Notes on practical clinical forensic pathology
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This document provides information on typical organ weights, dimensions, lengths, and capacities in the human body. It also lists average anthropometric measurements in newborns and children of different ages. Post-mortem findings are described for various causes of death including hanging, strangulation, drowning, poisoning, heat stroke, and suffocation. Time since death is estimated based on factors like rigor mortis, lividity, and discoloration.
Notes on practical clinical forensic pathology
- 1. NOTES ON PRACTICAL FORENSIC PATHOLOGY Dr Udai Bhan Yadav MBBS,DMCH SMO & Medical Jurist General hospital Alwar Rajasthan.
- 2. WEIGHT OF HUMAN ORGANS Brain 1250—1400gm (1.4% body wt Spinal cord 25—30gm Heart 250—300gm Lung left 325—425gm Lung right 350—550gm Liver 1500—1800gm Spleen 120—180gm Kidney each 125—150gm Testes each 22—25gm Prostrate 15—30gm Uterus 100—115gm Ovary each 5—7gm Stomach 150---200gm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 2
- 3. DIMENSIONS OF ORGANS Liver 15—17x15x13cm Kidney 10.5x5.5x3.5cm Testes 4x3x2cm Prostrate 4x3x2cm Uterus (nulliparous) 8x4x2cm Ovary 4x2x1cm Spleen 12x8x6cm Heart 12x8x6cm Thickness Rt atrium 2mm Lt atrium 3mm Rt ventricle 5mm Lt ventricle 10—15mm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 3
- 4. LENGTH OF ORGANS Spinal cord 45cm oesophagus 25cm stomach 25—30cm Duodenum 25cm Small intestine 550—650cm Large intestine 150—170cm Trachea 12cm Ureter 25cm Male urethra 20cm Female urethra 4cm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 4
- 5. CAPACITES Stomach 1500ml Urinary bladder 225ml Heart chamber 70ml Csf 100—150ml Circulating blood 5 litre Gall bladder 30—50ml Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 5
- 6. CIRCOMFERENCE Mitral valve 10cm(8—10.5cm) Aortic valve 7.5cm(6—7.5cm) Pulmonary valve 8.5cm(7—9cm) Tricuspod valve 12cm(10—12.5)cm Pulmonary artery 8.0cm Aorta (thoracic &abdominal) 5cm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 6
- 7. NEW BORN FULL TERM MEASUREMENTS Length 45—50cm Weight of body 3—3.5kg Brain 350-400gm Thymus 12—15gm Heart 22—25gm Liver 125—140gm Spleen 10—15gm Stomach Weight 20—30gm Capacity 30ml Both lungs 60—70ml Both kidneys 20—25gm Both testes 1gm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 7
- 8. FOETUS AGE DETERMINATION Weeks Length in cm weight 12wks 9cm 20gm 16wks 16cm 100gm 20wks 25cm 300gm 24wks 30cm 600gm 28wks 35cm 1000gm 32wks 40cm 1800gm 36wks 45cm 2200gm 40wks 50cm 3500gm Length is more important Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 8
- 9. DURATION OF GASTATION 1st five months of gastation the square root of length,for example foetus of 25cm is five month old After 1st five months of gestation the length in cm divided by five gives age in months for example 40cm is eight month old. Length and weight indicate intrauterine age.at which child is born.Twice the number of intrauterine months is length of foetus in inches(Hess’s formula) .It is usually around 20 inch or 50cm at ful term,wt is 2.5--3.5kg avarage. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 9
- 10. APPROXIMATE ANTROPOMETERIC VALUES IN RELATION TO AGE IN CHILDRENS Age Weight kg Length/height cm Head cicunferance Birth 3kg 50cm 34cm 6month 6kg double in 5months 65 cm 42cm 1yr 9kg triple 75 m 45cm 2yr 12kg quadruple 85cm 47cm 3yr 14kg 95cm 49cm 4yr 16kg 100cm 50cm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 10
- 11. POST MORTEM FINDINS IN TYPICAL HANGING FOR EXAMPLE A male/female age about…..moderately built, nourished,wt….length….body is cold stiff.post mortem lividity seen on both forearms,hands,both legs,feets,face congested,eyes congested,sub conjunctival haemorrhage present,blood stained froth at nostrills,tongue protruded out,bitten and dry.vertical salavary trickle mark on left/right side of face and front of chest and abdomen,lips and nailbeds cynosed,seminal and faecal discharge present body natural orifices intact and healthy. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 11
- 12. LIGATURE MARK E.g size of ligature mark 26x2cm ,running obliquely above the thyroid cartilage ,upward and backward,patterned,grooved dark,chocolate colour/dark brown,dry and parchmentized and with bruswd edges. E.g ligature mark of size 18x1.5 to 1cm dark brown hard Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan over neck region start from left side of neck region 3cm from left side ear lobule passed anterior in front of neck,above thyroid prominance than back ward with a distance of 8cm from chin 9cm from sternal notch and 5cm from right ear lobule.there is a gap of 8cm in between two noose of ligatue mark,on dissection underlying of ligatue mark tissue is pale,hard ,parchmet like in consistency with no hematoma.no cartilage bone fracture..on further there is depression of posterior aspect of laryngeal wall to wards posterio side 12
