Forensic Medicine and Toxicology(FMT) - AIM4PG

TREATMENT IN A CASE OF DROWNING Artificial respiration and closed-chest cardiac compression should be started immediately. In fresh water drowning an external defibrillator should be applied to the chest and the electrolyte balance should be restored. In sea water drowning administration of oxygen and correction of haemoconcentration by infusion of hypotonic fluids should be carried out. The mouth and nostrils should be cleaned and air-passages kept clear by repeated suction. The body should be wrapped in warm blankets and stimulants given. Direct mouth-to-mouth or direct mouth-to-nose breathing are the best methods of artificial respiration. The patient is made to lie on his back, and the head is hyperextended. The operator takes a deep breath and then breathes directly mouth-to-mouth or mouth-to-nose, or through a specially designed tube. The patient is allowed to exhale passively. This is repeated about fifteen to twenty times per minute. This should be continued for about an hour or till natural respirations are restored. CLOSED-CHEST CARDIAC MASSAGE: The patient is made to lie on the back. The operator places his hands one on top of the other, on the lower end of the patient's sternum. Forcible rhythmic compressions are made 60 to 80 per minute to empty the blood from the ventricles. The force of compression must be sufficient to produce pulsation in the carotid and femoral arteries.

ATOMIC ABSORPTION SPECTROSC (AAS) AND FLAMELESS ATOMIC ABSORPTION SPECTROSCOPY (FAAS): It detects antimony, bariur lead from primer and copper vapourised from cartridge case or the bullet jacket. Palms and backs of hands (four surface swabbed with four cotton swabs moistened with hydrochloric acid. A fifth swab is moistened with acid and used as control. This analytical system utilises high temperatures to vapourise the metallic elements of the primer residues and to detect and to quantitate them. Typically the residue is deposited on the of the firing hand of the suspect who fired the gun. Detection of primer residue in the palm suggest defense gesture ra than firing of a gun. In suicide with handgun, primer residue on the palm may be due to cradling the gun with this handat the time of firing. With rifles and shotguns, residue is often detected on the non-firing hand that has been used to steady muzzle against the body. If the person survives, loss of residue may occur due to washing of hand or rubbing them against different materials. AAS can aid in (1) identify holes in clothing, tissues, wood, etc. as bullet holes, from presence of lead, antimony, barium and copper, (2) determining the range of fire from concentration pattern of antimony around the bullet hole, (3) determining common origin of bullet fragments of shotgun pellets found at different places, from the concentrations of lead, antimony, arsenic, copper and sil in these alloys, and (4) determining from the presence of lead, antimony and barium on hands whether or not a person has fired a gun.

Preservatives used in preservation of viscera in cases of suspected poisoning (1) Saturated sodium chloride solution, except in poisoning from corrosive acids (except phenol), alkalis, corrosive sublimate, and aconite. (2) Rectified spirit, except in cases of suspected poisoning by (a) alcohol, kerosene, (b) chloroform, ether, (c) chloral hydrate, (d) formic acid, (e) formaldehyde, acetic acid, (f) phenol, (g) phosphorus, and (h) paraldehyde, because the organic acids and paraldehyde are soluble in alcohol and the phosphorescence of phosphorus is diminished by alcohol. (3) Ten. mg./ml of sodium or potassium fluoride (prevents glycolysis, inhibits enzyme enolase and inhibits bacterial growth), and 3 mg. potassium oxalate (anti-coagulant) should be used for preserving blood. One ml of concentrated hydrochloric acid or 100 mg. of thymol or 100 mg, of sodium fluoride can be used for 10 ml urine as a preservative. Toluene is better. Preservative is not necessary if (1) viscera can be of analysed within 24 hours, (2) if sample can be kept in a refrigerator or ice box, (3) bone, hair, nails, (4)lung for detecting inhaled poisons. N.B: The viscera should not be preserved in formaldehyde because extraction of poison. especially non-volatile organic compounds becomes difficult. For blood grouping and DNA profiling a piece of filter paper or clean cotton gauze can be used to soak up some blood and dried.

