Forensic (legal) medicine deals with application of medical knowledge to aid in administration of justice,

i.e. it deals with medical aspects of law, such as assault, murder, sexual offences, poisoning etc.

Medical jurisprudence deals with legal responsibilities of doctor, i.e. with legal aspects of practice of
medicine, such as medical negligence, consent, professional misconduct, duties of doctors, etc.

INQUEST

4. S/N: Inquest (2014)

 An inquest is an enquiry or investigation into the cause of death (S.174, Cr.P.C).
 It is conducted in cases of unnatural and suspicious deaths, such as suicide,
murder, accident, etc.

2. Differentiate: Police Inquest & Magistrate Inquest (2021) (2018) (2016) (2013) (2012)
 (1) Police inquest :

(1) It is conducted throughout India.

(2) The officer – in charge of police station, informs the Executive Magistrate, and proceeds to the
place where body of deceased person is.
(3) He conducts investigation (panchanama), in the presence of two witnesses (panchas).
(4) The report includes the description of wounds, the nature of weapon and apparent cause of
death.
(5) The report is signed by police officer and witnesses.
(6) If foulplay is suspected, the body is sent for autopsy with a requisition to the authorised
Government doctor.
(7) If no foul play is suspected, the dead body is handed over to the relatives for disposal.

(2) Magistrate’s inquest :

This is conducted by an Executive Magistrate (who are revenue officials), such as

 District Collector
 deputy Collector
 Tahasildar, etc.
It is done in cases of
(1) death in prison,
(2) death in police custody,
(3) death due to police firing,
(4) dowry death,
(5) exhumation,
(6) death in a psychiatric hospital (S. 176, I.P.C)

(3)Coroner’s inquest
is not done in India, but is done in U.K., some states in U.S.A and some other countries.
(4) Medical examiner’s inquest
is done in most States of USA. Trial by Jury is not done in India
5. Enumerate the different criminal courts of India with reference to their powers. What are the
different punishments awarded by the Indian Courts? (2+4+2) (2013)
 Conduct money :

1. It is fee paid to a witness in civil cases only at the time of serving summons to meet the
expenses towards attending a Court.
2. If the amount is less, the witness can appeal to the Judge, who will decide the amount to be
paid.
3. In criminal cases no fee is paid.

Subpoena or summons :

3. S/N: Subpoena (2017)

7. What is Summon?
(1) It is a written document issued and signed by the Court in duplicate, and served on the witness
under penalty, for giving evidence on a particular day and time.
(2) It is served on the witness by a police officer, or other public servant.
 It may also be sent by registered post.
(3) Apart from giving evidence, the witness should produce documents if asked for.
(4) If the witness fails to attend the Court in a civil case, he will be liable to pay damages, and in
criminal case, fine or imprisonment.
(6) The witness will be excused from attending the court, if he has valid and urgent reason.
(7) Criminal Courts have priority over Civil Courts and higher Courts have priority over lower.
(8) If he is summoned from two courts of same status, he must attend the court from where he
received the summons first, informing the other court about it.

Medical Evidence:

Documentary evidence is of three types:

1. Medical Certificates
2. ML reports
3. Dying Declaration

(1) Medical certificates :

(1) They refer to ill-health, insanity, age, death, etc.
(2) They are accepted in a Court of law, only when they are issued by a qualified registered
medical practitioner
(3) A doctor is legally bound to give death certificate, stating the cause of death without
charging fee, if a patient being treated by him dies.
(4) The doctor should not issue death certificate
(a) without inspecting the body himself, and satisfying that the person is really
dead,
(b) if he is not sure of cause of death,
(c) if there is least suspicion of foulplay. In such cases, the police should be
informed.
(5) Death certificate should not be delayed, even if the doctor’s fee is not paid.
(6) Issuing or signing a false certificate is punishable
2) Medico legal reports:
(1) They are reports prepared by a doctor usually in criminal cases, e.g., assault, rape,
murder, poisoning, etc.
(2) The injured person or dead body is examined, when there is a requisition from a police
officer or Magistrate.
(3) They consist of
(a) facts observed on examination, and
 (b) opinion drawn from the facts.
(4) They are admitted as evidence in court only when the doctor gives oral evidence under
oath.
(5) Exaggerated terms, superlatives, etc. should not be used.
(6) The opinion should be based on the facts observed by the doctor.
(7) The report will be given to the defence lawyer, as such care should be taken in writing
the report.
(8) The doctor should sign or initial at the bottom of each page, if the report exceeds one
page in length.
(9) If immediate opinion is not possible, the patient should be kept under observation, and
investigations done.

6. Differentiate: Dying Declaration & Dying Deposition (2013) (2011) (2005) (2012)
9. S/N: Dying Declaration (2005)

(2) Dying declaration:

 It is a written or oral statement of a person, who is dying due to some unlawful act, relating
to the cause of his death.
(1) A Magistrate should be called to record the declaration.
(2) The doctor should certify that the person is conscious and his mental faculties are
normal.
(3) If the patient’s condition is serious, the doctor, police, village headman, or any other
person can record the D.D. in presence of two witnesses, but its evidential value is less.
(4) Oath is not administered, because it is believed that a dying person will only tell the
truth.
(5) It is recorded in the man’s own words.
(6) Leading questions should not be put.
(7) No influence or outside prompting should be permitted.
(8) Questions may be put to make points clear.
(9) The statement made must be of fact and not opinion.
(10) If it is made in the form of an opinion, questions should be put to bring out the
facts. (11) If the dying person is unable to speak, but is able to make signs in answer
to questions, this can be recorded, which is considered as “verbal statement”.
 (12) The doctor and the witness should sign the declaration.
(13) Even if the declarant was not under expectation of death, it is admissible in the court.
(14) If the declarant survives, the declaration is not admitted but has corroborative value

Dying deposition
Dying deposition is statement of a dying person on oath.
It is superior to dying declaration, as it is recorded by the Magistrate, and the accused or his lawyer
can cross-examine the dying person.

This is not parcticed in India.

Chain of custody of evidence:

It is a method to verify the actual possession of an object from the time it was first identified until it
is offered into evidence in the Court room.

Each specimen when obtained, should be labelled with the victim’s name, the time and date, the
nature of the specimen, identification number, and signed by the doctor.

This information must be documented, each time the material is handled by another person, and
that person must give receipt for the material and will be included in the chain of custody.

The evidence must not be damaged, contaminated, or altered in any significant way.

The shorter the chain the better.

Oral evidence

1. Reason out: Oral evidence is superior to documentary evidence (2023)

It is evidence which is given orally by witness under oath in a court of law.
(1) It is more important than documentary evidence, as it admits cross-examination.
(2) In all cases, it must be direct, i.e. evidence of a person who saw, heard or perceived it.
(3) A deaf and mute witness may testify by signs, by writing or through interpreter.
(4) If oral evidence refers to any material thing, e.g, weapon, blood stained clothing, etc, it must be
produced in the court.
(5) Documentary evidence is accepted by court only on oral evidence by concerned person.

Exceptions to oral evidence :

(1) Dying declaration.
(2) Expert opinion expressed in a treatise
. (3) Evidence of doctor recorded in a lower Court.
(4) Evidence given by a witness in a previous judicial proceeding.
(5) Reports of Chemical Examiner.
(6) Reports of Director of Central and State Forensic Science Laboratories.
 (7) Reports of Director Finger print Bureau.
(8) Report of Serologist to Government.

Witnesses

A witness is a person who gives evidence regarding facts.

(1) Common witness is a person who gives evidence about the facts observed or perceived by
him. He must show that
- he was capable of perceiving the fact by one his own senses and
- that he actually observed this fact.
(3) This is known as “First-hand knowledge rule”, which may be used to establish the exact
circumstances of the case for the court

(2) Expert witness is a person who has been trained or is skilled in technical or scientific subject,
and capable of drawing opinions and conclusions from the facts observed by himself, or noticed by
others, e.g doctor, fingerprint expert, handwriting expert, firearms expert, etc.
(2) An expert witness may give his opinion
(a) upon facts which are either admitted, or proved by himself or other
witnesses at the trial,
(b) on matters of common knowledge,
(c) on hypothetical questions based thereon.
(3) The main obligation of an expert is to point out professional facts.
(4) The opinion on a key question must be given in a guarded manner using terms such as,
that the findings are consistent with an alleged form of trauma, such as a fall aginst a hard object,
or with the striking of the head with a blunt instrument.
(4) An expert witness may refer to books to refresh his memory or to correct or confirm his
opinion. 0
(5) A doctor can be both a common and expert witness.
10. S/N: Hostile Witness (2003)
Hostile witness is one who is supposed to have some interest or motive for concealing part
of truth, or for giving completely false evidence.
(2) The court will declare a witness as hostile on the suggestion of the lawyer of the party
who has summoned the witness or prosecution lawyer.
(3) A hostile witness can be cross- examined by the same side lawyer.
(4) Common or expert witness can be hostile.