- 13. INTERNAL EXAMINATION IN HANGING. Brain congested,oedematous with multiple haemorragic spots in substance of brain. Walls,ribs cartilage healthy Larynx ,trachea congested. Both lungs congested.oedematous with blood stained frothy oozing on cut section. Pericardium heart large vessels healthy.both coronaries with patent luman. Walls,peritonium healthy.mouth pharynx oesophagus healthy,congested.stomach healthy.empty,small intestin and large intestine healthy but distended with gages.liver,spleen kidneys healthy congested. bladder empty .organ of generation healthy. OPINION ---- post mortem appearance are suggestive Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan of death due to asphaxia resulting from hanging 13
- 14. LIGATURE STRANGULATION FOR EXAMPLE A male/female age about …well built and nourished .wt….length……cm.body cold,stiff/rigor mortis present at...... ,post mortem lividity seen on back and fixed.face livid,eyes congested and sub conjunctival haemorrhages.blood stained fluid flowing out through ears and nostrills.lips and nails bluish.A jute rope material used for strangulation measuring 1.6 mts was found round the neck of victim with double reef knot on front of neck over Adam’s apple.body orifices intact and healthy. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Brain congested oedematous ,with multiple peticheal heamorrhagic spots in brain substance 14
- 15. . Thorax -Walls,ribs cartilages,pleurae healthy. Larynx trachea ,healthy,but contain blood stained froth. Rt ,lt lungs congested oedematous with blood stained froth oozing on cut section. Pericardium,heart healthy,both coronarries with patent luman.large vessels intact healthy. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Abdomen –walls,peritonium healthy .mouth pharynx oesophagus healthy ,congested.stomach healthy empty.small intestin,large intestine healthy and distended with gas. Liver ,spleen, kidneys healthy congested.bladder healthy and full. ext and int genital healthy. 15
- 16. . Muscles bones joints- 1 –injuries bloodless dissection dissection of neck revealed ecchymosis of muscles of neck underneath ligature mark. Disease deformity nil. Fracture- the thyroid cartilage in neck is fractured in midline Ligatue mark was a pressure abrasion measuring 28x1.5cm continuous and running horizontally encirclin the neck at the level of adam’s apple.mark was grooved discoloured with with bruses at edges. Abrasion 3x2cm outer aspect back of rt fore arms. Abrasion 4x2 on outer aspect tr knee. Opinion –post mortem appearance are suggestive of death due to asphaxia resulting from ligatue strngulation. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 16
- 17. PM FINDINGS IN DRAWNING FOR EXAMPLE Body cold ,wet,rigor mortis well established. PM lividity on face chest abdomen front of thigh and fixed. Fine whitish lathery froth seen at mouth and nostrils. Lips and nails bluish.Hands clenched. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Both palms and soles were soddened bleached.groose skin (cutis anserina) appearance present. Brain intact healthy but congested,edematous with multiple petecheal haemorrhagic spots in brain substances. Larynx trachea intact healthy but containing fine whitish leathery froth Lungs voluminnous ,congested,edematous with fine whitish lathery froth on cut section. or Lungs are water logged bulge out pit on pressure,moderately congested and feel doughy. Mouth pharynx oesophagus intact ,healthy congested. Liver,spleen kidneys congested OPINION –POST MORTEM APPEARANCE ARE CONSISTENT WITH DEATH DUE TO DRAWING. Case of death asphaxia,ventriculr fibrillation,laryngeal spasm ,vagal inhibition,injuries etc 17
- 18. PM FINDINGS IN POISONINGS FOR EXAMPLE Cold, stiff, pm lividity on back and fixed ,face bluish,pinkish frothy fluid flowing out of nose. Brain congested edematous,multiple petecheal hemorrhagic spots in brain substance. Larynx trachea intact healthy congested. Lungs congested edematous with pinkish fine oozing on cut section. Mouth pharynx oesophagus intact healthy.congested Stomach mucosa congested and showed submucosal erosion.liver intact healthy congested.spleen intact healthy congested.and pulpy.kidneys congested. Visceras are collected and sealed in glass jar glass Jar A Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan contains whole stomach and its contents,glass Jar B contains piece of liver,kidney,spleen .lungs. Vial C contain blood.Glass jar A,B ARE preserved in saturated sol of common salt. In Vial C no preservative used 18
