A Practical Handbook of Forensic Medicine &

Toxicology

A Practical Guide for Autopsy Procedures, Medicolegal work

and Court Evidence for Undergraduates, Post Graduates,
House Officers, Medical Officers and Lawyers
All Rights Reserved

All right are reserved with the authors. No part of this publication may be reproduced by any
mechanical, photographic, or electronic process, nor may it be stored in a retrieval system, or
copied without written permission from the author.

First Edition 2021

Author Prof. Dr. Rizwan Zafar Ansari

 PREFACE
All praise be to Allah to whom I seek for mercy, the cherisher & sustainer of all the worlds,
to guide me for the right course of action. His bounties go before even the need arises and
flows Allah most gracious to all his creatures protecting them, guiding them and leading
them to clear light and higher life.
It is humbly prayed that, read these instructions carefully, imbibe them and if you find any
queries regarding the subject, kindly convey the message with positive suggestions as any
error or omission will be accepted with an open heart.

Dedicated to
Prof.Dr.Mian Abdul Rasheed (FCPS)
(Prof & Dean Forensic Medicine CPSP)
Prof.Dr.Zahid Hussain Khalil (FCPS)
(Supervisor Forensic Medicine CPSP)
Prof.Dr.Pervaiz A Rana
(Mentor & Ex Head King Edward Medical College, Lahore)
Prof.Dr.Waseem Haider (MD, PhD)
(Ex Surgeon Medicolegal Punjab)

Contributors
Prof.Dr.Rizwan Zafar Ansari
(MBBS, DMJ, ADHPE)
Associate Prof. Dr.Ijaz Aziz
(MBBS, FCPS,CHPE)

Dr. Tariq Dr.Lutfia

Demonstrator Demonstrator

Edited & Composing

Wishal Nadeem
Computer Operator
 CONTENTS
Section 1
Laws Related to Medical Man
A. Stage of Evidence 1

