Forensic Medicine and Toxicology(FMT) - AIM4PG

Weed killers 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

Medicolegal Importance of abrasion  (1) They give an idea about the site of impact and direction of the force. (2) They may be the only external signs of a serious internal injury.  (3) Patterned abrasions are helpful in connecting the wound with the object which produced them.  (4) The age of the injury can be determined, which helps to corroborate with the alleged time of assault.  (5) In open wounds, dirt, dust, grease or sand are usually present, which may connect the injuries to the scene of crime.  (6) Character and manner of injury may be known from its distribution.  (a) In throttling, crescentic abrasions due to fingernails are found on the neck.  (b) In smothering, abrasions may be seen around the mouth and nose.  (c) In sexual assaults. Abrasions may be found on the breasts, genitals, inner side of the thighs and around the anus.  (d) Abrasions on the face of the assailant indicate a struggle.  (e) Abrasions on the victim may show whether the fingernails of the assailant were long, irregular or even broken

Therapeutic Misadventure To avoid a therapeutic misadventure in prescribing drugs, the following points should be noted. (1) Before prescribing any drug known to cause any adverse reaction, the doctor should make a reasonable effort to determine if any adverse reaction is likely to occur. (2) Sensitivity tests should be done before injecting preparations which are likely to produce anaphylactic shock. (3) The doctor should warn the patient of side-effects particularly possible drowsiness or similar accident-producing, reaction, which may occur while he is taking the drug. (4) The doctor should inform the patient about the possibilities of permanent side-effects. A physician is not liable for injuries resulting from adverse reaction to drug unless some negligence on his part contributed to cause the injury, however in the above question,it was the fault of the doctor for not doing the sensitivity tests,therefore the physician is liable.

Lung Flotation Test  Determination of live birth was considered to be largely dependent on the result of the lung flotation test, also known as the “lung test,” “flotation test,” and “hydrostatic test.” The test is based on the premise that if an infant has breathed then the lungs will be inflated. Hence, if the lungs float when placed in water, this indicates that they are inflated and the infant had breathed and was born alive. If the lungs sink when placed in water, the lungs are not inflated and the infant had not breathed and was stillborn.

The Circumstances of Abrus precatorius Poisoning: ( 1) The seeds are used for killing cattle and rarely for homicide. The cattle are poisoned by leather workers to obtain hides cheaply or for revenge. The seeds are decorticated, and alone or mixed with datura, opium and onion, are made into paste with spirit and water, and small sharp-pointed spikes or needles or 'suis' are prepared, which are then dried in the sun. The needles are 15 mm. long and weigh 90 to 120 mg. Two needles are inserted by their base into holes in a wooden handle. A blow is struck to the animal with great force which drives the needle into the flesh. (2) For homicide, the needle is kept between two fingers, and the person is slapped which drives the needle into the body. (3) Powdered seeds are used by malingerers to produce conjuctivitis. (4) When taken internally they disturb the uterine function and prevent conception. (5) The seeds are used as an abortifacient and as arrow poison

Res indicata:- A suit for damages for negligence against the doctor should be filed within two years from the date of alleged negligence. A suit filed after. two years will be dismissed as being beyond the period of limitation. Where breach of duty to provide care as per a particular contract between a patient and a doctor is committed, legal action can be initiated up to three years from the date of alleged negligence. THE DOCTRINE OF RES IPSA LOQUITUR: The patient need not prove negligence in case where the rule of res ipsa loquitur applies, which means "the thing or fact speaks for itself". The patient has to merely state what according to him was the act of negligence. Conditions to be satisfied: (1) that in the absence of negligence the injury would not have occurred ordinarily; (2) that the doctor had exclusive control over the injury producing instrument or treatment; (3) that the patient was not guilty of contributory negligence. Res judicata (S. 300, Cr.P.C.):- If a question of negligence against a doctor has already be~n decided by a Court in a dispute between the doctor and his patient. the patient will not be allowed to contest the same question in another proceeding between himself and the doctor on the same set of facts. Only appeal can be made.

VOLATILE SUBSTANCE ABUSE: 1.Huffing refers to inhaling vapours from a cloth that is saturated with the volatile substance and held over or near to the nose and mouth. 2.Bagging refers to inhaling and exhaling into a bag that has been filled with a small amount of a volatile substance. Clinical manifestations depend on the substance abused. Gaseous substances may be introduced directly into the mouth or nose from either a large cylinder or from the small ampoule cylinders. Others are used directly from pressurised aerosol cans, includingpain-relieving sprays. 3.Sniffing is done by inhaling directly from the neck of a container, such as jerry cans and petro-fillers.

