Forensic medicine and toxicology sample

FORENSIC

MEDICINE AND

TOXICOLOGY medpgnotes

FORENSIC MEDICINE AND TOXICOLOGY

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1 GENERAL FORENSIC MEDICINE

CONTENTS GENERAL FORENSIC MEDICINE ..................................................................................................................................... 5

IDENTIFICATION ........................................................................................................................................................ 5

PRIMARY TEETH ........................................................................................................................................................ 5

SECONDARY TEETH ................................................................................................................................................... 6

DENTITION ................................................................................................................................................................ 6

ESTIMATION OF AGE ................................................................................................................................................. 7

ESTIMATION OF SEX .................................................................................................................................................. 7

ESTIMATION OF RACE ............................................................................................................................................... 8

ESTIMATION OF STATURE ......................................................................................................................................... 9

DEATH AND POSTMORTEM .......................................................................................................................................... 9

DEATH AND CHANGES AFTER DEATH ....................................................................................................................... 9

AUTOPSY ................................................................................................................................................................. 10

POSTMORTEM TEMPERATURE CHANGES ............................................................................................................... 11

POSTMORTEM STAINING/POSTMORTEM LIVIDITY ................................................................................................ 12

RIGOR MORTIS AND CADAVERIC SPASM ................................................................................................................ 12

MUMMIFICATION ................................................................................................................................................... 13

ADIPOCERE .............................................................................................................................................................. 13

PUTREFACTION ....................................................................................................................................................... 13

MAGGOTS ............................................................................................................................................................... 14

ANTEMORTEM AND POSTMORTEM BURNS ........................................................................................................... 14

ASPHYXIA .................................................................................................................................................................... 14

CAFÉ CORONARY ..................................................................................................................................................... 14

HANGING ................................................................................................................................................................ 14

DIFFERENT FORMS OF ASPHYXIA ............................................................................................................................ 15

DROWNING ................................................................................................................................................................. 16

FIREARM INJURIES ...................................................................................................................................................... 17

TYPES OF FIREARM .................................................................................................................................................. 17

TYPES OF BULLET .................................................................................................................................................... 17

TYPES OF FIREARM INJURIES .................................................................................................................................. 18

WOUND AND INJURY .................................................................................................................................................. 19

GRIVEOUS INJURY ................................................................................................................................................... 19

INJURIES .................................................................................................................................................................. 19


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FRACTURES ............................................................................................................................................................. 19

WOUND ................................................................................................................................................................... 20

LAW IN RELATION TO MAN ......................................................................................................................................... 21

COURTS ................................................................................................................................................................... 21

EVIDENCE ................................................................................................................................................................ 21

OFFENCE ................................................................................................................................................................. 22

IPC, CrPC AND IEA ................................................................................................................................................... 22

INQUEST .................................................................................................................................................................. 23

EXHUMATION ......................................................................................................................................................... 23

TORTURE ................................................................................................................................................................. 23

CRIMINAL RESPONSIBILITY...................................................................................................................................... 23

CONSENT ................................................................................................................................................................. 24

MEDICAL LAW ......................................................................................................................................................... 24

MEDICAL NEGLIGENCE ............................................................................................................................................ 24

TESTS AND RULES ........................................................................................................................................................ 25

SEXUAL OFFENCES ...................................................................................................................................................... 26

RAPE ........................................................................................................................................................................ 26

OTHER SEXUAL OFFENCES ...................................................................................................................................... 27

INFANTICIDE AND FETAL DEATH ................................................................................................................................. 28

FETAL DEATH ........................................................................................................................................................... 28

BATTERED BABY SYNDROME .................................................................................................................................. 28

TOXICOLOGY ............................................................................................................................................................... 29

GENERAL FEATURES OF POISONING ....................................................................................................................... 29

POISONING BASED ON PHYSIOLOGICAL STATE ...................................................................................................... 30

HYDROGEN SULPHIDE ............................................................................................................................................. 30

ARSENIC .................................................................................................................................................................. 30

LEAD ........................................................................................................................................................................ 31

PHOSPHORUS .......................................................................................................................................................... 32

MERCURY ................................................................................................................................................................ 32

COPPER ................................................................................................................................................................... 33

ZINC ......................................................................................................................................................................... 33

CADMIUM ............................................................................................................................................................... 33

ALUMINIUM PHOSPHIDE ........................................................................................................................................ 34

CYANIDE .................................................................................................................................................................. 34


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PARACETAMOL POISONING .................................................................................................................................... 34