- 19. PM FINDINGS IN HEAT STROKE FOR EXAMPLE No characteristic findings . Eyes open drying of cornea and pitting.and sinking of eye balls.(appearance of avulsion of eyes.) Rigor mortis appears early and disappear early. Putrifaction rapid.lividity is mark. Degeneration of neurones in cerebral cortex cerebellum and basal ganglion is common Visceral congestion well mark.Peticheal haemorrhage found in skin ,visceras and in walls of third and fourth ventricle and aquaduct. Pulmonary oedema is some time found. Face is flushed and skin is hot and dry. Brain and membranes congested.peticheal haemorrhage are seen in white matter. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 19
- 20. . Respiratory system trachea bronchi contains frothy haemorrhagic fluid.lungs edematous congested,haemorrhage. Heart dilatation of right auricle. Liver kidney congested General peticheal and confluent haemorrhage in most organs. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 20
- 21. PM FINDINGS INSUFFOCATION FOR EXAMPLE Ext –closure of mouth and nostrils.pressure on chest. Int –clsure of glottis or luman of air tube.,decrease O2 in atmosphere.,inhalation of irritant gases. PM examinaton –signs of asphaxia well pronounced such as cynosed face, open eyes,prominent eye balls,dilated pupils,deeply injucted conjuctiva,livid lips,protruded tongue,blood stain froth per mouth and nostrils.etc. Mark of violance-bruses and abrasions round about lips.cheeks, scratches near about nose and mouth,injuries on inner surfaces of lips ,bruses of gums.signs of strugles on other part of body. Compression of chest –injury on chest,# of ribs,extravasation of blood in subcutaneous tissues. In overlaying of nose is flattened deviated to one side. # of cervical vertebrae seen if neck is forcibly wrenched or twisted. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 21
- 22. . INTERNAL – Forign body detected in mouth ,throat. Larynx and trachea –red congested,blood stained froth in luman. Death by pressure on chest -#of ribs some times,lungs congested contused or lacerated even without #ribs,superficial air vesicles ruptured,int organs congested,tradieu’s spots on pleurae,meninges,pericardium. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 22
- 23. TIME SINCE DEATH These are avarage time.in cold wheather they may be doubled or trebled.in hills they are quite inapplicable. Less than 1 hour-body is warm 3 hours –patchy post mortem lividity. 6 to 8 hours –lividity fully developed and fixed. 12 hours –rigor mortis all over ,green patch showing over the caecum. 24 to 36 hours –rigor mortis receding/absent, green discolouration over whole abdomen and spreading to chest,abdomen distended with gases ,ova of flies seen. 48 hours –trunk bloated,face discoloured and swollen Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan blisters present.moving maggots seen. 23
- 24. . 72 hours –whole body grossly swollen and disfigured.hairs and nails loose.tissue soft and discoloured. One week –soft viscera putrefied. Two weeks –only the more resistant viscera distiguishable ,soft tissues largely gone. One to three month –body skeletonised. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 24
- 25. STANDARD OPINIONS IN DEATH BY SNAKE BITE (PM) SNAKE BITE-cobra &similar snake which have neurotic venum. ‘’on perusal of the pm report case sheet and circumstantial evidence I am of the opinion that the death is due to respiratory failure consequent upon snake bite. In case of vipar and other similar snake which have hemolytic venom. (a) If bleed to death ‘Death is due to shock and haemorrhage as a result of snake bite.’ (b) If there is haemorrhage in brain stem ‘Death is due to coma as a result of brain stem haemorrhage secondary to snake bite, ; Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 25
- 26. ESTIMATION OF AGE Below 20 years x rays advised-wrist,elbow,pelvis. 21 years – Abve x ray + X ray clavicle 25 years - above + xray strnum ,skull ap lat view. FOLLOWING X RAY OF RIGHT SIDE ARE TAKEN- RT side of jaw oblique view. RT shoulder ap view. RT elbow ap and lat view. RT wrist with hand ap view. Pelvis with upper third of femur ap view. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 26
- 27. FOETUS AGE DETERMINATION Week length in cm weight 12 wk 9cm 20gm 16wk 16cm 100gm 20wk 25cm 300gm 24wk 30cm 600gm 28wk 35cm 1000gm 32wk 40cm 1800gm 36wk 45cm 2200gm 40wk 50cm 3500gm Length is more important. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 27