Perjury means wilful giving of false evidence by witness while under oath, or failure to tell
what he knows or believes to be true (imprisonment up to 7 years)

Record of Evidence:

Write the procedure of recording evidence in the Court of Law. (2+6) (2010)
8. S/N: Examination of witness in the Court of Law (2006)

(1) Oath: “I do swear in the name of God (solmenly affirm in case of atheist) that what I shall state,
shall be the turth, the whole truth, and nothing but truth.”
 (2) Oath is required by the law which is compulsory.
(3) A chid below 12 years is not required to take an oath.
(2) Examination - in chief :

(1) In this questions are put to the witness by the lawyer for the side which has summoned him.
(2) In criminal trial, Public prosecutor first examines the witness.
(3) The object is to elicit all relevant medical facts, and the conclusions drawn from these facts.
(4) “Leading questions are not allowed”, except when witness is hostile.
(5) The questions are short and demand some specific fact and short answer.
(6) The answer can be given in narrative form, if it would be more informative and convincing.

A leading question is one which suggests to the witness the answer desired, or which includes the
answer implied in the question itself and admits of a conclusive answer by “Yes” or “No”.

(3) Cross-examination :

(1) The witness is questioned by the lawyer of the opposite party, i.e. defence lawyer.
(2) The main objects are:
(a) to elicit facts favourable to his case,
(b) to test the truthfulness of the statements made by witness
, (c) to modify or explain what has been said,
(d) to develop new or old facts,
(e) to discredit the witness,
(f) to remove any excessive emphasis, which may have been given to any facts.

(2) It need not be confined to the facts to which witness testified in exam-in-chief.
(3) The competence, credibility and character of the witness may be tested.
(4) The judge can always disallow questions which are irrelevant, incriminating or scandalous, but
if they are relevant to the matter, they cannot be disallowed.
(5) Leading questions are permissible.
(6) It has no time limit.
(7) It may act as double-edged sword, i.e. it may damage both the prosecution and defence.

(4) Re-examination :

(1) This is conducted by the lawyer who has conducted examination-in-chief.

(2) The objects are:
(a) to correct any mistake,
(b) to clarify or to add details to statements the witness has made in cross-examination.
(3) The witness should not introduce any new subject. If he does so, he will be liable for cross
examination again.
(4) Leading questions are not allowed.
(5) Questions by Judge : At any stage of examination, the Judge may ask any questions to clear up
doubts

DEATH AND ITS CAUSES:

 There is a progression from clinical death to brain death, biological death and then cellular death
As long as circulation of oxygenated blood is maintained to the brain stem, life exists.
4. Define death.
5. Define death.

Death is defined as permanent disappearance of all evidence of life at any time after livebirth has
taken place.

Somatic death is the complete and irreversible stoppage of circulation, respiration and brain
functions (tripod of life). The question of death is important in resuscitation and organ
transplantation.

Molecular death is death of cells and tissues individually, which occurs 1 to 2 hours after stoppage
of vital functions.

Brain death consists of ---

 Cerebral death (cerebral hypoxia; loss of power of perception of sense, respiration
continues),
 brain stem death(intracranial pressure or haemorrhage ; spontaneous respiration lost),
 whole brain death

(1) deep unconsciousness,

(2) no movements,
(3) no spontaneous breathing,
(3) stoppage of spontaneous cardiac rhythm,
(4) no reflexes,
(5) bilateral dilatation and fixation of pupils,
(6) flat EEG, provided all of above are present
 (a) for 24 hours,
(b) body temperature is not below 320 C.
(c) no metabolic and endocrine disturbances.
Name the death in which organ removal from a dead body is permissible as per provisions of the
Transplantation of Human Organs Act.

Mention the testes to confirm such death. (2+2+4) (2016)

TESTS TO CHECK BRAINSTEM DEATH
Personnel who should perform the tests:
(1) Brainstem death tests must be performed by two medical practitioners.
(2) Doctors involved. should be experts in this field. Under no circumstances are brainstem death
tests performed by transplant surgeons.
(3) At least one of the doctors should be of consultant status.
Junior doctors are not permitted to perform these tests.
(3) Each doctor should perform the tests twice.

TESTS TO BE PERFOMED:

Before the tests are performed the core temperature of the body is taken to ensure that it is above
35°C.

The diagnosis of brainstem death is established by testing the function of the cranial nerves which
pass through the brainstem.

If there is no response to these tests, the brainstem is considered to be irreversibly dead:

(1) Pupils are fiXed in diameter and do not respond to changes in the intensity of light.
(2) There is no corneal reflex.
(3) Vestibulo-ocular reflexes are absent, i.e. no eye movement occurs after the instillation of cold
water into the outer ears.
( 4) No motor responses within the cranial nerve distribution can be elicited by painful or other
sensory stimuli, that is the patient does not grimace in response to a painful stimulus.
(5) There is no gag reflex to bronchial stimulation by a suction catheter passed down the trachea.
(6) No respiratory movements occur when the patient is disconnected from the ventilator for long
enough to ensure that the carbon dioxide concentration in the blood rises above the threshold for
stimulating respiration, i.e. after giving the patient 100% oxygen for 5 minutes. If no spontaneous
breathing of any sort occurs within that 10 minutes, the brainstem is incapable of reacting to the
presence of the carbon dioxide and is thus dead.
When two doctors have performed these tests twice with negative results, the patient is
pronounced dead and a death certificate can be issued.

Harvard Criteria:

(1) Unreceptivity and unresponsivity:

(2) No movements
((4) Absence of elicitable reflexes:.
 The pupils are fixed and dilated and do not respond to a direct source of bright light.
 Ocular movement and blinking are absent.
 There is no evidence of postural activity.
 Corneal and pharyngeal reflexes are also absent.
 Stretch tendon reflexes also cannot be elicited.
(4)Apnoea
(5) IsoelectricEEG: It has confirmatory value.

Modes of Death

(1) Coma. (2) Syncope. (3) Asphyxia.

Coma is insensibility which involves central portion of brain stem.

Syncope is sudden stoppage of action of heart, which may be fatal

Asphyxia:

(1) It is a condition caused by interference with respiration, or due to lack of oxygen in respired air
(and failure to eliminate Co2 ), due to which organs and tissues are deprived of oxygen, which may
cause unconsciousness and death.

(2) Neurons of cerebral cortex will die in 3 to 7 minutes of complete oxygen deprivation.

(3) Breathing stops within 20 seconds of cardiac arrest, and heart stops within 20 minutes of
stopping of breathing

Pathology: Asphyxia ......reduction in oxygen tension...capillary dilation ...capillary stasis... capillary

engorgement..... stasis of blood in organs..... diminished venous return to heart ..... reduced
pulmonary flow.... deficient oxygenation in lungs.... asphyxia (vicious cycle)
Types of Asphyxia:

(1) Mechanical : Due to mechanical blocking of air- passages, such as smothering, hanging,
strangulation, drowning, traumatic asphyxia.

(2) Pathological : due to disease of upper respiratory tract,

e.g. acute oedema of glottis,

laryngeal spasm and abscesses.

(3) Toxic :

(A) Use of oxygen is prevented, e.g. CO.

(B) Enzymatic processes are blocked, e.g cyanides.
(C) Paralysis of respiratory centre, e.g poisoning by opium, barbiturates, strychnine.
(4) Environmental:
(A) Insufficient oxygen in air, e.g. enclosed places, trapping in disused refrigerator or
trunk.
(B) exposure to irrespirable gases, e.g. CO, CO2 , sewer gases.
(5) Traumatic :
(a) pulmonary embolism,
(b) pulmonary fat embolism,
(c) pulmonary air embolism,
(d) bilateral pneumothorax.
(6) Postural asphyxia : It occurs when an unconscious person lies with upper half of body lower than
the remainder, and also from forcible flexion of the neck on the chest.
(7) Iatrogenic is associated with anaesthesia,
 Tardieu spots

5. S/N: Tardieu spots (2002)

1. Cyanosis occurs due to diminished oxygen tension in blood and an increase of reduced
haemoglobin.
The cyanotic colour of blood will be seen if there is at least 5 g/100 ml. of reduced haemoglobin in
capillary blood.

2. Petechial haemorrhages (Tardieu spots) are caused due to raised venous pressure from
impaired venous return, and not due to hypoxia of the vessel walls.

3. A minimum of 15 to 30 seconds is required to produce congestion and petechiae

4. They are usually round, dark-red, well-defined, pin-head sized spots, found in those parts
where capillaries are least supported, e.g. conjunctiva, face, epiglottis, subpleural surface
of lungs, heart, meninges and thymus.

5. They tend to be better made out in fair skinned persons, readily visible in fresh bodies, and
disappear with putrefaction.

6. They are not pathognomic of asphyxia, and their absence does not exclude asphyxia (rarely
seen in drowning)

7. It can be seen in other forms of death—electrocution, poisoning, coronary thrombosis, in

persons on anticoagulants, with bleeding disorders such as scurvy, leukemia and
thrombocytopenia, but distribution is more generalized.

