Forensic Medicine and Toxicology(FMT) - AIM4PG

Preparations of Cannabis sativa (1) Bhang (siddhi, sabji): It is prepared from the dried leaves and fruit shoots. It is used as we use tea to prepare a decoction. It is the mildest and contains 15% of active principle. Fresh bhang is highly intoxicating and narcotic. Bhang kept in storage for two to three years is mildly stimulating and pleasure-giving. (2) Majoon: It is a sweet prepared with bhang. It increases the appetite and sexual desire. (3) Ganja: It is prepared from the flower tops of the female plant. It has a rusty-green colour and a characteristic odour. It is mixed and smoked with tabacco in a pipe or hukka. It contains 15 to 25% of the active principle. Ganja (pot, grass, weed,maryjone,) also known as marihuana, is used for smoking in cigarettes, which contain 0.3 to 0.6 g. cannabis are are known as Reefer or Joint. (4) Charas or hashish: It is the resin (dope or shit) exuding from the leaves and stems of the plant, and it contains 25% to 40% of the active principle.

Heat Ruptures: In severe burning or charring skin contracts markedly and heat ruptures occur, either before or after death. They are produced by splitting of tion the soft parts. These splits may be anywhere, but are burnt usually seen over fleshy areas of the body, like calves, len thighs and extensor surfaces, joints and on the head. Splits of abdominal walls occur parallel to muscle fibres. eck These ruptures or splits in the skin may be several centimetres in length, and superficially they may ion resemble lacerations or even incised wounds. They due can be differentiated by: (1) Absence of bleeding in the wound and surrounding tissues, since heat coagulates in the blood in the vessels. ( 2) Intact vessels and nerves are seen in the floor. (3) Irregular margins. (4) Absence of the bruising or other signs of vital reaction in the margins. the When the skin is completely burnt, the underlying muscle usually shows rupture due to heat. Flash burns: Flash burns are a variant of flame ng, burns. They occur due to sudden ignition or ne explosion of gases or fine particulate material, e.g. explosions, or ignition of highly inflammable of liquids or gases, and produce a uniform first and second degree burns of all of the exposed areas of skin due to brief but intense exposure to heat. If ch clothing is ignited, a combination of flash and flame ted burns occur. Pure cotton fabrics transmit more thermal energy to skin than polyester- cotton blend fabrics.

HYPERTHERMIC ANHYDROSIS OR DESERT SYNDROME: The features are like that of heat exhaustion .After profuse generalised sweating for several days, perspiration stops suddenly in all parts of the body below the neck region but persists in face and neck. There is hyperkeratotic plugging of sweat glands leading to functional failure of sweat apparatus. Papular rashes appear over face and neck. It was observed in U.S. soldiers having training in deserts. HEAT CRAMPS: (miner's cramps, stoker's or fireman's cramps): They are caused by a rapid dehydration of body through the loss of water and salt in the sweat. It is seen in workers in high temperature, when sweating has been profuse. The onset is usually sudden. Severe and painful paroxysmal cramps affecting the muscles of the arms, legs and abdomen occur. The face is flushed, the pupils dilated and the patient complains of dizziness, tinnitus, headache and vomiting. cramps. Intravenous injection of saline gives rapid relief. HEAT PROSTRATION (heat exhaustion, heat syncope, or heat collapse): Heat prostration is a condition of collapse hers, without increase in body temperature, which follows exposure hold to excessive heat. It is precipitated by muscular work and unsuitable clothing. There is extreme exhaustion and peripheral vascular collapse. The patient feels suddenly weak, giddy and sick. He may stagger or fall. The face is pale, the skin cold, the temperature subnormal. The pupils are dilated, the pulse small and thready and the respiration sighing. The patient usually recovers if placed at rest, but death may take place from heart failure. Heat Hyperpyrexia or Heat Stroke : A fever above 41.5°C is termed hyperpyrexia. Heat stroke is a condition characterised by rectal temperature greater than 41°C., and neurological disturbances, such as psychosis, delirium, stupor, coma and convulsions. The term thermic fever or "sunstroke is used when there has been direct exposure to the sun

EFFACEMENT OR OBLITERATION OF IDENTITY: The identity of a dead body may be destroyed by the following methods. (1) Purposive removal of the identifying features, e.g, fingerprints, tattoo marks, scars, moles, teeth, hair, etc. and articles of clothing. (2) Animals, e.g., rats, dogs, jackals and hyenas and birds, such as vultures may attack a dead body and mutilate it in a very short time, when the body is exposed in an open place. (3) Burning or incineration. (4) Advanced putrefaction. (5) Dismemberment and burying or throwing different parts in different places. (6) Biocremation or chemical hydrolysis: The body is placed in a stainless steel cremation chamber (similar to pressure cooker), A mixture of 95% water and 5% of potassium hydroxide is added. 150°C heat and 60 pounds of pressure a square inch is applied The average adult body takes about 2 to 3 hours to complete a biocremation. The bones are dried. powdered, placed in an urn and given back to family. The sterile solution is recycled to the earth. It is an environmentally friendly option as it uses less energy and releases less carbon dioxide. (7) Dismemberment by moving vehicles, like trains or by machinery. (8) Bomb explosions, which may disintegrate body.