- 28. DURATION OF GASTATION 1st five months of gestation the square root of length, for example foetus of 25cm is five month old. After 1st five months of gestation the length in cm divided by five gives age in months for example 40cm is eight month old. Length and weight indicate intrauterine age.at which child is born.Twice the number of intrauterine months is length of foetus in inches(Hess’s formula) .It is usually around 20 inch or 50cm at ful term,wt is 2.5--3.5kg avarage. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 28
- 29. ENUMERATION THE SIGN OF RESIPIRATION CHARACTERSTIC BEFORE AFTER Shape of chest Flat Arched Diaphragm at 4-5 Ribs 6-7 Ribs level Lungs size Small voluminous Fodere’s test 500qraim 1000qraim Ploquet’s test 1:70 1:35 Edge sharp round Colour reddish brown mottled pinkish red Consistency Liver like spongy and crepitant Section Dark blood Red blood Hydrostatic test Sinks Floats Stomach Bowel test Sinks Floats. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 29
- 30. VARIOUS CHANGES IN FOETUS 30 Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
- 31. FEATURES HELPING IN ESTIMATING FOETAL AGE Length –measure crown – heal (vertex to heal) length by flexible tape. Weight Midpoint ofbody in relation to sternom and umbilicus. Skin wrinkle or presence of fat,presence of fat,presence and amount of vernix. Nail appeared or not ,extent of growth. Scalp hairs –appeared or not Eyelashes and eye brows appeared or not. Eyelids –adherent or open. Testicles in male ,ascertain the position by incising the scrotum and inguinal canal.if necessary. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Ossification centre. 31
- 32. EXAMINATION OF MALE IN SEXUAL OFFENCE FOR IMPOTENCY Name …. s/o… cast.. Sex.. Age… R/o…… R/o ……….. Sent by …… MI………. In presense of …….. General development …. Ht……..Wt ……Teeth…….. Hairs scalp ……eyebrows….upperlip….axillary….pubic…. Breast…. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Injury on body… 32
- 33. . BP…. PULSE 80 per minut…. HEART,LUNG …nad.. UROGENITAL TRACT nad…H/O DIABETTES,HT…nil STAINS OVER EXTERNAL GENITALS.. absent INJURY nil…SUPERFICIAL VEINS OVER PENIS-prominent on stimuls of penis…DEVELOPMENTAL ABNORMALITY IF ANY…no .SORTAL REFLAX…present. ON STIMULUS PENIS BECOMES STIFF HARD AND ELONGATED AND ERECTILE. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan SEALEAD ENVELOP CONTAINS FOLLOWINGS FOR GROUPING AND CROSS MATCHING IF NEEDED. 33
- 34. . A –Blood staned dried gauze B-- Saliva staned dried gauze OPINION- I am the opinion that there is nothing to suggest that the persion is incapable of performing sexual intercourse. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 34
- 35. RAPE CASE SAMPLES TAKEN AND SEALED Sealed envelop contains following for spermatozoa and chemical examination to detect out human seminal stain blood stain and cross matching if needed. A –blood soaked dried gause B - saliva soaked dried gause C – vulvovaginal swab smear 2 D –vulvovaginal swab stic . Opinion –regarding recent sexual act kept reserved till receiving FSL report. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 35
- 36. PM FINDINGS IN BURN(SAMPLE CASE) e.g.-body cold and stiff. Face is totally burnt,blackened,swollen,with scalp hairs burnt in patchy area on the front and on the sides of the head,have been trimmed short up to neck level. Eyes brows &eyelashes are also burnt completely. Rest body showed infected deep skin burn injuries with greenish black sloughing except a thin strip of intact skin around the waist line 1x30 cm,perineum and inner aspect of both feet(total skin area burnt90%).Suturing venesection wound measuring 1.5x0.25cm were seen one each on the inner aspect of both ankles. Superficial to deep burn,peeling of skin present,skin Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan black.red line present 36
- 37. . Brain congested,edematous Pleurae intact healthy.but with an effusion of straw yellow fluid measuring 400ml on rt side and200mlon lt side. Larynx and trachea intact healthy and showed blakish shoot particals . Lungs congested,edematous Mouth,pharynx,oesophagus intact healthy,congested Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Stomach mucosa congested and showed submucosal erosion at duodenal end. Liver,kidney,congested.spleen congested and pulpy 0PINION-DECEASED DIED DUE TOCOMPLICATION OF BURN INJURIES SUSTAINED. 37
- 38. DURATION OF BURN Rednss –immediate Vesication –about 2-3 hours Pus,Slough –about 36-72 hours Fall of superficial slough –about 1 week. Fall of deep slough –about 2 weeks. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 38