Sudden Death

4. Define sudden death. (1) (2009)

Death is said to be sudden or unexpected when a person not known to have been suffering from any
dangerous disease, injury or poisoning is found dead or dies within 24 hours after the onset of
terminal illness (WHO)
Causes: (I) Diseases of the Cardiovascular System (45 to 50%):
 Coronary atherosclerosis with coronary thrombosis.
Coronary artery embolism
Angina pectoris
Acute endocarditis
(II) Respiratory System
Lobar pneumonia.
Influenza
Diphtheria
Bronchial asthma
Pleural effusion
Pneumothorax

(III) Central Nervous System (10 to 18%):

(1) Cerebral haemonhage.
(2) Cerebellar haemonhage.
(3) Pontine haemorrhage.
(4) Subarachnoid haemorrhage.
(5)Meningitis.
(IV) Alimentary System
Strangulated hernia.
Appendicitis.
Rupture of enlarged spleen
(V) Genito-urinary system
Chronic nephritis.
Tumours of the kidney or bladder

(2) About 50% deaths occur due to diseases of cardiovascular system

(3) The major cause of deaths is myocardial infraction due to coronary thrombosis, embolism and
obliteration of lumen of coronaries by the atherosclerosis.
(4) Most common cause of death due to CNS lesion is intracerebral hemorrhage in the region of
internal capsule due to rupture of lenticulostriate artery

AUTOPSY

1. S/N: Negative autopsy (2021)

2. S/N: Obscure autopsy (2019)
 Obscure autopsy:

OBSCURE AUTOPSIES are those which do not show a definite cause for death, in which there are
minimal, indefinite or obscure findings, or even no positive findings at all.

They are a source of confusion to any pathologist.

Frequently, these deaths are due to obscure natural causes, but they may be due to certain types of
injury or complications of injury, or to poisoning.

Deaths due to following causes may be missed:

(1) Natural:
(a) Death precipitated by emotion, work stress,
(b) functional failure, such as epilepsy, paroxysmal fibrillation.
(2) Biochemical:
(a) Uraemia, diabetes, potassium deficiency.
(3) Endocrine dysfunction:
Adrenal insufficiency,
(b) thyrotoxicosis, myxoedema.
(4) Concealed trauma:
(a) Concussion,
(b) self-reduced neck injury,
(c) blunt injury to heart,
(d) reflex vagal inhibition.
(5) Poisoning:
(a) Narcotic poisoning,
(b) neurotoxic or cytotoxic poisons,
(c) plant poisoning,
(d) anaesthetic overdose.
(6) Allergy and drug idiosyncrasy

Inhibition of heart (vagal inhibition or instantaneous physiological death) :

(1) Death occurs suddenly, within seconds or in 1 to 2 minutes due to minor trauma or relatively
simple or harmless peripheral stimulation.
(2) Some persons have marked hypersensitivity to stimulation of carotid sinuses, which causes
bradycardia and cardiac arrhythmias and arrest.
(3)
Death occurs
 due to pressure on neck, particularly on carotid sinuses as in hanging or strangulation
 a blow on the abdomen or testicles,
 unexpected blows to the larynx, chest, abdomen and genital organs,
 impaction of food in larynx,
 unexpected inhalation of fluid into the upper respiratory tract as in drowning,
 sudden immersion of body in cold water,
 insertion of an instrument into bronchus, uterus, bladder or rectum
 sudden distension of hollow muscular organs, e.g during attempts at criminal abortion,

(4)Death is accidental and initiated by microtrauma.

(5) The stimulus should be sudden and abnormal for the reflex to occur.
(6) The reflex is exaggerated by high emotional tension, mild alcoholic intoxication and
hypoxia.
(7) Autopsy is negative.
(8) The cause of death is inferred from the circumstances of death.

Negative autopsy:

When gross and microscopic examination,

toxicological analyses and
laboratory investigations
fail to reveal a cause of death, the autopsy is considered to be negative.
2 to 5% of autopsies are negative.
Causes:
(1) Inadequate history: Deaths from vagal inhibition, hypersensitivity reactions.
(2) Inadequate external exam:
Burns in electrocution
Injection marks
Snake bite marks may be missed.
(3) Inadequate internal exam: Air embolism and pneumothorax may be missed.
(4) Lack of toxicological analysis.
(5) Insufficient laboratory exam.
(6) Lack of training of doctor.
exhumation
 POST MORTEM CHANGES

Reason out: The first external sign of putrefaction appears in the right iliac fossa (2023)
12. Mention the signs of decomposition in a human body recovered 48 hours after death
in a hot summer season.

6. Classify and enumerate the changes after death.

7. 9. Mention the early changes after death.
8. 11. Enumerate changes occurring after death.
Complete loss of circulation and respiration for more than 4 to 5 minutes is accepted as death.
P.M changes help in rough estimation of death

8. S/N: Suspended animation (2011)

Suspended animation (PYQ)

(1) Signs of life are not found as functions are impaired for some time or reduced to minimum.
(2) However, life continues and resuscitation is successful in such cases.
(3) The metabolic state is so reduced that the requirement of individual cell for oxygen is satisfied
through the use of oxygen dissolved in body fluids.
(4) In freezing of the body or in severe drug poisoning of the brain, the activity of the brain can
completely stop, and in some cases start again.
(5) It can be produced voluntarily as in yoga.
(6) Involuntary suspension of animation for few seconds to half-an-hour or more may be found in
newborn infants, drowning, electrocution, cholera, shock, sunstroke, cerebral concussion, after
anaesthesia, insanity, etc.
How will you ascertain the time since death considering the early changes after death?
(3+4) (2009)
 How will you assess the time passed since death during medico-legal autopsy? (2+2+4)
(2006) after knowing the changes after death.

Skin
Skin becomes pale, ashy-white and loses elasticity within few minutes
Eyes
(1) Loss of corneal reflex.
(2) Opacity of cornea occurs due to drying.
If eyelids are closed, cornea will be clear for 2 hours.

If eyelids are open for a few hours after death, a film of cell debris and mucus forms two yellow
triangles on sclera each at side of iris, which becomes brown and then black, called “tache noir”,
upon which dust settles and surface becomes wrinkled.
(3) The eyes look sunken and become flaccid.
(5) Pupils are slightly dilated soon after death due to relaxation of muscles of iris. Later, they are
constricted due to rigor mortis of constrictor muscles.
(6) Retinal vessels show fragmentation or segmentation of blood columns within minutes after
death, which persists for an hour.
(7) A steady rise in the potassium value occurs in vitreous humour.

COOLING OF BODY (ALGOR MORTIS)

(1) For half to one hour after death, rectal temperature falls little or not at all.
(2) The curve of cooling is sigmoid in pattern.
(3) Body heat is lost by conduction, convection and radiation and small fraction by evaporation of
fluid from skin.
(4) A laboratory thermometer is inserted 8 to 10 cm into rectum for two minutes, or under the liver
through small midline opening, or into nose up to cribriform plate or in the ear through tympanic
membrane to record temperature.
(5)**** A marked rise in temperature occurs in case of fat or air embolism, infections, heat stroke,
pontine haemorrhage, and exercise or struggle before death.
(6)***** Low temperature occurs in cases of collapse, congestive heart failure, massive
haemorrhage, secondary shock.
(7) In tropical climates the heat loss is roughly 0.4ºc to 0.6ºc per hour.
(8) Rectal temperature of naked body reaches that of environment in about 20 hours.
(9) Time in hours of death can be obtained by the formula:
(11) Rate of cooling is affected by :
(1) Difference in temperature between body and medium.
(2) The build of cadaver : Children and old people cool rapidly.
(3) Physique of cadaver : Fat bodies cool slowly.
(4) Environment of body :
Cooling is rapid in a well ventilated room,
humid atmosphere,
body immersed in cold water,
and buried in earth.
Cooling is slow when the body is clothed.
(12) M.L Importance:
It helps in estimation of time of death in cold and temperate climates only, but not in tropical
countries.

Post-mortem Caloricity

(1) The temperature of body remains raised for two hours or so after death.
(2) This occurs when the regulation of heat production has been severely disturbed before
death, as in
(a) sunstroke and some nervous disorders,
(b) Great increase in heat production in muscles due to convulsions, e.g. tetanus and
strychnine poisoning,
(c) excessive bacterial activity, e.g. septicaemic condition, cholera and other fevers

Post Mortem Hypostasis (post mortem staining) (PYQ)

4. S/N: Post-mortem staining (2019) (2002)

(1) It is bluish-purple or purplish-red discolouration which appears under skin in the
most superficial layers of dermis of dependent parts of body after death, due to
capillo-venous distension.
(2) The intensity of the colour depends upon the amount of reduced haemoglobin in
blood.
(3) The upper portions of the body are pale.
 (4) It begins soon after death, but is visible half to 1 hour after death in normal persons,
and 1 to 4 hours in anaemic persons.
(5) In early stages mottled patches are seen, which later enlarge and unite to produce
extensive discolouration.
(6)It is well-developed in 4 hours and reaches maximum between 6 to 12 hours.
(7) When it first develops, it disappears when pressed by finger, and reappears after
pressure is released.
(8) It is well marked in asphyxia.eg hanging
(9) Any pressure prevents capillaries from filling, such as collar band, belt, wrinkles in
clothes, etc. and such areas are seen as pale strips, resembling marks of beating.
(10) As the vessel walls become permeable due to decomposition, blood leaks through
them. At this stage, hypostasis does not disappear if finger is firmly pressed against the
skin.

Distribution:

It depends on position of body :

(1) In a body lying on its back, it first appears in neck and then spreads over entire
back, except on the parts directly pressed on, i.e. occipital scalp, shoulder-blades,
buttocks, posterior aspects of thighs, calves and heels.
(2) It is absent under collar bands, belts, wrinkles in clothes, etc. which are seen as
strips and bands callled vibices.
(3) If the body is in prone position, lividity appears in front, colour is intense and
Tardieu spots are common.
(4) If the body is inverted as in drunken persons, hypostasis appears in head and
neck.
(5) If the body is lying on one side, blood will settle on that side.
(6) If the body is suspended as in hanging, hypostasis will be marked in legs, externa
genitalia, lower parts of forearms and hands.
(7) In drowning, it is found on the face, upper parts of chest, hands, lower arms, feet
and calves. If the body is constantly moving its position, as in moving water, it may not
develop.
(8) Fixation of post-mortem staining occurs in about 6 hours, due to blood
coagulation in capillaries.