Inquests by region 2

Mens REA and Actus REUS 4

First Tier, Second Tier, Third Tier 4

Stage of Evidence 5

Role Play (Stages of Evidence) 6

B. Medicolegal Certificate 10

What is Medicolegal Certificate? 10

How to communicate with police? 12

General Instructions for Conducting Medicolegal Examination 15

Specific Instructions for Various Medicolegal Examinations 18

Practical No.1: a. Examination of Female Victim of Sexual Assault 20

b. Examination of Male Victim of Sexual Assault 24

Practical No.2: Medicolegal Examination of Sexual Offender 26

Practical No.3: Examination of Alleged Pregnancy / Criminal Abortion 29

Practical No.4: Instructions for Dental Surgeons While Conducting Medicolegal 30

Examination

Practical No.5: Estimation of Age from Radiological Examination 32

How to write a medico-legal report? 37

Exercise Medicolegal Cases 40

C. Medicolegal Autopsy 64

What are the types of Autopsy? 64

External Examination 65
 Internal Examination 65

Instruction Regarding Postmortem Examination 67

Exhumation 70

Exercise Medicolegal Autopsy Cases 72

Expert Opinion in Medicolegal and Postmortem Examination 95

Some Important Definitions in Qisas & Diyat Ordinance 96

D. Death Certificate 100

International Certificate of Cause of Death 100

Exercise Death Certificates 101

Section 2
Forensic Serology
A. Trace Evidence 103

B. Visiting a Scene of Crime 106

Practical No.6: Preservation of Samples 112

Practical No.7: Dispatch of Sample 114

Chain of Custody 115

Examination of Blood 117

Practical No.8: Collection of Blood from a Crime Scene 117

Practical No.9: Blood Detetion (Screening Tests) 119

a. Benzidine Test 119

b. Phenolphthalein Test 120

Practical No.10: Spectroscopic Examination of Blood 121

Practical No.11: Confirmatory Test: A. Takayama Test 123

B. Teichmann Test 123

Practical No.12: Microscopic Examination of Blood 125

Practical No.13: Origin of Blood (human, non-human) Precipitin Test 126

Practical No.14: B. Microscopic Examination of Blood Cell Size 127

Practical No.15: Difference between Male / Female Blood 128

Practical No.16: Blood Grouping 129

Practical No.17: Examination of Semen / Saliva 131

Practical No.18: Examination of Hair 133

Practical No.19: DNA Finger Printing 139

Practical No.20: Latent Finger Printing 142

Practical No.21: Collection, Preservation & Dispatch of Samples 145

Practical No.22: Examination of Blood under Ultraviolet light 150

Section 3
Analytical Toxicology

Practical No.23: Steam Distillation 154

Practical No.24: Stass Otto (Liquid-liquid Extraction) 155

Practical No.25: Reinsch Test 158

Practical No.26: Marquis Test 159

Practical No.27: Examination of A Drunk Individual 161

Practical No.28: Detection of Drugs of Abuse / Poisons 163

Practical No.29: Thin-layer chromatography (TLC) 164

Practical No.30: Gastric Lavage / Stomach Wash 166

Practical No.31: Examination of Urine 168

Practical No.32: Margin of Safety 170

Practical No.33: Aluminum Phosphide / Wheat Pill Poisoning 171

Forensic Toxicology 172

 Section 1

LAWS RELATED TO MEDICAL MAN

A. Stages of Evidence
B. Medicolegal Certificate
C. Medicolegal Autopsy
D. Death Certificate

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 LAWS RELATED TO MEDICAL MAN
A tort, in common law jurisdictions, is a civil wrong that causes a claimant to suffer loss or harm,
resulting in legal liability for the person who commits the tortious act. It can include the
intentional infliction of emotional distress, negligence, financial losses, injuries, invasion of
privacy and many other things.
Tort law, where the purpose of a legal action is to obtain a private civil remedy such as damages,
may be compared to criminal law, which deals with criminal wrongs that are punishable by the
state. Tort law may also be contrasted with contract law, which also provides a civil remedy after
breach of duty; but whereas the contractual obligation is one chosen by the parties, the obligation
in both tort and crime is imposed by the state. In both contract and tort, successful claimants must
show that they have suffered foreseeable loss or harm as a direct result of the breach of duty
An inquest is a judicial inquiry in common law jurisdictions, particularly one held to determine
the cause of a person’s death. Conducted by a judge, jury, or government official, an inquest may
or may not require an autopsy carried out by a coroner or medical examiner. Generally, inquests
are conducted only when deaths are sudden or unexplained. An inquest may be called at the
behest of a coroner, judge, prosecutor, or, in some jurisdictions, upon a formal request from the
public. A coroner›s jury may be convened to assist in this type of proceeding. Inquest can also
mean such a jury and the result of such an investigation. In general usage, inquest is also used to
mean any investigation or inquiry.
Q&A
Q-1 What are the 7 Torts?
Q-2 What are 3 elements of Tort?
Q-3 How do you win a tort case?
Inquests by region
United Kingdom
England and Wales
In England and Wales, all inquests were once conducted with a jury. They acted somewhat like a
grand jury, determining whether a person should be committed to trial in connection to a death.
Such a jury was made up of up to twenty-three men, and required the votes of twelve to render a
decision. Similar to a grand jury, a coroner’s jury merely accused, it did not convict.
Since 1927, coroner’s juries have rarely been used in England. Under the Coroners Act 1988, a jury
is only required to be convened in cases where the death occurred in prison, police custody, or in
circumstances which may affect public health or safety. The coroner can actually choose to
convene a jury in any investigation, but in practice this is rare. The qualifications to sit on a
coroner›s jury are the same as those to sit on a jury in the Crown Court, the High Court, and the
County Court.
Additionally, a coroner’s jury only determines the cause of death, its ruling does not commit a
person to trial. While grand juries, which did have the power to indict, were abolished in the
United Kingdom by 1948 (after being effectively stopped in 1933), coroner’s juries retained
those powers until the Criminal.