Motive of self -inflicted wounds and fabricated wounds :- They may be produced for the following reasons. (1) To charge an enemy with assault or attempted murder. (2) To make a simple injury appear serious. (3) By the assailant to pretend self-defence or to change the appearance of wounds, which might connect him with the crime. (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property. (5) In thefts by servants or messengers for the above reason. (6) By prisoners, to bring a charge of beating against officers. (7) By recruits to escape military service. (8) By women to bring a charge of rape against an enemy. (9) Injuries may be seen in parasuicide or in mental illness.

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Medical laws/sections related to examine tion of medicolegal cases If the investigating officer give requisition for any clarifications regarding any points in the report, the answers should be given in writing 179, I.P.C.; S. 161, Cr.P.C.). If the investigating officer requires any documents, such as case sheet, er the original or the xerox copy, it should be given I a receipt obtained (S.91, Cr.P.C.). If the Court uires X-rays, postmortem report, or any other uments, they should be deposited in the Court and ceipt obtained. The doctor can be summoned the police station for recording a statement if investigation demands (S.160 Cr.P.C.). The moned person is bound to attend and answer stions put to him. Refusal to answer questions is ishable with imprisonment up to six months 179, I.P.C.) Oral statements made to the police recorded by the police should not be signed (S. 62, Cr.P.C.)

Aqua fortis/red spirit of nitre/ nitric acid :- It is a clear, colourless, fuming, heavy liquid, and has a peculiar and choking odour. In concentrated form it combines with organic matter and produces an yellow discolouration of tissue due to the production of picric acid (xanthoproteic reaction). PHENOL MARASMUS/chronic poisoning of phenol It is characterised by anorexia, weight loss, headache, vertigo, dark urine and pigmentation of skin and sclera. The hydroquinone and pyrocatechol may cause pigmentation in the cornea and various cartilages, a condition called oochronosis. Oochronosis is commonly associated with alkaptonuria (an inborn error of metabolism), in which homegentisic acid gets deposited in cartilages, ligaments and fibrous tissues

DINITRO ORTHO CRESOL AND DINITRO PHENOL Dinitro Ortho Cresol and dinitrophenol are commonly used weed-killers. They are also used to kill insects and fungi and to preserve wood.  They act by greatly increasing the cellular metabolism of any cell with which they come in contact.  They are absorbed orally, through the skin, and respiratory tract. Inhalation and ingestion may occur during spraying of crops.  Fatal dose one to 2 g. and  fatal period 4 to 15 days.  SYMPTOMS : They appear rapidly and resemble a thyrotoxic crisis. CONTACT : Yellow colour of the skin and hair and rashes. Burns of lips and buccal mucosa. CNS: Anxiety, restlessness, tiredness, insomnia, convulsions, coma. C.V.S: Tachycardia and arrhythmias. R.S. : Tachypnea and pulmonary congestion. METABOLIC :Hyperpyrexia and intense perspiration. RENAL: Acute renal failure. HEPATIC: Acute liver necrosis. EYES: Severe irritation, redness, watering: TREATMENT : Symptomatic

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Postmortem Appearances of calotropis poisoning :- Dilated pupils, froth at the nostrils, stomatitis, and inflammation of gastrointestinal tract are seen. The abdominal viscera and brain are congested. Circumstances of calotropis Poisoning: (1) The flowers, leaves, root and juice are used in Indian medicine. (2) The juice is taken by mouth or introduced into uterus on an abortion stick for criminal abortion. (3) It is sometimes used for infanticide and rarely for suicide or homicide. (4) Juice is used as a vesicant, depilatory and for chronic skin infection. (5) Occasionally, to produce artificial bruise. (6) As a cattle poison, it is smeared on a cloth and pushed into the rectum of the animal, or is given with fodder. (7) It is sometimes used as arrow poison. (8) The root of catotropis procera is highly poisonous to cobras, and other poisonous snakes, which cannot stand even its smell