Distinct colouration of hypostasis is seen in :

(1) Co poisoning: cherry -red.
(2) HCN poisoning : bright-red.
(5) Asphyxia: deeply bluish-violet or purple.
(6) Hypothermia: bright pink.
(7) Clostridium perfringens septicaemia: bronze.

Internal :
(1) All internal organs show hypostasis in the dependent parts.
(2) In heart it can simulate myocardial infarction, in lungs pneumonia and
dependent coils of intestine appear strangulated.

M.L. Imp :
 (1) Sign of death.
(2) Its extent helps is estimating time of death.
(3) Indicates posture of the body at time of death.
(4) In some cases, colour may indicate cause of death

Muscular Changes
I. Primary Flaccidity
(1) Death is somatic.
(2) It lasts for one to two hours.
(3)*** All muscles of the body begin to relax soon after death.
(4)*** Body flattens over areas which are in contact with the surface on which it rests
(contact flattening).
(5) Lower jaw falls, eyelids loose tension.
(6) Muscular irritability and response to mechanical or electrical stimuli persist.
(7) Anaerobic chemical process may continue.
(8) Pupils react to atropine or physostigmine.
(9) Peristalsis may occur in bowel

ii. Rigor Mortis

5. Define rigor mortis.

Write mechanism of development and medico-legal importance of rigor mortis. (2+6)
(2017) (2004)
Describe rigor mortis along with its mechanism and the conditions stimulating it. (2+4+2)
(2013)
10. S/N: Rigor mortis (2008) (2003)
It is a state of stiffening of muscles, with slight shortening of fibres.

Mechanism :

(1) A voluntary muscle consists of bundles of long fibres.

(2) Each fibre is formed of densely packed myofibrils, which are protein filaments of two
types, actin and myosin.
(3) In relaxed condition, actin filaments interdigitate with myosin filaments to a small
extent.
(4) If there is a nerve impulse, arrays of actin filaments are drawn into arrays of myosin
filaments, rather like pistons into cylinders which causes muscles to contract.
(5) After death, ATP is progressively and irreversibly destroyed leading to increased
accumulation of lactates and phosphates in mucles.
(6) Membrane disruption and lack of ATP after death results in increased calcium level
in the sarcomeres and muscle contraction occurs.
(7) When ATP is reduced to 85% of normal, overlapping portions of myosin and actin
filaments combine as rigid links of actomyosin, which is sticky and inextensible, and
causes rigor.
(8) Simultaneously, a rise in lactic acid and fall in hydrogen ion concentration occurs.
(9) When lactic acid concentration reaches a level of about 0.3%, muscles go into
irreversible state of contraction.
(10) Rigor mortis persists until decomposition of proteins of muscles occur.

Order of appearance:
(1) It first appears in involuntary muscles (myocardium in one hour).
(2) It begins in eyelids, “lower jaw and neck”, and passes upwards to muscles of face
and downwards to muscles of chest, upper limbs, abdomen, lower limbs and lastly in
fingers and toes (proximo-distal progression).
(3) In the limbs it extends from above downwards.
(4) It disappears in the same order in which it appeared.
(5) It always sets in, increases and decreases gradually
 Development :

(1) When rigor is developing limbs can be moved, which later develops in the new
position, although rigidity is less.
(2) If force is applied when rigor is fully developed, stiffness is broken up permanently.
(3) When rigor is fully developed, the entire body is stiff, muscles shortened, hard and
opaque, knees, hips, shoulders and elbows are slightly flexed and fingers and toes often
show a marked degree of flexion.
(4) Pupils are partially contracted.
(5) It develops independent of integrity of nervous system.

Cutis anserina or goose skin is caused by rigor of erector pilae muscles.

Time of onset :

In India, it begins one to two hours after death and takes further one to two hours to
complete, i.e 2 to 4 hours.

Duration :

In India it lasts for 24 to 48 hours in winter, and 18 to 36 hours in summer.

Conditions altering onset and duration:

(1) Age : It does not occur in a foetus of less than 7 months.

In healthy adults it develops slowly, and is well-marked; in children and old people
it is feeble and rapid.

(2) Nature of death: In deaths from diseases causing great exhaustion and wasting,
e.g. cholera, typhoid, tuberculosis, cancer, etc. and in violent deaths, e.g. cut-
throat, firearms, electrocution onset is early and duration short. (Early and short)

Onset is delayed in deaths from asphyxia, severe haemorrhage, apoplexy,

pneumonia, and paralysis of muscles. (Late)

(3) Muscular state: Onset and duration long if muscles are healthy and at rest.(Late
and long)
Onset rapid, if there is fatigue or exhaustion before death.(Early)

(4) Atmosphere: In cold weather onset is slow and duration long. (Late and Long)
In hot weather onset is rapid and duration is short. (Early and short)

M.L.Imp:
(1) Sign of death.
(2) Time since death can be made out.
(3) Indicates position of body at time of death.
 Conditions simulating rigor mortis:

(1) Heat stiffening: When body is exposed to temperatures above 65ºC, stiffness
occurs which is more marked than RM,
e.g. deaths from burning,
high voltage electric shock,
fall into hot liquid (pugilistic attitude)

It remains until muscles soften from decomposition, and normal RM does not
occur

(2) Cold stiffening :

When exposed to freezing temperatures, all the body tissues become frozen
and stiff.

If the body is shifted to hot atmosphere, stiffness disappears, and later normal
R.M occurs

CADAVERIC SPASM OR INSTANTANEOUS RIGOR

7. S/N: Cadaveric spasm (2012) (2002)

It is very rare

(1) In this, muscles that were contracted during life, become stiff and rigid immediately after death,
without passing into stage of primary relaxation.
(2) The change preserves the exact attitude of person at the time of death.
(3) It occurs in cases of sudden death, excitement, fear, severe pain, exhaustion, severe
haemorrhage, injury to nervous system, firearm wound of head, convulsant poisons, etc.
(4) It is usually limited to a single group of muscles, and usually involves hands, but very rarely
whole body is affected.
(5) It cannot be produced artificially.
 (6) Stiffness is more than as seen in R.M.
(7) It passes without interruption into normal R.M and passes off when rigor disappears.
(8) Its mechanism is obscure.
(9) At the time of its development molecular death does not occur, and the body is warm.

M.L. Imp :

(1) Rarely, in case of suicide, weapon is seen firmly grasped in the hand.
(2) In drowning, firm grasping of weeds, grass, gravel, etc. in the hand, indicates that victim was alive
on entering the water.
(3) In cases of assault, some part of clothing, hair, etc. from the assailant will be found firmly
grasped in the hands
3. Differentiate: Rigor mortis & Cadaveric spasm (2019) (2015) (2011) (2010)

Putrefaction
Putrefaction :

(1) Putrefaction or decomposition is final stage following death, produced mainly by bacterial
enzymes, mostly anaerobic organisms derived from the intestines. Other enzymes are derived from
fungi and insects.

(2) “Cl welchii is the chief destructive agent”, which causes marked haemolysis, liquefaction of P.M
clots and fresh thrombi and emboli, disintegration of tissue and gas formation in blood vessels and
tissues.

(3) Lecithinase produced by C1 welchii is important, which hydrolyses lecithin in all cell membranes
and causes haemolysis of blood.

1. Colour Changes
2. Foul smelling gases
3. Liquifaction of tissues
4. Conditions affecting rate of putrefaction – external and internal

Adipocere(Saponification)
 2. S/N: Modified forms of putrefaction (2021)
(8) (2001) 13. S/N: Production of adipocere (2001)

(1) Gradual hydrolysis and hydrogenation of pre-existing fats, such as olein, into higher fatty acids,
which being acidic, inhibit putrefactive bacteria.
(2) Ultimately, whole of fat is converted into palmitic, oleic, stearic and hydroxystearic acids, and a
mixture of these substances forms adipocere.
(3) Intrinsic lipases start the process, which is continued by bacterial enzymes, especially clostridia
group.
(4) Water required for hydrolysis is obtained mainly from body tissues. If body is in water, this fluid
contributes to hydrolysis of subcutaneous fat.
(5) It is delayed by cold and formed rapidly from heat.

Properties :

(1) It has offensive or sweetish smell, but in early stages it has penetrating ammoniacal odour.
(2) Fresh adipocere is soft, moist, whitish, translucent, and old is dry, hard, cracked, yellowish,
brittle.
(3) It is inflammable.
 Distribution :

(1) It first forms in subcutaneous tissues.

(2) Face, buttocks, breasts and abdomen are usual sites.
(3) Rarely entire body is converted into adipocere.
(4) Fatty tissues in viscera and muscles are also affected.

Time required :

(1) In India, it may be seen within 3 to 4 days.

(2) In temperate countries, it starts in 3 weeks.
(3) Complete conversion in an adult limb occurs in 3 to 6 months.
(4) Foetuses of less than 6 months do not show adipocere.