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Law Act 1977. This change came about after Lord Lucan was charged in 1975 by a coroner›s
jury in the death of Sandra Rivett, his children›s nanny.
The charity Inquest looks at inquests concerning contentious deaths including those in places of
detention, and has campaigned for reforms to the inquest and coroner›s system in England and
Wales.
Scotland

There are no inquests or coroners in Scotland, where sudden unnatural deaths are reported to,
and investigated on behalf of, the procurator fiscal for an area. The procurator fiscal has a duty
to investigate all sudden, suspicious, accidental, unexpected and unexplained deaths and any
death occurring in circumstances that give rise to serious public concern. Where a death is
reported, the procurator fiscal will investigate the circumstances of the death, attempt to find
out the cause of the death and consider whether criminal proceedings or a fatal accident inquiry
is appropriate. In the majority of cases reported to the procurator fiscal, early enquiries rule out
suspicious circumstances and establish that the death was due to natural causes.
Deaths are usually brought to the attention of the procurator fiscal through reports from the
police, the registrar, GPs or hospital doctors. However, anyone who has concerns about the
circumstances of a death can report it to the procurator fiscal. There are certain categories of
deaths that must be enquired into, but the procurator fiscal may enquire into any death brought
to his notice.
United States

In the United States, inquests are generally conducted by coroners, who are generally officials
of a county or city. These inquests are not themselves trials, but investigations. Depending on
the state, they may be characterized as judicial, quasi-judicial, or non-judicial proceedings.
Inquests, and the necessity for holding them, are matters of statutory law in the United States.
Statutes may also regulate the requirement for summoning and swearing a coroner’s jury.
Inquests themselves generally are public proceedings, though the accused may not be entitled
to attend. Coroners may compel witnesses to attend and give testimony at inquires, and may
punish a witness for refusing to testify. According to statute coroners are generally not bound by
the jury’s conclusion, and have broad discretion, which in many jurisdictions cannot be appealed.
The effect of a coroner’s verdict at common law was equivalent to a finding by a grand jury,
whereas some statutes provide that a verdict makes the accused liable for arrest. Generally, the
county or city is responsible for the fees of conducting an inquest, but some statutes have provided
for the recovery of such costs. Whether the evidence presented at an inquest can be used in
subsequent civil actions depends on the jurisdiction, though at common law, the inquest verdict
was admissible to show cause of death. Coroners› reports and findings, on the other hand, are
generally admissible.
A coroner’s jury deemed Wyatt Earp, Doc Holliday, and their posse guilty in the death of Frank
Stilwell in March 1882.
Q&A

Q-1 What inquest system is in Pakistan?

Q-2 What is the purpose of inquest?
Q-3 Where can I find inquest report?

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Mens REA and Actus REUS
The standard common law test of criminal liability is expressed in the Latin phrase actus reus non
facitreum nisi mens sit rea, i.e. “the act is not culpable unless the mind is guilty». In
jurisdictions with due process, there must be both actus reus («guilty act») and mens rea for a
defendant to be guilty of a crime (see concurrence). As a general rule, someone who acted
without mental fault is not liable in criminal law. Exceptions are known as strict liability
crimes.
In civil law, it is usually not necessary to prove a subjective mental element to establish liability for
breach of contract or tort, for example. But if a tort is intentionally committed or a contract is
intentionally breached, such intent may increase the scope of liability and the damages payable
to the plaintiff.
i. A “Three Tier Structure” for conducting of medico legal work has been established.

FIRST TIER
The initial medicolegal examination shall be carried out by the medical officers/ woman medical
officers at the rural health centers, Tehsil headquarters hospitals, district headquarter hospitals
and at teaching hospitals.