SALICYLATE POISONING .......................................................................................................................................... 34

COPPER SULPHATE POISONING .............................................................................................................................. 35

ACID POISONING ..................................................................................................................................................... 35

SULPHURIC ACID ..................................................................................................................................................... 35

NITRIC ACID ............................................................................................................................................................. 35

CARBOLIC ACID ....................................................................................................................................................... 35

OXALIC ACID ............................................................................................................................................................ 36

KEROSENE POISONING ............................................................................................................................................ 36

CARBON MONOXIDE ............................................................................................................................................... 36

CHLORAL HYDRATE ................................................................................................................................................. 36

METHYL ALCOHOL ................................................................................................................................................... 37

BARBITURATES ........................................................................................................................................................ 37

ACONITE .................................................................................................................................................................. 37

DHATURA ................................................................................................................................................................ 38

STRYCHNINE ............................................................................................................................................................ 38

OPC ......................................................................................................................................................................... 38

PRESERVATIVES FOR POISONING ............................................................................................................................ 39

SNAKES .................................................................................................................................................................... 40

MUSHROOM POISONING ........................................................................................................................................ 40

PLANT POISON ........................................................................................................................................................ 41

GENERAL FEATURES OF MANAGEMENT OF POISONING ........................................................................................ 41

HEMODIALYSIS ........................................................................................................................................................ 41

ALKALINE DIURESIS ................................................................................................................................................. 41

SALINE DIURESIS ..................................................................................................................................................... 42

GASTRIC LAVAGE ..................................................................................................................................................... 42

BAL .......................................................................................................................................................................... 42

EDTA ........................................................................................................................................................................ 42

METALLOTHIENES ................................................................................................................................................... 43


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KEY TO THIS DOCUMENT

Text in normal font – Must read point.

Asked in any previous medical entrance

examinations

Text in bold font – Point from Harrison’s

text book of internal medicine 18th

edition

Text in italic font – Can be read if

you are thorough with above two.


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GENERAL FORENSIC MEDICINE

IDENTIFICATION

Superimposition technique is used in Skull

Cheiloscopy is the study of Lips

Palatoprints are taken from Anterior hard palate

Study of fingerprinting Dactylography

Dactylography is also known as Galton system, dermatoglyphics Majority of fingerprints in Indians Loop

MC type in Dactylography Loop

Least common type of finger printing Composite NOT a type of fingerprinting Circle

System of Dactylography first used in India

First finger loop bureau established in Kolkatta

Disease permanently altering fingerprints Leprosy

Identical twins may NOT have Same fingerprinting

Most sensitive and specific for identification Dactylography

To make a positive identification with the help of a partial fingerprint, the points of similarity should be

16

Most reliable method for identification of person Galton method

Tattoo is useful in identifying Decomposed body

Blackening and tattooing of skin and clothing best demonstrated by

Infrared photography

Faint letter mark can be made visible by Infrared photography

Identity in convict established by Anthropometry

Bertillon system is used for Identification

Bertillon system Identification based on body measurements

PRIMARY TEETH

TEETH ERUPTION

Lower Central Incisor 6 months Upper Central Incisor 7 months Upper Lateral Incisor 8 months Lower Lateral Incisor 9 months First Molar 1 year

Canine 1 ½ years Second Molar 2 years


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SECONDARY TEETH

TEETH ERUPTION

First Molar 6 years Central Incisor 7 years Lateral Incisor 8 years First Premolar 9 years Second premolar 10 years Canine 11 years Second Molar 12-14 years Third Molar 17-25 years

DENTITION

Natal teeth Present at birth, usually 2 incisors of mandibular teeth, need not be removed in all cases

Hardest part of the tooth Enamel

Best method to determine age up to 14 years Dentition

Charting of left lower canine 33 in FDI, 43 in modified FDI, -3 in Haderup

Dental numbering is done by FDI two digit system, Anatomic and diaphragmatic charting, Palmer notion

Dental numbering is NOT done by Acrogram

Stack formula for age estimation from dental pattern in Infants

Gustafson method is used for Age estimation

Most reliable criteria in Gustafson’s method of identification

Transparency of root

Gustafson method Estimation of age in adults over 21 years, transparency of root is not seen until 30 years, error in estimation is + 4 to 7 years

Most reliable criteria in Boyde’s method Incremental lines Eruption of tooth Canine is the second last to appear in primary dentition,