M.L Imp :
If face is affected identification can be established.
(2) Cause of death and time of death can be determined

Mummification :

(1) Dehydration or drying and shrinking of cadaver occurs from evaporation of water, but natural
appearance and features are preserved.
(2) It begins in exposed parts of body like face, hands and feet and then extends to entire body
including internal organs. (
3) Skin is contracted, shrunken, dry, brittle, leathery, rusty-brown in colour and adheres to bone.
(4) Liquid oil is forced into dermis, which becomes translucent.
(5) Tissues are dry, leathery and brown.
(6) Face is distorted.
(7) Whole body loses weight, becomes thin, stiff and brittle.
(8) If protected it is preserved for years.
(9) Body is odourless.
(10) It takes 3 months to 1 to 2 years for mummification of whole body.
(11) Absence of moisture in air and continued action of dry or warm air is necessary for its
production.
(12) Marked dehydration before death favours its development.
(13) It is seen in bodies buried in shallow graves in dry sandy soils, where evaporation of body fluids
is rapid.
(14) Rarely body may show mummification in some parts and adipocere in others.

(15) M.L Importance is same as for adipocere.

EMBalming :

(1) It is a method to preserve body.

(2) Contents of G.I tract, bladder and blood vessels are removed through a wound of abdomen.
(3) Venous drainage is done through internal jugular or axillary vein.
(4) Embalming fluid consists of formalin (6% to 10%) sodium borate, sodium citrate, sodium chloride
and eosin.
MAGGOTS
 MECHANICAL INJURIES

Postmortem wound vs antemortem wound

How can you give your opinion of age of an injury? (2+4) (2015)
How, in general, age of an injury be assessed? (3+3) (2014)
How will you assess the duration of injuries? (2+3+3) (2007)
Describe in detail various medico-legal aspects of injuries. (4+4) (2008)
. Give a brief account of injuries caused by blunt forces.
2. S/N: Sec. 44 IPC. (2023) (2019) (2015) (2014) (2011)

An injury is any harm, illegally caused to any person in body, mind, reputation or property
(S.44, I.P.C)

Classify different types of injuries

Classify injury
Classify mechanical injuries
1. 22. Classify wounds. (5+6) (2001)

Medical:
(I) Mechanical Injuries:

(A)Due to blunt force:

(1) Abrasions.
(2) Contusions.
(3) Lacerations.
(4) Fractures and Dislocations.
(B) Due to sharp force:
(1) Incised wounds.
(2) Chop wounds.
(3) Stab wounds.
(C) Firearms:
(1) Firearm wounds.
(II) Thermal Injuries:
(1) Due to cold.
(a) Frostbite.
(b) Trenchfoot.
(c) Immersion foot.
(2) Due to heat.
(a) Burns.
(b) Scalds.
(III) Chemical Injuries:
(1) Corrosive acids.
(b) Corrosive alkalis.
(IV) Miscellaneous:
Electricity, lightning X-rays, radioactive substances, etc.
(V) Explosions
Legal :
(1) Simple.
(2) Grievous.
Medicolegal :
(1) Suicide.
(2) Homicide.
(3) Accident.
(4)Fabricated.
(5) Defence.
(6) Undetermined.

1. 20. Define abrasion. What are the different types of abrasion? State the medico-legal
importance. Discuss healing of an abrasion. (2+2+2+2) (2003)
2. 5. Differentiate: Ante-mortem & Post-mortem wounds/abrasions (2018) (2013) (2010)
3. Discuss how the study of abrasion helps in solving various crimes. 2001

(1) Abrasion is destruction of skin, usually involving superficial layers of epidermis

only.
(3) Some pressure and movement by agent on the surface of skin is
essential.
(4) Abrasion has only length and breadth.
(5) ((They are caused by lateral rubbing action by a blow, a fall on rough
surface, being dragged in vehicular accident, fingernails, throns or teeth-
bite. ))
M.L.Imp :
(1) Site of impact and direction of force is indicated.
(2) They may be only external sign of serious internal injury.
(3)Patterned abrasions indicate the object causing them.
(4) Age of injury can be made out.
(5) Scene of crime may be known from presence of dust, dirt, sand, etc. in the open wounds.
(6) Character and manner of injury may be known from distribution, e.g., in throttling,
smothering, sexual assault, struggle, etc

CONTUSIONS (BRUISES) :

(1) Contusion is an effusion of blood into tissues due to rupture of venules and
arterioles due to blunt violence.
(2) There is a painful swelling and crushing and tearing of subcutaneous tissues.
(3) They are caused by blunt force, such as fist, stone, stick, boot, etc.
(4) Skin is not usually damaged.
(5) It also occurs in deeper structures and viscera.
(6) They may be associated with abrasions (abraded contusions) or lacerations.
(7) Haematoma (tumour-like mass) is produced when large blood vessel is injured.
(8) Fresh bruise is tender and slightly raised.
(9)The colour is lighter in the centre.
(10) Size varies from pinhead to large collections, and slightly larger than the surface of agent
which caused it.
Chronic alcoholics bruise easily/women bruise easily/natural diasese – leukemia, purpura,
haemophilia
Black eye: Haemorrhages in the soft tissues around the eyes and
in the eyelids (spactacle haematoma, black eye) may be caused by
: (1) punch in the eye, (2) blunt impact to forehead, (3) fracture of
anterior cranial fossa.
1. 15. Differentiate: True bruise & False bruise (2011)

2. 11. Differentiate: Bruise & Post-mortem hypostasis (2012)

 3. 14. Describe a bruise in all its medica-legal aspects. (6) (2011)
(1) Size may indicate degree of violence.
(2) Patterned bruises may connect victim and object or weapon.
(3) Age of injury.
(4) In case of fall, sand, dust, gravel, etc. may be found on the body.
(5) Character and manner of injury may be known from its distribution as in case of
abrasions.

Bruises are of less value than abrasions because :

(1) Their size may not correspond to size of weapon.
(2) They may become visible several hours or one to two days after injury.
(3) Direction of force cannot be made out
4. Describe the types of laceration and their causation. Write its medico-legal importance. (4+2)
(2019)
1. 13. S/N: Lacerated wound (2012)
Avulsion :
(1) It is caused when sufficient force is applied at an acute angle to detach (tear off) a portion of skin
or organ from its attachment.
(2) The shearing or grinding force by weight, such as lorry wheel passing over a limb, may produce
separation of skin from underlying tissues (avulsion) over a large area. This is
called ‘flaying’.
(3) Underlying muscles are crushed and bones may be fractured.
(4) The separated skin may show extensive abrasions.

19. What is incised wound?

21. Define incised wound.
Suicidal incised wounds are :
 (1) Multiple, and parllel in any area.
(2) Uniform in depth and direction.
(3) Relatively trivial.
(4)Fatal wounds are present on several limited, easily reached areas of the body, such as
neck, wrist, groin, etc.
(5) Hesitation marks or tentative cuts or trivial wounds are present, which are multiple,
small and superficial, and are seen at the beginning of incised wounds.

When a safety razor blade is used unintentional cuts are found

on the fingers, where the blade has been gripped

M.L Importance :
Indicates:
(1) Nature of weapon.
(2) Direction of force.
(3) Age of injury.
(4) Mode of production, i.e. suicide, homicide, accident
Cut-throat wounds cause immediate death from haemorrhage, air embolism, or inhalation of
effused blood.

2. Differentiate: Incised & Lacerated wounds (2008)

3. 9. S/N: Cut-throat injury (2013)

4. 16. Differentiate: Suicidal & Homicidal cut-throat injury (2009)
5. How will you differentiate suicidal cut-throat from homicidal cut throat? (2+6) (2005)
6. Write the characteristics of an incised cut-throat wound. (2+6) (2002)
7. 10. S/N: Stab wound (2013)
M.L. Imp:
(1) Type of weapon known from shape of wound.
(2) Depth indicates amount of force.
(3) Age of injury.
(4) Broken fragment of weapon if found will identify weapon.
(5) Manner of production.
(6) Direction of wounds indicate relative positions of victim and assailant.
Complications:
(1) Internal haemorrhage.
(2) Infection.
(3) Air embolism if jugular veins are damaged.
(4) Pneumothorax.
(5) Asphyxia due to inhalation of blood.
Concealed puncture wounds:

(1) They are seen in concealed parts of the body, such as nostrils, fontanelle, fornix of
upper eyelid, axilla, vagina, rectum, nape of neck.
(2) A careful search is necessary to detect them.
(3) Fatal injuries may be caused without leaving any external marks, e.g. thrusting a needle or
pin into the brain through the fontanelles, through the inner canthus of the eye, or into the
medulla through the nape of the neck.