EAR PRINTS: Ears have four basic shapes: oval, round, rectangular and triangular. The shapes of ear lobes and the tips of ears are of various types. Most of the ear prints are found on doors or windows. From the suspect three prints are taken (1) functional pressure, (2) gentle pressure, (3) more pressure, on a glass pane. The print is made visible as in the case of fingerprints and a photograph of the print is taken. The same process is applied to the ear prints from the scene. Photocopies of both known and unknown ear prints are produced on plain and transparency overlays. The transparency overlay is put on the top of the unknown print and taped to the top of a light box. If the tragus point, crus of the helix points and anti-tragus point fit, look at the lower and upper crura of the anti-helix and the helix rim. If all details coincide the prints are from the same source. The opinion can be positive, highly probable, probable, possible or no basis for comparison. NOSE PRINTS: The lines on the nose and the shape of the tip are helpful in identification. Chance impressions may be found over door, wall, etc.

DEVELOPMENT OF LATENT PRINTS: Fingerprints may be taken from almost any surface with which the fingers come in contact, including certain fabrics and human skin. A latent print may be developed by dusting the area with coloured powders to provide a contrast, and its pattern is recorded by photography. It can also be examined by oblique lighting. The commonly used powder is 'grey' powder (chalk and mercury), but white powders (lead carbonate or French chalk) are used for dusting dark surfaces. Fingerprints on paper, wood and fabrics are developed by treating them with 5% silver nitrate solution and then fixing them with sodium thiosulphate. Fingerprints on paper can also be developed by exposing it to the vapours of iodine or osmium tetroxide. Electron autoradiography method uses a high energy beam of X-rays to irradiate the lead dust on finger marks. The scanning electron microscope visualises latent fingerprints on metal and glass. Using a continuous wave argon ion laser and observing through suitable filters, latent fingerprints show luminescence. Even ten years old fingerprints can be developed. LIFTING OF FINGERPRINTS: Fingerprints on a large immovable hard surface is developed, photographed and then adhesive surface of cellophane tape is pressed on the print, taken out gently and pasted against a cardboard sheet for permanent preservation.

Techniques of Fingerprinting: The hands are washed, cleaned and dried, as otherwise the print will be blurred. The fingerprints are recorded on unglazed white paper using printer's ink. (1) A plain print is taken by applying ink to the tips of the fingers and placing the fingers directly on paper. (2) The rolled fingerprint is taken by rolling the fingers on paper from outward to inward in such a way as to obtain an impression of the whole tip. If rigor mortis is well developed, incision into the palmar surface of the fingers at the proximal interphalangeal joint will enable the fingers to be straightened, and printing can be carried out. Types: (1) The latent print (chance print) is an invisible or barely visible impression left on a smooth surface. (2) Visible prints are formed by fingers stained with blood or ink or other medium. (3) The plastic print is an impression made on a soft surface such as soap,cheese,mud,pitch etc

POROSCOPY: This is further study of fingerprints, described by Locard. The ridges on fingers and hands are studded with microscopic Dores, formed by mouths of ducts of subepidermal sweat glands. Each millimetre of a ridge contains 9 o 18 pores. These pores number in thousands per quare centimetre. These pores are permanent and unchanged during life and vary in size, shape, width, starting and stopping on occasion and ranching at points, position, extent and number, istribution and arrangement of the pores over given length of ridge in each individual. This method of examining pores is called poroscopy, and is useful when only fragments of fingerprints are vailable in which there is no specific pattern. Ridgeology is the study of friction ridges which re composed of the edges of ridge units which vary size, shape and alignment. Edgeoscopy is the study of edges of friction ridges which normally show seven characteristic features.