Conium maculatum (hemlock ) Conium maculatum (hemlock ) contains coninne and several other alkaloids.Toxic properties are due to alkoloids coniine and methyl connine, thereby causing paralysis of motor nerves terminals in muscles and spreading to motor cells of cord and brain. Fatal dose :- 60mg of coniine Fatal period :-few hours. Signs and symptoms:- 1. Gastric irritation,abdomen pain ,loose stools and vomiting 2. Muscle weakness and gradually increasing paralysis due to depression of motor nerves. 3. Lower limbs are first affected and paralysis ascends till the muscles of respiration are affected 4. Patient might die of asphyxia due to respiratory paralysis. Treatment:- 1.gastric lavage with tannic acid 2.artificial respiration 3. Oxygen inhalation

ALCOHOL "Under the influence" means that due to drinking alcohol, a person has lost (to any degree), some ofthe clearness of the mind and self-control that he normally possesses. Loss of judgement and the capacity for self-criticism occur long before the obvious symptoms of intoxication. All individuals with a blood alcohol level of 140 mg% are intoxicated to the point where they cannot deal with unusual, emergency or non- customary problems. Below 10 mg%: Sober. 10 to 80 mg% : Drinking. 80 to 150 mg % : Under'the influence. 150 to 300 mg% : Drunk or intoxicated. 300 to 400 mg : Stupor. 400 mg% and above : Coma, and death. Alcoholic Palimpsests :- It is a condition seen among alcoholics, and rarely in the non-addictive drinker, after drinking a moderate amount of alcohol. The behaviour resembles the 'blackouts' in anoxaemia.

Judicial punishment : According to the Juvenile Justice (Care and protection of children) Act, 2000 "juvenile or boy" means a person (boy or girl) who has not completed eighteenth year of age. "juvenile in conflict with law" would mean a juvenile alleged to have committed an offence and not completed 18 years of age on the date of commission of such an offence (Juvenile Justice care and protection of children amendment bill, 2006). Juvenile Justice Boards exercise powers in relation to juverniles in conflict with law. The board may advice or warn the juvenile, or order to participate in group counselling or perform community service, or to be released on probation of conduct or to pay a fine, or to make an order directing the juvenile to be sent to a special home for the period until he becomes major. No juvenile in conflict with law shall be sentenced to death or life imprisonment, or committed to prison.

Fat embolism Clinical features: The emboli enter the pulmonary vesse and obstruct the flow of blood through the lungs. Cyanosis ,precordial pain, rapid pulse and respiration, hyperpyrexia an petechial haemorrhages caused by impaction of fat drople in small venules on any part of the body, typically seen in the conjunctivae, on the chest and axillae may develop in 8 to 2 hours. There may be fever, thrombocytopaenia, fat globules i the urine, and sputum and renal failure. Death may occur with severe dyspnoea about 30 hours after the trauma. In such cases fat globules are probably transported to the lungs in moderat quantities at intermittent intervals until the circulation is obstructed. Tests to establish fat embolism as the cause of death A piece of lung tissue in 20% caustic potash is compressed by a coverslip and examined under the microscope as a rapid method of identification. After a few minutes, red cells disappear and fat is seen lying as plugs in the pulmonary capillaries. They appear highly refractile and show a narrow dark edge. The diagnosis is made by microscopic examination of frozen section of the lungs, stained for fat with Sudan III (orange colour), Scharlach R or osmic acid (black).

PUTREFACTION IN WATER: Casper dictum states that a body decomposes in air twice as rapidly as in water, and eight times as rapidly as in earth. The rate of putrefaction is slower in water than in air. Putrefaction is more rapid in warm, fresh water than in cold, salt water. It is more rapid in stagnant water than in running water. Putrefaction is delayed when a body is lying in deep water and is well protected by clothing, while it is rapid in a body lying in water contaminated with sewage. As the submerged cadavers float face down with the head lower than the trunk, gaseous distension and postmortem discolouration are first seen on the face and then spread to the neck, upper extremities, chest, abdomen and the lower extremities in that order. Fluid gravitation in the head favours marked decomposition. When the body is removed from the water, putrefaction is hastened as the tissues have absorbed much water. The epidermis of the hands and feet becomes swollen, bleached and wrinkled after immersion, and may be removed as a cast of the extremity, after 2 to 4 days. After several weeks in water, macerated flesh may be stripped off from the body by the action of currents or the contact with the floating objects. Fish, crustacea (crabs, lobsters, shrimps, etc.) and water-rats in a sewer may destroy the body. Moulds may be located anywhere on the body, but generally are found only on the exposed surfaces. Fungus may grow on body which varies in colour from white and yellow to green black