Defence wounds:
They are caused due to immediate and instinctive reaction of victim to save himself, either
by raising arm to prevent the attack or by grasping the weapon.
Self-inflicted and fabricated wounds:

(1) Self-inflicted wounds are those inflicted by a person on his own body.
(2) Fabricated (fictitious, forged or invented) wounds are those which may be produced
by a person on his own body or by another with his consent.
(3) Fabricated wounds are mostly incised, and sometimes contusions, stab wounds and burns.
(4) Lacerated wounds are rarely fabricated.
(5) Incised wounds are usually superficial, multiple and parallel.
(6) Stab wounds are multiple and superficial.
(7) Burns are superficial.
(8) Clothes are not cut.
(9) The history of assault is incompatible with the injuries

FIREARMS – PROXIMAL, INTERMEDIATE AND TERMINAL BALLISTICS

8. 12. Differentiate: Entrance wound & Exit wound in gunshot injury (2012) (2010)
ABRASION COLLAR
5. Differentiate: Stab wound & Gunshot wound (2017)
 REGIONAL INJURIES

S/N: Puppe’s rule (2023)

2. S/N: Contre-coup injury (2009)
Contrecoup injuries:
(1) Coup (blow, impact) means that the injury is located under the area of impact and is caused
directly by impacting force.
(2) Contrecoup means that the lesion is present in an area opposite the side of impact.
(3) They are produced mainly due to local distortion of the skull and sudden rotation of the head
resulting from blow, which causes shear strains due to pulling apart of constituent particles of the
brain.
(4) A certain amont of shear may occur below the point of impact, particularly if the skull is
fractured, which causes coup.
(5) They are not seen if the head is well fixed and cannot rotate.
(6) Contrecoup injury is caused when moving head is suddenly decelerated by hitting a firm surface,
e.g. striking of the head on the ground.
(7) When the head is suddenly arrested, the brain will be still in motion and strikes the skull.
(8) Occipital injuries produce severe and extensive contreocoup injuries in the
frontal region. The irregular bony prominences, especially orbital and cribriform plates, and lesser
wings of sphenoid, contuse or lacerate the base of frontal lobes and tips of temporal lobes.
(9) The second factor causing contrecoup injury is formation of a cavity or vacuum in the cranial
cavity on opposite side of impact as the brain lags behind the moving skull. The vacuum exerts a
suction effect which damages the brain.
(10) A blow to the head produces coup contusions, while contrecoup contusions are either small or
absent.
(11) A fall on the head produces contrecoup contusions while coup contusions or small
or absent.
(12) Before 3 years, contrecoup injuries are rare.
1. Reason out: Extradural hemorrhage is rare in the first two years of life (2023)
 MEDICOLEGAL ASPECTS OF WOUNDS

1. Enumerate grievous hurt

2. S/N: Grievous wound (2002)
Hurt: Hurt means bodily pain, disease or infirmity caused to any person (S.319, I.P.C.).

Grievous Hurt:

According to S.320. I.P.C. any of the following injuries are grievous.

(1) Emasculation (loss of potency).

(2) Permanent privation (loss) of sight of either eye.

(3) Permanent privation of hearing of either ear.

(4) Privation of any member or joint.

(5) Destruction or permanent impairing of the power of any member or joint.

(6) Permanent disfiguration of the head or face.

(7) Fracture or dislocation of a bone or tooth.
(8) Any hurt which endangers life, or which causes the victim to be in severe bodily pain, or unable
to follow his ordinary pursuits for a period of twenty days.

Simple injuries: All injuries which are not grievous are simple

THERMAL DEATHS
1. Differentiate: Ante mortem & Postmortem burns on autopsy (2008) (2006)
Pugilistic attitude (boxing, fencing or defence attitude) :
(1) If body is exposesd to great heat, legs are flexed at hips and knees, arms are flexed at
elbows and held in front of body, all fingers are hooked like claws.
(2) Opisthotonus is seen due to contraction of paraspinal muscles.
(3) Flexor muscles being bulkier than extensors contract more due to which joints of all
limbs are flexed.
(4) It occurs whether the person was alive or dead at the time of burning.
(5) Stiffening is due to coagulation of proteins of the muscles and dehydration
2. S/N: Rule of 9 (2005)
Age of burns

MECHANICAL ASPHYXIA
Enumerate the various causes of asphyxia deaths

Define strangulation.
3. Define hanging.
4. Define hanging.
5.
6. Describe postmortem findings in a case of typical hanging. (2012) (2+6) [+ Partial hanging
(2m) (2011)]
7. describe in detail the autopsy features of hanging deaths. (2008) (4+4)
8. c) Ligature mark of hanging & Strangulations (2014) (2007)
9. Write in short, the factors which modify ligature more of hanging. (2002) (2+6
(1) Mark is above level of thyroid cartilage in 80%, at the level in
15% and below cartilage in about 5% of cases.
(2) Width of groove is about, or slightly less than width of ligature.
(3) The mark may be patterned.

Pseudo strangulation

10. Differentiate: Hanging & Strangulation (2021)

11. b) Hanging & Strangulation (2021) (2015) (2013)
13. S/N: Causes of death due to strangulation (2001)
Enumerate the different types of strangulation. Discuss the postmortem findings in a case of
strangulation by ligature. (2005) (2+2+4)
2. S/N: a) Cafe Coronary (2019) (2011)
b) Traumatic asphyxia (2018) (2001)
10. S/N: Burking (2003)

c) Sexual asphyxia (2017)

6. WhaT is drowning?
Describe the different types of drowning.
TYPES OF DROWNING
a) Fresh water & Saline water drowning (2016)

Discuss how you will diagnose cases of ante mortem drowning. (2002) (3+5)
1. What are the postmortem findings in the case of freshwater drowning?
5. S/N: Diatoms. (2012) (2008)
2. Mention the medico-legal importance of diatom test. (2010) (2+4+2)
 1. Enumerate the characteristics of drowning froth (2) (2023)
3. Differentiate:
8. 9. A body was found floating in a pond. Discuss how to assess during PM examination: a)
identification
b) cause of death
c) time passed since death (2003) (2+3+3)

IMPOTENCE & STERILITY

3. S/N: Impotence quad hoc (2006) (2001)

1. S/N: Artificial insemination (2013) (2011)
2. 5. S/N: Artificial Insemination Donor (AID) (?)
 2. Differentiate: Artificial insemination & Adoption (2011)
4. Why is temporary impotence expected in case of acid/alcohol/organophosphorus/potassium
cyanide poisoning (?)

VIRGINITY, PREGNANCY & DOLIVERY

4. S/N: Virginity (2011)

2. S/N: Hymen (2013)
3. Describe the different signs of pregnancy. What are its legal aspects? (2013) (4+4)
 (6) Jacquemier’s sign : Mucosa of vagina changes from pink to violet
deepening to blue due to venous obstruction after fourth week.
Hegar’s sign: It is
positive about sixth week. If one hand is placed on abdomen and two
fingers of other hand in vagina, firm hard cervix is felt, and above it
elastic body of uterus, and between the two isthmus is felt as a soft
compressible area. This is the most valuable physical sign of early
pregnancy.
(2) Cervix : From second month, cervix progressively
softens from below upwards which is well marked by four months.
This is known as “Goodell’s sign”.

Ballottement
: It is positive during fourth and fifth months. If sudden motion is
imparted to abdominal wall, the rebound of foetus can be felt in a
few seconds.

(3) Signs of foetal death are:

(a) Spalding’s sign. (
b) Collapse of spinal column.
(c) Presence of gas in heart and great vessels
Virginity vs defloration
5. S/N: Affiliation cases (2010)

9. S/N: Lochia (2001)

 7. Differentiate: Recent delivery & Remote delivery (2006)

1. Differentiate: True virgin & False virgin (2021) (2018) (2014) (2012) (2011)

6. S/N: Blood examination in disputed paternity (2008)

8. S/N: Disputed paternity (2003)

ABORTION

2. Define abortion.

1. S/N: MTP Act (2019)

Discuss the provision of the MTP Act. (2004) (2+6)
3. Describe the ways & means used for procuring criminal abortion (2001)
(6)
Natural abortion vs criminal abortion
 SEXUAL OFFENCES

4. Define rape.
 Custodial rape

Describe of the procedures of examination of female victim of sexual assault & specimen to be
collected for laboratory investigation. (2017) (2011) (2010) (3+5)
Dangers of rape

11. S/N: Incest (2003)

5. Describe the unnatural sexual offences. (2015) (6)
 sodomy

Sexual perversions
5. S/N: Sadism (2012)
9. Differentiate: Sadism & Masochism
voyeurism

Troilism is an extreme degree of voyeurism. It is sexual practice

involving 3 persons, 2 of one sex and one of the opposite sex. A
perverted husband gets sexual satisfaction by inducing his wife to
sexual intercourse with another man and by watching the same

indecent assault

transvetism
1. Reason out: The medicolegal examination of a survivor of rape should not be done
without her consent. (2023)
2. S/N: Custodial rape (2021) (2002)
4. Describe the laboratory tests to confirm the act of sexual intercourse in an allegation of rape.
(2016) (6)
7. S/N: MLI of semen examination (2008)
8. S/N: Precaution of medicolegal examination of rape victim. (2008)
10. Enumerate the materials which should be preserved during examination. (2003)
12. What are the dangers of cape on a victim? (2001)

INFANT DEATH

2. S/N: Battered baby syndrome/Caffe's syndrome (2018) (2009)

munchausen

3. S/N: Sudden infant death syndrome (2014)

 1. A dead foetus was brought to a Medical College Hospital for postmortem examination by the
police. As per the history, the foetus was found on the outskirts of the city near a drain. On
examination - the length of the foetus was 26 cm, and the weight was 380 g, downy lanugo hairs
were present, the head was about one-fourth of the length of the body and a developing penis
was observed.
a) How will you establish the gestational age of the foetus?
b) Is this a viable foetus?
c) Enumerate the signs of live birth?
d) Write the difference in lungs before and after respiration. (2023) (2+2+3+3)
4. Differentiate: Respired & unexpired lungs (2013) (2011)
5. S/N: Precipitate labour (2012) (2005)
6. Differentiate: Still born & Death born child (2010)
7. Differentiate: Still born & Live born child (2007)
Signs of live birth
Maceration