Air embolism can be demonstrated by:  (1) Before handling the thoracic organs, the pericardium is opened, heart is lifted upwards and the apex is cut with a knife. The left ventricle is filled with frothy blood, if air is present in sufficient quantity to cause death.  (2) If the right ventricle contains air, the heart will float in water.  (3) Another method of demonstrating air embolism is by cutting the pericardium anteriorly and grasping the edges with haemostat on each side. The pericardia] sac is filled with water and right heart is punctured with a scalpel and twisted a few times. Bubbles of air will escape if air is present. (4) A wide-bore needle attached to a 50 ml syringe filled with water is inserted into the right ventricle. If air is present it will bubble out through the water. (5) Pyrogallol test: 4 ml. of a 2% freshly prepared pyrogallol solution is collected into two 10 ml syringes. To the first syringe four drops of 0.5 M sodium hydroxide solution is added. Gas is aspirated from the right side of the heart. The needle is removed and replaced with a stopper, and the syringe shaken. If air (oxygen) is present, the mixture turns brown. In the second syringe some air is introduced and the test repeated as a control. The solution should turn brown. This test helps to differentiate gas present in the heart from gas formed due to decomposition. (6) Air in inferior vena cava can be demonstrated by puncturing it under water, and looking for escape of bubbles of gas.  (7) Chest x-ray.

Punishment for commercial dealings in human organs.—Whoever— (a) makes or receives any payment for the supply of, or for an offer to supply, any human organ; (b) seeks to find a person willing to supply for payment any human organ; (c) offers to supply any human organ for payment; or (d) initiates or negotiates any arrangement involving the making of any payment for the supply of, or for an offer to supply, any human organ; (e) takes part in the management or control of a body of persons, whether a society, firm or company, whose activities consist of or include the initiation or negotiation of any arrangement referred to in clause (d); or (f) publishes or distributes or causes to be published or distributed any advertisement,— (1) inviting persons to supply for payment of any human organ; (2) offering to supply any human organ for payment; or (3) indicating that the advertiser is willing to initiate or negotiate any arrangement referred to in clause (d);shall be punishable with imprisonment for a term which shall not be less than 2 [five years but which may extend to ten years and shall be liable to fine which shall not be less than twenty lakh rupees but may extend to one crore rupees].

Justifiable Homicide This is the homicide which is justified in the circumstances which led to the killing of a person. This may occur ( l) in the administration of justice, like execution of sentence of death, (2) the maintenance of justice, e.g., in suppressing riots, orexecuting arrest, or killing in course of violent crime, e.g., a woman who kills a person who attempts to rape her. Excusable Homicide This is the homicide caused unintentionally by an act done in good faith. This includes (1) killing in self-defence when attacked, provided there is no other means of defence, (2) causing death by accident or misadventure, (3) death following a lawful operation, (4) homicide committed by an insane person.

Sec 31 IPC “A will”.—The words “a will” denote any testamentary document. Sec 32 IPC Words referring to acts include illegal omissions.—In every part of this Code, except where a contrary intention appears from the context, words which refer to acts done extend also to illegal omissions Sec 33 IPC “Act”, “Omission”.—The word “act” denotes as well a series of acts as a single act: the word “omission” denotes as well a series of omissions as a single omission. Sec 34 IPC Acts done by several persons in furtherance of common intention.—When a criminal act is done by several persons in furtherance of the common intention of all, each of such persons is liable for that act in the same manner as if it were done by him alone.

Points for comparison in superimposition The following points are then compared. (1) The eyes within the orbital plates, with the two pairs of canthuses properly aligned. (2) The nasion. (3) The prosthion in the central line. (4) The nasal spine in the centre which is a little above the tip of the nose. (5) The lower border of the nose. (6) The lower border of the upper jaw, i.e., below the tip of the nose. (7) The zygomas below the eyes. (8) Supraorbital ridges. (9) Angle of the jaw. (10) External auditory meatus. (11) Angle of the jaw. (12) Teeth.

