Practical forensic pathology

PRACTICAL FORENSIC PATHOLOGY
Dr Udai Bhan Yadav
MBBS,DMCH
SMO & Medical Jurist
General hospital Alwar Rajasthan.

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
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DrUdaiBhanYadavSMO&MedicalJurist
GHAlwarRajasthan

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
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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
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CAPACITES
Stomach 1500ml
Urinary bladder 225ml
Heart chamber 70ml
Csf 100—150ml
Circulating blood 5 litre
Gall bladder 30—50ml
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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
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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
Capacity
20—30gm
30ml
Both lungs 60—70ml
Both kidneys 20—25gm
Both testes 1gm
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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
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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.
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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
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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.
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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
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
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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
of death due to asphaxia resulting from hanging 13
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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.
 Brain congested oedematous ,with multiple
peticheal heamorrhagic spots in brain substance 14
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.
 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.
 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
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.
 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.
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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.
 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
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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
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
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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. 19
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.
 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.
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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. 21
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.
 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.
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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
blisters present.moving maggots seen. 23
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.
 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.
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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, ;
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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.
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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. 27
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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.
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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.
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VARIOUS CHANGES IN FOETUS
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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.
 Ossification centre. 31
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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….
 Injury on body… 32
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.
 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.
 SEALEAD ENVELOP CONTAINS FOLLOWINGS
FOR GROUPING AND CROSS MATCHING IF
NEEDED. 33
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.
 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.
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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.
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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
black.red line present 36
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.
 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
 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.
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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.
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CAUSE OF DEATH IN BURN
 Shock –within 2 days
 Toxaemia -2 to 4 days
 Septecemia –if infection
 Rarely MI,and Fat embolism
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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.
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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
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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
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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
 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
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.
 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
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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.
45
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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.
46
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,
 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.
47
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AGE INCISED AND STAB WOUND
48
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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.
49
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POST MORTEM OF BURN ABOUT 90—95%
FOR EXAMPLE
50
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 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

.
 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.
51
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.
 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.
52
GHAlwarRajasthan

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.
53
GHAlwarRajasthan

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
54
GHAlwarRajasthan

 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
 55
GHAlwarRajasthan

 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.
56
GHAlwarRajasthan

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
 3 Presence of lubricant/seman/venerial discharges. 57
GHAlwarRajasthan

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.
 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
GHAlwarRajasthan

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)
59
GHAlwarRajasthan

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.
60
GHAlwarRajasthan

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.
61
GHAlwarRajasthan

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
swollen,tender,abraded, brused. 62
GHAlwarRajasthan

.
 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.
63
GHAlwarRajasthan

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 64
GHAlwarRajasthan

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.
65
GHAlwarRajasthan

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.
66
GHAlwarRajasthan

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
antiepileptic drugs which the pt was taking.this can be
taken as laboratory evidence rule out fowel play and
other cause of death. 67
GHAlwarRajasthan

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.
68
GHAlwarRajasthan

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.
69
GHAlwarRajasthan

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.
 Scar can be removed by plastic surgery.scar
produced is less pbvious. 70
GHAlwarRajasthan

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
71
GHAlwarRajasthan

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.
72
GHAlwarRajasthan

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.
 3Abdominal changes-lax,,pendulous,stria gravidorum present 73
GHAlwarRajasthan

.
 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
74
GHAlwarRajasthan

ASSULT PM
 Conjunctiva ,lip nail pale
 Liver spleen kidneys healthy but pale.
 Cranium spinal cord brain –skull showed fissure
fracture measuring 7cm in lengthcorresponding to
the external injury. No ……membranesshowed
diffuse extradural ,subdural and subarachnoid
haemorrhage. Brain is congested and oedimatous
.shows laceration of frontal pole.on both side
dissection brain intraventricular haemorrhage
present
75
GHAlwarRajasthan

RTA PM SKULL
 Skull showed a 14 cm long fissured fracture on the
vault. Of skull.commencing 2cm above and right to
glabella.membranes intact but showed diffuse
subdural and subarachnoid haemorrhage. Brain
congested and oedimatous.
76
GHAlwarRajasthan

CORROSIVE POISONING
 Corrosion especially lips,mouth,chin,angle of mouth
hands etc, also clothing.
 Intestinal findings restricted to upper
gastrointestinal and respiratory tract.
 Pharynx,oesophagus –oedema,bleeding.
 Stomach –soft,boggy,black (H2SO4) ,yellow(HNO3)
Brownish(HCL)
 Surrounding visceras- sloughing (if stomach
perforated) perforation common in H2SO4
 Larynx trachea corrosion inflammation congestion
 Of respiration common in HNO3 due to fumes. 77
GHAlwarRajasthan

SULFURIC ACID
 Cloth burn
 Corrosion of mucous membrane of lips mouth and
throat and skin over the chin angle of mouth and
hands seen.
 Necrotic area are at first grayish white but soon
become brown or black and leathery.
 Internal changes limited to upper digestive tract and
respiratory system.
 Upper digestive tract is inflamed and swollen by
oedema and severe interstitial haemorrhage .The
greater part of stomach may be converted in to a
soft boggy black mass which readily disintegrated
when touch 78
GHAlwarRajasthan

 Mucosal ridges more damage than the furrows.
 In the damaged area the mucosa is brown or black.
 Perforation may occur with escape of stomach
contents in to the peritoneal cavity.
 Small intestine may show sign of irritation.
 Corrosion or severe inflamation of larynx and
trachea may be present.
79
GHAlwarRajasthan

NITRIC ACID
 Finding of sulfuric acid but tissue stain yellows.
 Perforation of stomach is not common
 In death from inhalation of fumes the larynx trachea
bronchi are congested and lung oedema
80
GHAlwarRajasthan

HYDROCHLORIC ACID
 Finding similar to sulfuric acid
 Corrhosion is less severe
 Perforation of stomach is rare.
 Acute inflamation and oedema of respiratory tract
and lungs are common.
81
GHAlwarRajasthan

DEATH BY COLD
 1 skin- pale with dark red patches on more exposed
parts post mortem staining is red in colour.
 2 muscles-cold stiffening of muscles occur with
delayed appearance and disappearance of rigor
mortis.
 3 brain- congested with ventricle filled with serum.
 4 heart- full of blood on both sides
 5 other organs- congested sub mucosal
haemorrhages in stomach and
duodenum.Gangrenous changes with mucosal
ulcers are seen in intestine.
82
GHAlwarRajasthan

EFFECT OF HEAT
 Rigor mortis well marked come early passrapidly.
 PM lividity well marked due to fluidity of blood.
 Brain and its membrane congested and also other
organs pin point haemorrhagic area seen
 Rt side of heart filled up with dark liquid blood.left is
empty. Petecheal haemorrhage on pericordial and
endocardial surface of heart.
83
GHAlwarRajasthan

Practical forensic pathology

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Practical forensic pathology