- 39. CAUSE OF DEATH IN BURN Shock –within 2 days Toxaemia -2 to 4 days Septecemia –if infection Rarely MI,and Fat embolism Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 39
- 40. LUNG TUBERCULOSES Congested,edematous multiplegray white nodules ranging from pin point size up to 1 cm were diffusely distributed through out the lung parenchyma Or –bluish discoloration over left side lower chest on dissection pleurae adhere to cavity wall and lungs multiple nodular lesion over both upper lobes on cut fibrocaseous lesion filled with blood mixed pale column fluid with foul smell ,bridging of tissues inside cavetious lesion. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 40
- 41. AGE OF ABRASION Bright red-Fresh Red scab-12-24 hr Redish brown scab 2-3days New growth of epithelium 4-7days Scab dried shrink and falls off -7days.some time may take 10-15 days Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 41
- 42. AGE OF CONTUSION Red-Fresh Blue-After few hours to three days Bluish black/brown- 4th day Green 5-7days Yellow 7-12 days Normal 2 weeks Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 42
- 43. DETEMINATION OF AGE OF INJURY Scab over abrasion and superficial cut-12-24hr In case of bruse change of color commence from the circumferance by 12-24hr and passes through usual changes In ordinary wound inflamation sat in within48 hr. If it is not rendered properly aseptic pus also forms by this time Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Skin wounds or contused wound on the head will generally heal within a week.if margins is considerably brused,it may take a fortnight.Healing of wound depend much on the constitution of pt and treatment 43
- 44. . In fracture ,inflamation and exudate of blood in soft tissue around the fracture site are noticed from 1st to 3rd days.callus begins to form the third day onwards.If inflamation subsides callus begins to ossify from 2nd to 3rd week on wards.it is fully absorbed by about 6-8 weeks Granulation tissues appears about 1 week When tooth knocked out.bleeding stops in24 hrs cavity fills in 7-10days time.smooth after 14 days Dution estimated by color change in bruse if present Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 44
- 45. CHARACTERS OF INCISED AND LACERATED WOUNDS Incised wound – edges are regular, clean cut,retracted,everted,except in neck&scrotum where edges are inverted,spindle shaped ,length is greaterin three dimensions,haemorrage isexcessive,Edge of wound may be irregular in care skin is loose eg neck &scrotum. Lacerated wound-margins are irregular ragged and inverted.tissues are torn and not cot.bleeding may not be marked due tocrushing of tissues. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 45
- 46. PM FINDING IN ELECTRIC BURN(ELECTROCUTION) FOR EXAMPLE e.g-multiple burn injuries present over an area 6cmx5cm.and contact electric burn of 5cmx3cmon palmar aspect of left hand. e.g-an oval crater like electric burn mark measuring 2cmx0.4cm with a pale flattened floor and a ridge of elevated skin and blackening around. e.g-split laceration skin wound 0.75x0.3cm with elevated ridge,seen on middle of the sole of left foot. Face is pale,eyes congested Brain congested,oedimatous,multiple petichial haemorrhagic spots in brain substance. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 46
- 47. , Larynx and trachea congested Rt&Lt Lungs congested,oedimatous. Mouth,pharynx,oesophagus,stomach mucosa.liver,spleen,kidneys all are congested. OPINION –Post mortem findings are consistent with death due to electrocution. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 47
- 48. AGE INCISED AND STAB WOUND 48 Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
- 49. MORPHOLOGICAL CHANGES IN MYOCARDIAL INFARCTION ½---4hr none 4---12hr occasional dark mottling. 12---24hr dark mottling. 1---3days mottling with yellow tan infarct centre. 3---7days hyperemic border,cental yellow tan softening. 7---10days maximally yellow tan and soft with depressed red tan margins. 10---14days red gray depressed infarct border 2---8weeks gray white scar progressing from border to ward core of infarct. >2months scarring complete. e,g-pericardium and heart adhere to lower anterior surface of heart,pale glistering waxy lesion of size 0.5x0.3 cm over lower part of anteror ventricula region left side. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 49