Diagnosis of death by drowning The reliable signs of drowning at autopsy are: (1) Fine, white froth at the mouth and nose. (2) The presence of weeds, sand, mud, etc., firmly grasped in the hands. (3) The presence of fine froth in the lungs and air-passages. (4) The voluminous water-logged lungs. (5) The presence of water in the stomach and intestines, and (6) Finding of diatoms in the tissues. ABSENCE OF SIGNS OF DROWNING: The above signs will not be found, if death occurs due to vagal inhibition. In death from syncope, or when a person is in a state of helplessness from drink or other cause, or when a person receives an injury during fall into the water which prevents him from struggle, the signs will be slight. In dry drowning, the postmortem appearances are those of asphyxia. If the postmortem is delayed for a few hours, or if any appreciable delay has occurred before recovery of the body from water, the signs of drowning will not be found to a great extent.

NATURE OF POISONING: (1) Ideal Homicidal Poison: The characters of an ideal homicidal poison should be: (i) cheap, (ii) easily available, (iii) colourless, odourless and tasteless (iv) capable of being administered, either in food. drink or medicine, without producing any obvious change to prevent suspicion, (v) highly toxic, (vi) signs and symptoms should resemble a natural disease, or the serious ill-effects should be delayedpulmonary sufficiently long for the accused to escape suspicion, (vii) there should not be any antidote, (viii) there should be no postmortem changes, (ix) should not be detected by chemical tests, or other methods, and (x) must be rapidly destroyed or made undetectable in the body. (2) Ideal Suicidal Poison: The characters of an poisons ideal suicidal poison should be: (i) cheap, (ii) easily available, (iii) highly toxic, (iv) tasteless or of pleasant taste (v) capable of being easily taken in food or drink, and (vi) capable of producing painless death.

INCEST Incest means sexual intercourse by a man with woman who is closely related to him by blood rohibited degrees of relationship), e.g., a daughter, granddaughter, sister, stepsister, aunt or mother. Incest between father and daughter and brothers and sisters are common. These cases usually have psychological features. In India, incest as such, is not an offence. Incest occurs (1) between mental defectives who are unable to understand the prohibitions against it, or whose feelings are too strong to inhibit them behaving in this way; (2) where alcohol removes the natural inhibitions; (3) in case of cerebral disease, such as general paralysis, senile cerebral degeneration, etc; (4) where a brother and sister have been separated since childhood or for a long period and meet later as strangers; (5) where close relations have to live in intimacy. Adultery: Sexual intercourse with the wife of another man, without the consent or connivance of that man constitutes adultery. It is punishable with imprisonment up to five years. In such a case, the wife a shall not be punishable as an abettor. I

Kidnapping: S. 361 to 369, I.P.C. deals kidnapping. Kidnapping means taking away a person by illegal means. It is an offence (a) to kidnap a child with the intention of taking dishonestly movable property, if the age of child is under 10 years (Sec. 369, I.P.C.); (b) to kidnap a minor lawful guardianship, if the age of a boy is under and that of a girl under 18 years (Sec. 361, I.P.C.) (C)to kidnap or maim a minor for purposes of begging(363-A, I.P.C.). (d) kidnapping, abducting or indu woman to compel her marriage (366, I.P.C.), (e)procure a girl for prostitution, if her age is under 18 years (Sec. 366-A, I.P.C.); and (f) to import into India from a foreign country a female for purposes of ill intercourse, if her age is less than 21 years (366 B I.P.C.).

DRAWBACKS OF THE INCISIONS DURING AUTOPSY Hidden injuries of posterior aspect of body are not visualized in all these incisions for confirmation of any suspected injury on the back, separate incisions are to be made at places. But many a time it is very difficult to distinguish between postmortem staining and bruises and also for injuries inflicted just before death and in dark complexion persons. For examination of spinal cord, we have to make a separate incision on the back. In cases of burn it is impossible to detect a bruise or any injury in deeper tissues of the back of the body as the posterior aspect of body cannot be visualized and so there is every chance that we may miss some important evidences of injuries on the back. In cases of death due to torture, in police custody or any suspicious death due to violence, it is not possible to examine the posterior aspect of the body with the conventional methods of incision. So, the chance of omitting injuries in the back become eminent. An important drawback is the seepage especially from the abdominal cavity as the cavity is closed in a single layer. We Indians always obey the religious rules and regulations. So, after taking the body from the mortuary when the close relatives prepare the body for last right, the seepage from the body imparts a negative impact on them. THE FOURTH INCISION To overcome from all these drawbacks,we can use the fourth incision, i.e., the Cosmetic Autopsy Incision. By using this incision we can expose both the front as well as the posterior aspect of the body and at the same time hide the stitch marks in the front of the body.