RECORDING AND REPRODUCING METHOD OF BITE MARKS: (1) PHOTOGRAPHIC METHOD: The bite mark is fully photographed with two scales at right angle to one another in the horizontal plane. Photographs of the teeth are taken by using special mirrors which allow the inclusion of all the teeth in the upper or lower jaws in one photograph. The photographs of the teeth are matched with photographs or tracings of the teeth. Tracings can be made from positive casts of a bite impression, inking the cutting edges of the front teeth. These are transferred to transparent sheets, and superimposed over the photographs, or a negative photograph of the teeth is superimposed over the positive photograph of the bite. Exclusion is easier than positive matching. As human tissues and foodstuffs do not reproduce exactly the character of the teeth biting into them, it is not always possible to relate teeth measurements to bitemarks with accuracy. (2) CASTS: A plastic substance, such as a rubber or silicone based medium containing catalytic hardener is laid over the bite mark, which produces a permanent negative cast. Plaster of Paris modelling clay, plasticine or bees wax also can be used. Impressions of the upper and lower teeth of the suspect are taken. (3) Digital imaging of the bite marks and rendering it as a 3D data set is possible. The image is measurable to high precision and accurately compared with measurements of the case of the dentition of the suspect. They are useful in identification because the alignment of teeth is peculiar to the individual. ML importance: Bite marks may be found in materials left at the place of crime, e.g., foodstuffs, such as cheese, bread, butter, sandwiches, fruit, or in humans involved in assaults, when either the victim or the accused may show the marks, usually on the hands, fingers, forearms, nose and ears.

Trauma and abortion The following criteria suggest a causal relationship trauma and abortion (1) The traumatic event was followed within twenty-four hours by a process that ultimately led to abortion. (2) The foetus and placenta should be normal. (3) The appearance of the foetus and placenta should be compatible with the period of pregnancy at which the traumatic event occurred. (4) Factors known to cause abortion should be absent, such as: (a) abnormalities of the uterus including congenital defect of uterine development, leiomyomas, endometrial polyps and incompetent cervical os; (b) a history of repeated abortion without any cause; (c) chronic infections in the mother, e.g., syphilis, or toxoplasmosis involving the uterus; (d) history of exposure to abortifacients, e.g., X-ray, lead, folic acid antagonists; (e) a physical attempt to induce abortion. (5) Adherent clot or a depression of the placental surface. between FOETAL INJURIES: Trauma may cause foetal injury or death. The age of the injury should correspond with the time passed after trauma. Soft tissue injuries heal in the uterus. In the case of fractures, the process can be dated by X-ray. A relationship may be established, if the age of fracture coincides with the traumatic event. Fractures of the skull and long bones can occur during delivery. To differentiate birth trauma from accidental trauma, X-rays are very helpful.

DECLARATION OF TOKYO, 1975 The World Medical Association adopted the followingguidelines for medical doctors concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in relation to Detention and Imprisonment. (1) The doctor shall not countenance, condone or participate in the practice of torture (physical or mental suffering) or other forms of cruel, inhuman or degrading procedure, whatever the offence of prisoners or detainees may be, and whatever be the victim's motives or beliefs, and in all situations, including armed conflict and civil strife. (2) The doctor shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment. (3) The doctor shall not be present during any procedure during which torture or other forms of cruel treatment is used or threatened. (4) A doctor must have complete clinical independence in deciding upon the care of a patient. (5) If a prisoner refuses nourishment, and is capable of forming a rational judgement about the consequences, he should not be fed artificially. (6) The doctor shall in all circumstances be bound to alleviate the distress of his fellow men, and no motive shall prevail against this higher purpose

AIRCRAFT INJURIES: Most of the aircraft accidents Occur on landing (35%), or take-off (35%). The sudden deceleration on crashing causes breakup of the aircraft and Injuries to the occupants. CRASH ACCIDENT : Both on landing and take- off the passengers are usually secured to their seats with lap type safety belts, which are fixed to the back of the base of the seats, and pass over the hips to tie across the abdomen just above the symphysis pubis. Many types of injuries are seen, in the relatively intact bodies. Fracture spine, especially thoracic spine are very common. These are usually hyperflexion injuries due to rapid deceleration when the aircraft strikes the ground. The forward momentum throws the head, on to the back of the front seat causing facial injuries. There may be fracture of the base of the skull, especially ring fracture. Fracture of the lower legs due to seat displacement is typical of the landing time accident, while fracture of the femur and internal injuries due to vertical deceleration, indicate a deep stall type of accident. Intrathoracic injuries occur due to squeezing of the chest by pressure against the sternum, which may rupture or detach the heart. Ruptures of the liver, spleen, kidneys and abdominal aorta occur. Death may be due to burning or CO poisoning. The seats may break loose due to which almost any type of injury may result. In about 20% of fatal crashes fire occurs. FLIGHT ACCIDENTS: The cabins are pressurised to prevent anoxia while in flight. If a door or window breaks, cabin pressure falls and anoxia may produce death. The rush of air out of the cabin is sufficient to blow a standing or even seated man out with it. The injuries vary from total disintegration of the body to relatively minor injuries. When a plane breaks up at a elatively high altitude, fragmented bodies may be distributed over wide area.