- 50. POST MORTEM OF BURN ABOUT 90—95% FOR EXAMPLE Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 50 Post mortem hypostases can not be determined due to burnt body surface area .pupil B/L fixed and dilated. Brain membrane congested brain oedematous cord—nil (not examined) Walls,ribs,cartilage,pleura congested. Larynx,trachea– mucus membrane congested, contain mucoid secretion with black shot particles over lower ends rt and lt both lungs congested Pericardium healthy,heart rt side chambers contains blood and left side chambers empty. Large vessels healthy
- 51. . Mouth ,pharynx ,oesophagus healthy. Stomach and its contents –mucous membrane congested contains 250ml dark brownish gluid Small intestine and their conents distended with gas ,large intestine contain foecal matter and gases.liver,spleen,kidneys congested,urinary bladder empty. Superficial to deep burn with sringing of hairs peeling and slough formation granulation tissye formation pus foci at places present over following parts of body. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 51
- 52. . 1 Head and neck as a whole 2 Anterior aspect of chest and abdominal wall as a whole 3 Posterior aspect of trunk(Back)as a whole . 4 Right side upper limb as a whole 5 Left side upper limb as a whole. 6 Genitals including both buttock as a whole. 7Right side lower limb as a whole.except some places over 1/3 of leg sole region. 8 Left side lower limbs as a whole except 1/3 of leg and sole region. Total burnt body surface area 90--95% Opinion –cause of death is shock brought about as a result of above mentioned antimortem dry heat flame. Burn with total burnt body surface are 90-95%sufficent to cause death in ordinary course of nature. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 52
- 53. ELECTRIC BURN 30—35% FOR EXAMLE Superficial to deep wounds with blackening of skin singing of hairs crater formatoin and charing of skin muscle with soft tissue and bones over following parts of body. 1 left side upper limb from shoulder region to hand as a whole. 2 anterior aspect of chest wall region 3Anterior abdominal wall up to pubic region 4right side lower limb from middle third of thigh to lower third of leg,anterior aspect as a whole 5 left side lower limb from lower third of thigh to middle third of leg ant erior aspect as a whole with distal of foot including great toe 1 and 2nd.total body surface area 30- 35% OPINION –Post mortem findings are consistent with death due to electrocution. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 53
- 54. STARVATION 30-48 hr feeling for hunger. Followed by pain epigastrium relived by pressure 4—5days general emaciation Absorption of subcutaneous fat Eyes sunken &glistening Pupil dilated Cheek sinks Bony prominence become visible Bichats buccal pad of fatis among the last subcutaneous adipose tissue which disappears Lips dry and cracked Tongue coats and dirty Thirst intolerable. Saliva thick and scanty,voice is week&whispering.skin dry rough thin inelastic wrinkled&pigmented,emaciation may be extreme Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 54
- 55. Abdomen concave limbs become thin flaccid with loss of muscular power muscular weakness is progresive and may be severe Cardiovascular changes are those of progresive insufficency.pulse is slow at rest but on exertion paroximal tachycardia supervens. Temperature sub normal.constipation is usual but towards death diarrhoea and disentry common. Urine scanty ,turbid concentrates and evedance of acidoses. Loss of wt is most marked &constent, in last stage body is reduced extreme state of emaciation Ribs are proment with concavity in intercostal spaces sunken superaclavicular fossa Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 55
- 56. Before death has offensive odour. Death usually occur when 40%of original weight. Intellect remain clear till death though in some cases delusion and hallucination of sight &hearing occur. Cause of death exahausion circulatory failur dehydration ,hypothermia Loss of weight acidoses with ketone bodies in urine are criteria to advise forced feeding. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 56
- 57. SODOMY FINDINGS IN HABITUAL PASSIVE AGENT. Shaving of anal and perianal hairs Loss of normal puckering around anus. Funnel shaped depression between buttocks around anus Skin around anus thickened and smooth –due to frequent friction On per rectal Prexamination 1 Loss of muscle tone(no radial constriction of anus on pinching the skin around.) 2 Presence of scars of old tear or fissure Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 3 Presence of lubricant/seman/venerial discharges. 57