BLOOD STAINS

1. S/N: Medicolegal aspect of blood (2021)

2. Describe the different biological stains having MLI of each of them. (4) (2009)
Seminal Stains
hair
 FORENSIC PSYCHIATRY

6. S/N: Delusion (2019) (2016) (2013) (2009)

 2. Enumerate the types of hallucination (2023) (2)
3. 8. S/N: Hallucination (2013) (2008)

5. Differentiate: True insanity & feigned insanity (2019) (2018) (2017) (2015) (2013) (2012) (2010)
(2008)
Differentiate: Civil and criminal responsibilities of a mentally ill person (2014)

Describe the civil responsibilities of an insane person (2011) (8)

S/N: Criminal responsibility of an insane person (2007)

4. Differentiate: McNaughten's Rule and Section 84 IPC (2021)
12. S/N: Legal test of Insanity. (2009) (2002)
9. S/N: Impulse (2012) (2010)

10. S/N: Testamentary capacity (2011)

1. S/N: Pugilistic attitude (2023)
2. Reason out: A marriage with a mentally ill person may be considered invalid under certain
circumstances. (2023)
13. 14. Write down the various methods of restraining of a mentally ill person (2002) (8)

Mental health care act

 MEDICAL LAW & ETHICS

S/N: 3 m Reason out: 5m

Differentiate: 3m No
OR 1. Enumerate the basic principles of ethics?
13. S/N: Professional misconduct (2008)

10. S/N: Professional secrecy (2012)

9. S/N: Privileged communication (2013) (2011)
3. S/N: Medical negligence (2014)
4. 4. Differentiate: Civil & criminal negligence (2019)
5. 5. S/N: Criminal negligence (2018)
6. 14. Differentiate: Civil & Criminal Malpraxis (2005)
15. S/N: Contributary negligence (2003)
S/N: Res Ipsa Loquitor (2013) (2010)
3. Reason out: The burden of proof of negligence does not lie on the patient where the Rule of Res
Ipsa Loquitur is applied (2023)
Novus Actus interveniens (unrelated action intervening):
2. S/N: Infamous conduct (2023) (2010)

6. S/N: Vicarious liability (2017)

7. What is consent? Enumerate the different types briefly.

8. S/N: Informed consent (2008)
9. Discuss the importance of informed consent in medical practice. (2023) (1+4)

10. What is the medicolegal importance of consent? (2012) (2+2+4)

11. 16. S/N: Age of consent (2002)
17. S/N: Acts of omission (2001)

IDENTIFICATION

Name the different data which help in identification.

7. S/N: Cephalic Index (2015) (2007)
SEX DETERMINATION
15. S/N: Intersex (2002)

8. Differentiate: Male skull & Female skull (2014) (2011)

12. Differentiate: Male pelvis & Female pelvis (2012)
AGE ESTIMATION

FETAL AGE ESTIMATION

ESTIMATION OF AGE FROM OSSIFICATION
AGE ESTIMATION FROM SKULL
What is the medico-legal importance of hair and teeth? (3+5) (2018)
13. Differentiate: Temporary teeth & Permanent teeth (2010) (2005)
13. S/N: Estimation of age from teeth (2006)
1. Reason out: Dactylography is considered one of the best techniques for establishing the
identity of a person. (2023)
2. 8. What are the different patterns of fingerprints with their percentages? Why is
dactylography much more reliable than DNA fingerprinting? (2+3+3) (2012)
3. 12. S/N: Latent Fingerprint (2009)

advantages
12. S/N: Poroscopy (2003)
3. Describe different prints in relation to Forensic Medicine.
. S/N: Superimposition (2018
14. S/N: Scar (2005)

Tattoo marks
5. Differentiate: Human hair & Animal hair (2017) (2007)

Medicolegal importance of hair

Medicolegal importance of teeth

9. S/N: Turner Syndrome (2011)
10. 2. One unidentified dead body of a male around 20 years of age was recovered by the local
police near the Loktak lake. Enumerate the different data that will help to determine the
age of the person. Discuss any one of these data to establish the age of this unidentified
person. What will be the surest data for identification in this case? What are the
drawbacks of DNA profiling in identification of an individual? (2+3+1+2) (2021)

TOXICOLOGY GENERAL CONSIDERATIONS

1. S/N: Chelating agents in treatment of poisoning (2016) (2008)

They inactivate a metallic ion with formation of an inner ring structure in the molecule, the
metallic ion becoming a member in the ring.

(A) B.A.L. (British anti-lewisite; dimercaprol):

(1) It is used in arsenic, lead, copper, mercury,, bismuth, gold and other heavy metals.
(2) Many heavy metals have great affinity for sulphydryl (-SH) radicles and combine with them
in tissues, and deprive the body of the use of respiratory enzymes of tissue cells.
(3) Dimercaprol has two unsaturated sulphydry1 groups which combine with metal, and
thus prevent union of metal with the -SH group of the respiratory enzyme systems.
(6)It is not used when liver is damaged.

(B) E.D.T.A. (ethylenediamine tetra-acetic acid; calcium disodium versenate):

(1) It is effective in lead, mercury, copper, cobalt, iron, cadmium poisoning. manganese
(3) It is superior to B.A.L. for the treatment of poisoning by arsenic and mercury.

(C) Penicillamine (cuprimine):

orally
slow normal saline drip
(3) It is the chelating agent of maximum efficiency for heavy metals. Copper

(D) DMSA (succimer):

(1) It is used in lead, mercury and arsenic poisoning.

(2) it is superior to EDTA in the treatment of lead poisoning.
(3) orally
(4) A combination of succimer and EDTA is more effective.
 (E) DMPS is used in mercury, lead and arsenic poisoning.
orally

(F) Desferrioxamine orally for poisoning by iron.

G. injection
2. Define poisons.

A poison is a substance (solid, liquid or gaseous) which if introduced in the living body, or brought
into contact with any part thereof will produce ill-health or death, by its systemic or local effects or
both.

5. S/N: Classification of poison (3) (2008) (2002)

Poisons may be classified according to chief symptoms which they produce:

(1) Corrosives:
(1) Strong acids:
(a) Mineral or inorganic acids: Sulphuric, nitric, hydrochloric.
(b) Organic acids: Carbolic, oxalic, acetic, salicyclic.
(2) Strong alkalis:
Hydrates and carbonates of sodium, potassium and ammonia.
(3)Metallic salts: Zinc chloride, ferric chloride, copper sulphate, silver
nitrate, potassium cyanide, chromates, bichromates.
(II) Irritants:
(1) Agricultural.
(2) Inorganic:
(a) Non-metallic: Phosphorus, iodine, chlorine.
(b) Metallic: Arsenic, antimony, copper, lead, mercury, silver, zinc.
(c) mechanical: Powdered glass, diamond dust, hair.
(3) Organic:
(a) Vegetable: abrus, castor, croton, calotropis, aloes.
(b) Animal: Snake and insect bites, cantharides, ptomaines.
(III) Systemic:
(1) Cerebral:
(a) CNS depressants: Alcohols, general anaesthetics, opioid analgesics, hypnotics, sedatives.
(b) CNS stimulants: Cyclic antidepressants, amphetamine, methyl phenedate.
(c) Deliriant: datura, belladonna, hyocyamus, cannabis.
(2) Spinal: Nux vomica, gelsemium.
 (3) Peripheral: Conium, currare.
(4)Cardiovascular: Aconite, quinine, oleanders, tobacco, hydrocyanic acid.
(5) Asphyxiants: CO, CO2, hydrogen sulphide.

(IV) Miscellaneous:
Food poisoning, botulism.

Discuss the management of a poisoning case in hospital.

3. Describe the general principle of management of a poisoning case. (8) (2013)
(1) Gastric lavage is useful within three hours after ingestion of a poison.
(2) It is done using a stomach tube (Ewald or Boas tube), or ordinary soft, non-collapsible rubber
tube of one cm diameter and 1.5 metres length, with a funnel attached at one end and a mark
about 50 cm. from the other end, which should be rounded with lateral openings.
(3) Dentures must be removed and a mouth gag used in patients whose mouth cannot be kept
open while passing the tube.
(4) Patient should be lying on his left side or prone with head hanging over the edge of the bed, and
face down supported by an assistant, so that the mouth is at a lower level than pharynx.
(5) The end is lubricated with olive or sweet oil, or glycerine and is passed into the stomach by
depressing the tongue with the finger and slowly passing it downwards till the fifty cm. mark is
reached.
(6) About 250 ml. of warm water (35°C) should be passed through the funnel held high up above
the patient’s head.
(7) When funnel is empty, compress the tube below it between the finger and thumb, and lower it
below the level of the stomach; its contents will be emptied by siphon action on releasing pressure
on the rubber tubing.
(8) Preserve this for chemical analysis.

(9) Gastric lavage may be done with

water;
1:5000 potassium permanganate;
five percent sodium bicarbonate,
four percent tannic acid;
one percent sodium thiosulphate;
one percent sodium or potassuim iodide;
one to three percent calcium lactate;
saturated lime water or starch solution.