Causes of Death in burns :- (1) Primary (neurogenic) shock due to pain, etc. (2) More than half of deaths from burns occur within the first 48 hours usually from secondary shock, due to fluid loss from burned surface. Circulatory collapse may occur with 15% of burns of total body surface area. (3) In smoke inhalation apart from CO, the other factors which contribute to death are oxygen deprivation, cyanide, free radicals (inactivate surfactants, thus preventing oxygen from crossing the alveoli into the blood), and non-specific toxic substances. (4) Toxaemia, due to absorption of various metabolites from the burnt tissue persists up to 3 to 4 days. (5) Sepsis is the most important factor in deaths occurring four to five days or longer after burning. (6) Biochemical disturbances, secondary to the fluid loss and destruction of tissue, e.g., hypokalaemia. (7) Acute renal failure, due to lower nephron nephrosis occurs on the third or fourth day. (8) Gastrointestinal disturbances, such as acute peptic ulceration, dilation of the stomach, haemorrhage into intestines. (9) Oedema of glottis and pulmonary oedema due to inhalation of smoke containing CO and CO,, if the person dies in a burnt house. (10) Accident occurring in an attempt to escape from a burning house or by injuries due to falling masonry, timber or other structures on the body. (11) Pyaemia, gangrene, tetanus, etc. (12) Fat embolism is rare. (13) Pulmonary embolism from thrombosis of veins of the leg due to tissue damage and immobility. (14) Often, multisystem failure. (15) Death may occur years after recovery from malignant transformation of a burn scar (Marjolin's ulcer).

Acute poisoning of amphetamine Toxicity is similar to cocaine. (1) Mild: Restlessness,talkativeness, insomnia, tremors, sweating, dilated pupils. (2) Moderate: Hyperactivity, confusion, hypertension, tachycardia, tachyapnoea, vomiting, sweating, hallucinations. (3) Severe: Delirium, hyperpyrexia, convulsions, coma, arrhythmias. Acute intoxication may present as a paranoid hallucinatory syndrome which closely mimicks paranoid schizophrenia. It can cause sudden death by stroke, seizure or cardiac dysrhythmia and may cause excited delirium. Chronic poisoning: (1) Amphetamine psychosis characterised by: (a) Stereotyped, compulsive behaviour, (b) paranoid personality, (c) delusions, usually persecution, (d) hallucinations, usually visual, sometimes tactile. (2) Cardiomyopathy. (3) Intracranial haemorrhage. M.L. imp: Long term use leads to psychological dependence and tolerance. Withdrawal of drug can lead to depression and sometimes suicide. 40% of amphetamine is excreted unchanged in urine. The term liquid gold is slang for urine for amphetamine addicts which is collected and sold. Dangers of misuse are: (1) Overactivity or aggressive behaviour, (2) Paranoid psychosis. (3) Shock and collapse. (4) Risk of suicide during the withdrawal phase.

CHRONIC POISONING OF PHENOL (PHENOL MARASMUS) It is characterised by anorexia, weight loss, headache, vertigo, dark urine and pigmentation of skin and sclera. The hydroquinone and pyrocatechol may cause pigmentation in the cornea and various cartilages, a condition called oochronosis. Oochronosis is commonly associated with alkaptonuria (an inborn error of metabolism), in which homegentisic acid gets deposited in cartilages, ligaments and fibrous tissues

Chronic Benzodiazepine Poisoning: High dose, long term therapy (30 to 40 mg of diazepam daily) may produce withdrawal symptoms when stopped suddenly, such as: C.N.S: headache, anxiety, insomnia, muscle spasms, tremors, rarely convulsions and psychiatric disturbances. G.I: anorexia, vomiting. R.S.: respiratory depression is rare. Treatment: (1) Gastric lavage. (2) Activated charcoal. (3) Flumazenil is an imidazodiazipine that selectively blocks the central effects of benzodiazipinesby competitive interaction at the benzodiazipine recognition site. (4) Forced diuresis. The withdrawal syndrome from benzodizipines includes fits and psychosis. In addition, anxiety symptoms, such as sweating, insomnia, headache, tremors, nausea and disordered perception such as feelings of unreality, abnormal bodily sensations and hypersensitivity to stimuli may be seen. Long term use may possibly cause behavioral disinhibition, which may induce a person to hostile acts, aggressive behaviour and verbal indecency.