- 58. SODOMY FORCIBLY VICTIMISED (NON HABITUAL)PASSIVE AGENT. Anus may appear to be swollen with temporary loss of tonicity of anal sphinctor Contusion/laceration of posterior & mucocutaneous tissues Seminal or seman mixed with faecal matter or blood stain may be seen If the victm is child penetration is usually forceful,resulting in tears and times prolapse of portion of anal canal seen. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan On per rectal examination---If one finger enters no intercourse may be opined.but if two finger can be inserted eliciting pain ,it is suggestive of anal intercourse. 58
- 59. SODOMY EXAMINATION OF ACTIVE AGENT Peculior smell of anal gland secretion Traces of faecal matter & lubricant used are often detected on the coronal sulcus,frenulam,prepause etc, Abrasion bruses laceration of prepause,frenulam,glans penis etc. Presence of STD lesion/discharge Note –the shape of glans penis may be found to be paping,elongated&constricted in habitual sodomist (active agent) Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 59
- 60. SIGN OF VIRGINITY Labia majora firm,elastic,rounded,lies in close contact with each other even in full abduction. Labia minora soft,elastic,small,rose coloured,lie in close contact ,not visible being hidden under labia majora.clitoris not enlarged.vestibule narrow. Posterior commissure and the fourchette are intact and crescent shaped(they are lacerated by sexual intercourse on children and rarely on adults. Vaginna narrow,tight with rugosed pinkish wall orifice is slit like due to opposition of wall and due to presence of hymen Perinium entire no sign of delivary hymen most imp sign of virginity. Extra genital BREAST-Hemispherical, firm,plumps,elastic. NIPPLE –Small pointed surrounded by pink areola. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 60
- 61. SIGN OF DEFLORATION Labia majora relaxed,not touching each other, Labia minora little elongated,protruted between labia minora. Clitoris enlarged Posterior commissure rupture Breast enlarged flabby,especially after child birth Nipple large Dilatation of vaginal canal and loss of corugation of its mucous membrane. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 61
- 62. RAPE EXAMINATION Injuries, number,appearanc.extent,probable duration Around mouth cheeks scratches ,abrasion,slight bruses Front of neck Thigh-inner side upper part –scratches abrasions bruses Arms –scratch,abrasion,bruses. Breast –ecchymoses,bruses ,mark of nail. Injuries resulting from struggle - Back,buttock,bony prominence,upper and lower extrmities. Blood or seminal stain on body of victim.vulva,vaina.thigh scraped by clean blunt knife and send for examination. Pubic hairs matted together with seminal fluid or blood.cut of by scissors and send for chemical examination. Examination for marks of violence on genitals Vulva—red Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan swollen,tender,abraded, brused. 62
- 63. . Vagina –dilated,hot mucous membrane of vagina – red,abraded,even lacerated(sexual intercourse without rupture of hymen if orifices allow two finger is possible) Hymen may be ruptured or lacerated edges torn segments swollen red tender ,usually shows radiate tears bleed on touching. Posterior commissure and fourchette ruptured in violance. Labia majora may be injured. Perinium swollen,tender.occasionally lacerated in children Vaginal discharge –thick in gonorrhoea,white in leucorrhoea. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 63
- 64. RAPE CASE EXAMINATION POSITIVE FINDING MAY BE (SAMLPE CASE) Findings examined by lady doctor Gait broad based,short paced Axillary and pubic hairs curly,dark,busy. Breast developed hemispherical,showed bite marks around the nipple on rt side. Back abrasion on both shoulders blades regions each mearuring 4x3cm. Finding on genital examination Vulva –labia majora,labia minora both contused edematous and inflamed. Hymen lacerated 1.5cmx0.75x0.5cm at 6.0 clock position Vagina bruised in posterior region in continuation with lacerated hymen over an area of 3x0.5cm Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 64
- 65. RAPE CASE SAMPLES TAKEN AND SEALED Sealed envelop contains following for examination of spermatozoa and chemical examination to detect out human seminal stain blood stain and cross matching if needed. A –blood soaked dried gause B - saliva soaked dried gause C – vulvovaginal swab smear 2 D –vulvovaginal swab stic . Opinion –regarding recent sexual act kept reserved till receiving FSL report. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 65