(10) Next, use about half litre of suitable solution and repeat till clear and odourless fluid comes
out.
(11) A small quantity of fluid containing the antitode is left behind in the stomach, so that it may
neutralise whatever small quantity of thempoison is left behind in the stomach.
What are the things to be preserved during treatment? (2+4+4) (2014)
Ideal homicidal poison:

(1) It should be cheap

(2) easily available
(3) colourless, odourless and tasteless,
(4) capable of being administered either in food, drink or in medicine without producing any
visible change,
(5) highly toxic
(6) signs and symptoms should resemble natural disease
(7) there should not be any antidote and
(8) no P.M. changes, should not be detected by chemical tests and
(9) must be rapidly destroyed in the body

(2) Fluorine and thallium satisfy several of above criteria.

(3) Arsenic and aconite are commonly used as homicidal poisons

Ideal suicidal poison:

(1) Cheap
(2) easily available
(3) toxic,
(4) tasteless or pleasant taste,
(5) easily taken in food or drink and cause painless death.
(2) Opium and barbiturates satisfy several criteria.
(3) Organophosphorus compounds are commonly used

Duties of medical practitioner in case of suspected poisoning:

The duties are
Medical: Care and treatment of the patient.
Legal: Assist the police to determine the manner of death.

(1) Note preliminary particulars of the patient, i.e. age, sex, address, date and time, identification
marks, etc.
(2) In case of suspected homicidal poisoning, the doctor must confirm his suspicion.
For this he must
(a) collect vomit and urine and submit for analysis.
(b) Observe and record the symptoms in relation to food.
(c) Consult in confidence senior doctor.
(d) Either remove the patient to hospital, or appoint nurses of his confidence.
(e) Keep detailed records of symptoms and signs observed and treatment given from time to
time.
(3) If a private practitioner is convinced that the patient is suffering from homicidal
poisoning, he is bound under S.39, Cr.P.C. to inform the police officer.

(4) If he is sure that the patient is suffering from suicidal poisoning, he is not bound to
inform police.
 (5) If the doctor is summoned by investigating police officer, he is bound to give all
information.

(6) A Government medical officer has to report to police all cases of suspected poisoning,
whether suicidal, homicidal or accidental treated in the hospital.

(6) If the condition of the patient is serious, he must arrange to record the dying
declaration.

(7) If patient dies, he should not issue death certificate but he should inform the police.

4. S/N: Universal antidote (2012) (2004)

7. S/N: Antidotes (2003) (2001)
Antidotes:
Antidotes are substances which counteract or neutralise the effects of poisons.

(a) Mechanical or physical antidotes:

They neutralise poisons by mechanical action or prevent their absorption.

Eg: Activated charcoal & Demulcents e.g. milk, starch, egg-white,

Bulky food acts as mechanical antidote to glass powder by imprisoning its particles
within its meshes.

Demulcents are substances which form a protective coating on the gastric

mucous membrane.

(b) Chemical Antidotes:

They counteract action of poison by forming harmless or insoluble compounds or
by oxidising poison when brought into contact with them.
Eg.
1. Common salt decomposes silver nitrate by direct chemical action, forming
insoluble silver chloride.
2. Potassium permanganate 1:5000 solution is used in poisoning for opium, strychnine,
cyanides, barbiturates, atropine, and phosphorus. When it reacts with the poison in the
stomach it loses its pink colour.

Universal antidote consists of

(1) activated charcoal (or burnt toast) two parts.
(2) magnesium oxide one part,
(3) tannic acid (or strong tea) one part.

(c) Physiological or pharmacological Antidotes: These act on the tissues of the body
and produce symptoms exactly opposite to those caused by the poisons.
Eg. Atropine and physostigmine are two real physiological antidotes

6. S/N: Role of stomach wash in management of poisoning (2006)

 AGRICULTURAL POISONS (2012)

1. Describe the signs, symptoms, and treatment of organophosphorus poisoning.

2. Discuss the clinical features and treatment of any one of such poison commonly used in
agriculture. (2+3+3) (2005
(7)
Pralidoxime and atropine work synergistically, and should be used
together.
3. Describe the post mortem appearance of organophosphorus poisoning.

4. What are the prophylactic measures to be adopted in persons working with OP

compounds? (3+2+3) (2018) (2008)
 Plant penicillin endrin

5.
6. 3. An adult person is brought to an emergency in an unconscious condition with the
history of convulsions and with kerosene-like smell and froth around the mouth. What is
your probable diagnosis? How are you going to manage and treat such a case? (2+2+4)
(2016)
Enumerate the poisons causing constriction of pupil.

CORROSIVE POISONS
Sulphuric acid and nitric acid
1. S/N: Vitriolage (2011) (2001)
2. Write the urine findings in chronic carbolic acid. (2) (2023)
1. 5. S/N: Carboluria (2009)
2. Describe the signs, symptoms, treatment, and postmortem examination findings of a case
of carbolic acid poisoning. (1+1+3+3) (2019)
Oxalic acid
1. Reason out: Gastric lavage is contraindicated in corrosive poisoning. (2023)

METTALIC POISONS

Arsenic
imbibition

1. 3. S/N: Mercuria lentis (2002)

1. . Describe the signs, symptoms, treatment of a case of chronic lead poisoning. Enumerate
the PM findings in a case of death due to chronic lead poisoning. (4+4) (2015)
2. Differentiate: Acute arsenic poisoning & Cholera (3) (2019) (2013) (2012) (2011)

3.
 INORGANIC IRRITANT POISONS

1. S/N: Phossy jaw/Lucifer’s Jaw (2017) (2003) (2002)

 ORGANIC IRRITANT POISONS

2. Differentiate: Poisonous snake & Non-poisonous snake (2017) (2010)

3. Classify poisonous snake in India.
Mention the outline of treatment in poisonous snake bite poisoning (4) (2009)
1. A middle-aged male was brought to the emergency department with an alleged history of snake
bite on the dorsum of the hand while he was working on his farm. The dorsum of his hand showed
two distinct fang marks with blood oozing out. The bystanders killed the snake on the spot and
brought the dead snake, which had a triangular head, a vertical pupil, a prominent neck, and a
tapering tail.
a) Identify the snake in the above case?
b) What should not be done in this case during first aid management?
c) What is the toxic effect of the venom of such a snake?
d) Write the signs and symptoms and management for the above case. (1+2+1+6) (2023)

PLANT IRRITANTS
 CNS DEPRESSANTS

1. Reason out: In methyl alcohol poisoning, ethyl alcohol is administered as an antidote. (2023) 2.
S/N: Morphinism (2010) 3. Define drunkenness. Write down the scheme of examination of an
alleged case of intoxication. (2+6) (2010) 4. What type of poison is opium? Name four alkaloids if
opium. Describe the PM findings of a case of death due to opium poisoning. (1+2+5) (2005) 5. S/N:
Delirium tremens (2002) (2001) 6. Describe the signs, symptoms, diagnosis, and management in a
case of opium poisoning. (2006) (2001) 7. Discuss the mode of action, signs, symptoms, treatment,
and postmortem findings in a case of morphine poisoning through intravenous route. (2+6+4+4)
(2001)

DELIRANT POISONS

1. Discuss the differential diagnosis of poisons causing dilatation of pupils.

2. Write the signs, symptoms, mode of action, treatment and MLI of any one of them/Datura
poisoning. (2+6) (2007) (2003)
RUN AMOK

COCAINE
 SPINAL POISONS

1. Differentiate: Tetanus & Strychnine poisoning (2015) (2013) (2012) (2010)

CARDIAC POISONS
2. What type of poison is aconite? Write the alkaloid it contains, signs, symptoms, and treatment.
(1+2+5) (2003)

1. While playing in the garden, a little girl from Chandel district chewed a few seeds of a globular
green colored fruit. On enquiry, she told that the tree from which she got the seed bears yellow
colored bell shaped flower. The ECG tracing of the child on admission showed features of heart
block. What could be the poison? Write down the names of the active principles of this poison.
Enumerate the different signs and symptoms of this poisoning. Write down the outline of
management of this case. (1+2+2+3) (2021)

FOOD POISONING

1. Enumerate four common natural food poisons. (2) (2023)

Causes :
(I) Poisoning due to bacteria and toxins. Eg Botulism
(II) Poisons of vegetable origin (natural food poisons) :
(1) Lathyrus sativus.
Consumption of
L. Sativus seeds in quantities exceeding 30% of the total diet for
more than six months have been known to causes paralysis.
(2) Poisonous mushroooms.
Amanita phalloides and Amanita muscaria
are the common varieties of poisonous fungi.
(7) Argemone mexicana.
The oil causes epidemic dropsy.
(4) Poisonous berries, such as atropa belladonna.
(3) Rye, oats, barley, etc.
(5) Lolium temulentum.
(6)Paspalam scrobiculatum.
(8) Cotton seeds.
(9) Groundnuts.
(10) Vitia fava.
(11) Cabbage.
(12) Solanine.
(13)Soyabean.
(14) Sweet clover.
(III) Chemical :
(1) Intentionally added, such as flavouring agents in processed food, colouring agents,
preservatives, extraction of fat by solvents like hydrocarbons.
(2)Accidentally added, such as pesticides and insecticides.
(3) Products of foods.
(4) Radionucleides.

APPENDICES

1. S/N: Neutron activation analysis (2010) 2

2. . S/N: Gas chromatography – its principles, field of application in detection of poisons.
(2008)
ALCOHOL NEUROTOXIC INEBRIANTS
METHANOL
BODY PACKER