERMANENT PRIVATION OF SIGHT OF EITHER EYE
  • Slide 21
  • Slide 22
  • Slide 23
  • PERMANENT PRIVATION OF HEARING OF EITHER EAR
  • PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
  • Slide 26
  • PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
  • DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
  • Slide 29
  • Slide 30
  • FRACTURE DISLOCATION OF A BONE OR TOOTH
  • Slide 32
  • ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
  • Slide 34
  • Slide 35
  • ABRASION
  • Slide 37
  • Slide 38
  • DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • BRUISE CONTUSION
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • LACERATIONS
  • Laceration Characteristics
  • Slide 58
  • Slide 59
  • MEDICOLEGAL IMPORTANCE OF LACERATION
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • INCISED WOUND
  • MEDICOLEGAL IMPORTANCE
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • STAB WOUND PUNCTURED WOUND
  • HOMICIDAL STAB WOUNDS
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • DEFENCE WOUNDS
  • Slide 83
  • SUICIDAL STAB WOUNDS
  • MEDICOLEGAL IMPORTANCE (2)
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Self-inflicted injuries
  • Self-inflicted injuries (2)
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • FIREARM INJURY
  • Slide 98
  • RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • DETERMINATION OF ldquoAGE OF INJURYrdquo
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
  • Slide 113
  • MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
  • Slide 115
  • Slide 116
  • Slide 117
  • Two zones around antemortem wounds-
  • Slide 119
  • Slide 120
  • Slide 121
  • CIRCUMSTANTIAL EVIDENCE
  • THE WEAPON
  • THE ldquoINJURYrdquo
  • SCENE OF CRIME
  • Slide 126
  • Slide 127