SPONTANEOUS HUMAN COMBUSTION (Preternatural combustion) : During putrefaction, inflammable gases are produced in abdomen due to the action of microorganisms upon organic matter. These gases are ignited if a flame is nearby. A human body may sometimes burn away almost completely, with minimal damage to the surrounding area. The burning may be confined to the body, its clothing and a narrow zone of floor or carpet. Often the victims are alcoholic and confused, instable and lack judgement. It appears that when a person usually an elderly woman collapses and falls, and part of the body comes in contact with a source of heat, clothing catches fire and burns the limited amount of oxygen available in the room, after which that part is ignited, and adjacent body fat melts and soaks into clothes. The clothing acts as a wick, melts the next zone of adjacent fat, and the process is repeated along the length of the body, till the knee joints are reached, and the burning stops because of less fat and also covered with less layers of the clothes. Often, all soft tissues are reduced to ash and most of bones are calcined. The only part of body left undamaged is likely to be one or both of lower legs. Usually CO is not found in the blood. The room in which the body is found is frequently very hot and the contents, walls, furniture, etc. are heavily soiled by soot, but there is no fire damage to any of the objects in the room.

DOMESTIC GAS EXPLOSIONS They occur due to leaks the gas supply, Natural gas explodes at concentrations in air netween 5 to 15 percent. Ignition is usually caused by matches or candles, fires, sparking electric switches. The explosion is accompanied by a momentary flame that sets fire to furnishings . The air pressure usually rises to less than 10 psi, due to escape through broken windows and doors. Deaths are rare. The person can be thrown off their feet and injured. The damage is haphazard or diffuse. The flame singes hair and causes localised superficial burns of exposed surfaces. Most deaths occur when the building collapses and the victims are buried in the debris MECHANICAL EXPLOSION Mechanical explain occur when a steam boiler bursts due to increased pressure. Neat and large volumes of gas are produced. The effects are similar to those of chemical explosion.

CLONING: It is the technique of producing a genetically identical duplicate of an organism artificially. Clone is an organism that has same genetic information as another organism. A clone is said to be all descendents derived asexually from a single individual. The procedure is known as Somatic Cell Nuclea Transplant (SCNT). Nucleus is removed from an egg cell and nucleus from a somatic cell is introduced into it. The resultant structure is triggered chemically or electrically to develop into an embryo. This is implanted in a surrogate mother. In India human cloning is officially banned. Therapeutic cloning aims to develop medical therapies fo which the cloned embryos grown only up to 14 days can harvest the stem cells that will be useful in treating certain diseases.

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ASSISTED REPRODUCTIVE TECHNIQUE (ART): In India, there is no law on issues relating to ART. The following is the code of conduct for ART as formulated by Indian Council of Medical Research (ICMR). (1) ART clinic has to get approval from the appropriate accreditation authority. (2) The ART clinic is not commercial party in donor programme or surrogacy. (3) No ART procedure can be done without the spouses informed consent. (4) The sperm donor and surrogate should not be a relative or a friend of the couple. (5) Sex selection is not permitted. There should be pre-implantation diagnostic testing of parents for genetic abnormalities. (6) The consent of the couples for the use of embryos is a must. (7) Biological parents must adopt a child born through surrogacy. (8) The sale or transfer of human embryos outside the country is prohibited. (9) Donors should be screened for HIV and hepatitis Band C infections. (10) The records have to be maintained and regularly chequed to guard against tampering.

SURROGATE MOTHERHOOD: A surrogate mother is a woman who by contract agrees to bear a child for someone else. It is intended to help a couple, of whom the woman is infertile, but the male has no reproductive deficiency. Artificial insemination with the semen of the barren woman's husband is carried out in a hired woman (womb leasing). Surrogate pregnancy can also be done with donated sperm or donated egg or donated embryo. After surrogate birth, the baby is returned to its biological father and his wife. The baby should be legally adopted by the couple. Another method is to remove a mature healthy ovum from the wife and fertilise it in 'vitro' with the husband's semen, and implant the embryo in the womb of a hired woman. Surrogate pregnancy can also be done with donated sperm or donated egg or donated embryo. According to the guidelines of Indian Council of Medical Research (ICMR), the genetic or biological parents names should only be mentioned in the birth certificate. In the birth registration,the hospital concerned should clearly indicate that the child was conceived through surrogate motherhood or by IVF procedure and pass on the information to the registrar concerned. The legal problems of surrogate motherhood are those of artificial insemination donor.