- 66. PM FINDINGS IN THROTTLING Ligature mark if throttling done by rt hand from front ,the impressin of thumb will be found ovr upper part of rt side of neck.and on lt side will be found four marks produced by four fingers. These four marks distributted from above downward and out wards .these marks are really due to bruses or contusions.they are accompaned by cresentic scratches produced by finger nails. Some time mark on left side may not be discrete but may be clusterd to gether. This may be reversed in case where lt hand or both hands are used. When both hands are used there will be several marks on each side of the neck. SIMPTOMS – ATTEMPTED THROTTLING. Brurse on neck,dysphasia,hoarseness of voice,marks of burse and abrasion on mouth ,nore cheek,fore head ,lower jaw,other part of body. Fracture of ribs with extravasation of blood in chest wall may be seen in some case. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 66
- 67. PM CHANGES IN EPILEPSY. H/O Attack and death. May die of asphaxia in an epileptic attack. Look for following 1-Bitten tongue. 2Hypertrophied gums if pt is on phenantoin sodium. 3Look for forign body in brain depressed fracture ,scarring of brain which are caused by secondary epilepsy. 4Relavent hospital record. 5Doctor can send organs and blood.for analyses of Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan antiepileptic drugs which the pt was taking.this can be taken as laboratory evidence rule out fowel play and other cause of death. 67
- 68. PM OF BRONCHEAL ASTHMA Autopsy finding are minimal. Hypertrophic emphysema of lungs Brown atrophy of heart Doctor must concentrate on 1 History and relevent hospital records. 2 Record of chronic use of antiasthmatic drugs ,bronchodilators. 3Rule out fowel play and other cause of death. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 68
- 69. MYOCARDIAL INFARCTION Hospital record.and laboratory investigation such as ecg,enzyme studies(sgot,sgpt,cpk etc) Look for atherosclertic changes of aorta,valves and coronaries. Look for coronary narrowing ,oclusion thrombus in coronaries etc. If pt die within about 6 to12 hr after MI ,no histopathological changes are noted.histopathological report normal Some time coronary may be within normal limit at autopsy,in such case the death was due to acute coronary spasm. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 69
- 70. SCAR (CICATRICS) Scar is a healed granulation (fibrous) tissue covered by epithelium formed as a result of healing of the wounds. It have no hair follicles No sweat glands. No elastic tissues. Slightly vascular by fine capallarries. It is 1st reddish brown later white or glistening. Scar of childhood grows in size with age. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan Scar can be removed by plastic surgery.scar produced is less pbvious. 70
- 71. MEDICOLEGAL IMPORTANCE OF SCAR. Marks of identification. Shape of scar may indicate nature of weapon causing injury. Age of scar is imp in criminal offence.(circumstantial evedence) Linea albicantes may indicate pregnancy Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 71
- 72. AGE OF SCAR Firm union occurs in 5 to7 days . producing a reddish or bluish,e.g.”angry’’ scar. At the end of 14 days scar is pale soft and sensitive .no further change up to end of second month. In about 2 to 6 months scar becomes brown or copper red but it remains soft and is not wrinkled. After 6 months scar become white and glistening ,become tough may wrinkled and after that no change occur. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 72
- 73. EXAMINATION OF DELIVERED FEMALE &ISSUE OF DELIVERY CERTIFICATE. A –Consent B –Brought by –relative/police –name C –MI D –Date and time of examination E—General particular name ……… age……sex…. Adress….. F—Name and signature of female attendent –this is important when a male doctor is examining G –General sign 1 General appearance (for first one to three days pt is exahasted with rapid pulse and raised temperatue etc. 2 Breast changes –enlarged ,tender,colostrum and milk come out.,engorged veins present,areola is darker, montgomery’s tubercle present etc. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 3Abdominal changes-lax,,pendulous,stria gravidorum present 73
- 74. . H-Local signs 1-external genitalia—vulva swollen,tender,blood stains may be present,vagina,cervix may be swollen,congested,roomy,may show injuries dilated cervix etc. 2—Lochia –last for two to three weeks,these can be-lochia rubra,lochia serosa lochia alba 3---Uterus –uterus takes 2to3 weeks to become pelvic organ. OPINION-I am of opinion that the women by name has local and general finding suggestive of recent delivery. Sd moi/c Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan 74