Hypothyroidism delays dentition

First incisors to erupt in an infant Lower central

All milk teeth are erupted by 2 years

Eruption of temporary teeth completed at 2-2 ½ years

Number of deciduous teeth 20

Period of mixed dentition 6-11 years

First permanent tooth to appear First molar

First Permanent tooth Maxillary molar

Second molar erupts at 12 years

Number of teeth in 3 years 20

No of tooth at 7 years 24

No of permanent tooth in 8 year old child 12


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No of tooth at 10 years 16, 8

20 permanent and 8 temporary teeth seen at 10 years

No of tooth at 12 years 24

Precocious dentition in newborn is associated with

Ellis van Crevald syndrome, Hallerman Streiff syndrome

Dentition occurs earlier in Syphilis Dentition is delayed in Rickets Delayed eruption if no teeth at age of 13 months

Permanent staining of teeth Tetracycline

Teeth typically grown in 20 – 30 months Second molar

Least medicolegal importance given to Second bicuspid Early loss of primary teeth Hypophosphatasia

Commonest morbidity in school Dental caries

Complication of Xerostomia Dental caries

MC tooth to be impacted Lower third molar

Impacted wisdom tooth produce referred pain via Branch of auriculotemporal nerve

On tenth day of a teeth being knocked out, the local clinical finding will be

Tooth socket is filled by tissue

Pantomogram is useful in visualization of Caries, Dental cyst, Temporomandibular joint

ESTIMATION OF AGE

Age assessment Clinical examination and Radiological evidence

Number of carpal bones seen in newborn X ray None

Number of carpal bones in skiagram of hand at the end of 1 year

2

X ray site for age determination of 16 year old female Lower end of radius and ulna

Attainment of 16 years of age best diagnosed on X-ray by

Elbow

X ray site for age determination of 21 year old female Iliac crest and clavicle

Most successful age estimation in skull Sagittal suture (lateral view) Metopic suture closes at 3 years Coronal, sagittal and lambdoid suture closes on inner side by

25 years

Closure of coronal suture starts by 30-35 years

Xiphoid process fuses with body of sternum at 40 years

Best bone to assess age between 20-50 years Skull

If the angle of mandible is obtuse, it means that the bone belong to

Young female child, Elderly

Mental foramen in older age Near upper border of mandible Two halves of mandible unite at 2 years

ESTIMATION OF SEX

Best bone for sex determination Pelvis Best criteria in pelvis Sciatic notch index Chilotic line Line on hip bone for sex determination


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Ischiopubic index is more in Females

Pubic arch in male pelvis 70 – 75* Pubic arch in female pelvis 90 – 100* Female pelvis Obtuse and U shaped subpubic angle, Broad greater

sciatic foramen, Broad lesser sciatic foramen, Pre and post auricular sulcus is prominent, Ischial tuberosity is everted and obturator foramen small and triangular, C shaped pelvic cavity

Male skull Muscular markings over occiput are more marked, Capacity greater than 1500 cc, Orbits square, Frontal eminence small

Skull of male from female Capacity > 1500 cc, Square orbit, Frontal eminence small

Features of male skull U shaped palate, steeper forehead, prominent zygomatic arch

Preauricular sulcus helps in determination of Sex

Corpobasal index is useful for determination of Sex

Corpobasal index is more in Males Corpobasal index of sacrum in females Less than 42 Sacral index in females Greater than 114 Scapular glenoid height in females Less than 36 mm Bicondylar width of femur in females Less than 72 mm Knogman table for Sex Sex differentiation from pelvic bone upto 95% accuracy from

Greater sciatic notch, Pre auricular sulcus, Obturator foramen, Sub pubic arch

Best bone for sex determination Pelvis

Female pelvis Wide sciatic notch, Shallow and wide symphysis pubis, Obtuse sub pubic angle, Light and graceful structure, Preauricular sulcus is larger

NOT useful for sex determination Clavicle

ESTIMATION OF RACE

Most reliable bones for purpose of medullary index Humerus, Tibia, Radius

Craniofacial angle 130*

AP diameter of skull is minimum in Brachycephaly

Cephalic index Maximum breadth/maximum length * 100 Cephalic index of Indian population 70-75

Cephalic index is used for determination of Race

Pure Aryans have Dolicocephalic

Rounded nasal opening, horse shoe shaped palatte, round orbit cephalic index above 80

Mongols

Squared orbit and rectangular palate with cephalic index 75,broad nose

Negroes

Fragmented medullary hair Negroes

Kidney shaped cross section of hair Negroes

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