SECOND TIER
The district standing medical boards, comprising the following shall act as first appellate authority
in all the districts of the province.
Medical Superintendent, DHQ Hospital Chairman
District Officer Health Member
Surgeon Member
These boards will conduct re-examination if the decision of the medico legal examiner is
challenged and also for examination of alleged cases of police torture / police encounter.

THIRD TIER
The role of Surgeon Medico-legal of each province is supervisory. He shall be the Chairman of
Provincial standing medical board, which shall be the final appellate authority against the decision
of District standing medical board. Other member of the Provincial Standing Medical Board
(PSMB) will be the Associate / Assistant Professor Forensic medicine of the Regional Medical
College and the medical superintendent of one of the attached Teaching Hospital. The board can
co-opt any other member when required.
ii. Following “Time Frames” have fixed to make the process of issuance of Medicolegal reports
simple quick and efficient:
1. In case of injuries “Kept under Observation” the examining doctor shall mention in writing
the due date for declaration of final opinion which will have to be declared within a
maximum period of 3 weeks.
2. The officers of Chief Chemical examiner, Bacteriologist and Serologist to Provincial
Government
shall be bound to issue the reports of samples sent to them within the following time frame.

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 i. Chemical Examiners:
a. Report of Alcohol & semen within 7 days
b. Poisoning Cases within 3 weeks
ii. Serologist: within 7 days
iii. Bacteriologist:
a. Report for soft tissues within 3 weeks
b. Report for bony tissues within 6 weeks

A. STAGE OF EVIDENCE (COURT PROCEEDINGS)

Examination-in-chief:
It is the first and main component of evidence. The party who produces the witness conducts it. The
facts deposed to in this examination must be within the memory and recollection of the witness.
Only scientific witnesses like medical practitioners or ballistic experts are allowed to refer to their
written notes. Leading questions are not permitted

Cross Examination:
It is the second part of the evidence, which is conducted by the party who defends the case. It is
required to test credibility of the witness, accuracy of the evidence and willful omission of
facts.
Leading questions are allowed

Re-examination:
It is the third stage providing an opportunity to rectify discrepancies that may have occurred due to
cross- examination.
The court may ask questions during any stage of examination to classify facts.
[

Scenario of Role Play

A suspected case of homicide of Mr. Umar, suspectedly murdered by Mr. Aziz on the morning
of 11th October, 2020 because of a dispute over money lent to Mr. Aziz by Mr. Umar.
There are two witnesses in the case. The first is an eyewitness who saw Mr. Aziz killing Mr.
Umar. The second witness is the doctor on duty who noted the dying declaration of the
deceased.
The court proceedings are as follows.

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 Role Play (Stages of Evidence)
Case 1
CRIMINAL MOCK TRIAL

IN THE SUPREME COURT OF PAKISTAN

BETWEEN

Mr. UMAR’S LAWYER (PLAINTIFF)

AND

Mr. AZIZ’S LAWYER (DEFENDANT)

[Issue: Mr. Umar was killed by Mr. Aziz]

CLERK: Order in court, The Honorable Mister Justice presiding. [Everyone stands as the Judge enters

the courtroom.]

JUDGE: You may be seated. [Everyone sits, except the Clerk.]

CLERK: The case of Mr. Umar the plaintiff vs. Mr. Aziz, the defendant my Lord. [Clerk sits.]

JUDGE: Thank you. Are all parties present? [Plaintiff ’s Counsel stands.]

PLAINTIFF’S

COUNSEL: Yes, my Lord. I am Adv. Shahmeer and I am acting on behalf of the plaintiff

Mr. Umar in this matter.

[Plaintiff ’s Counsel sits; Defendant’s Counsel stands.] DEFENDANT’S

COUNSEL: Yes, my Lord. I am Adv. Fida acting on behalf of the defendant, Mr Aziz, in this matter.

[Defendant’s Counsel sits.]

JUDGE: Thank you. Good day, ladies and gentlemen of the jury. I begin with some general comments

on our roles in this trial. Throughout these proceedings, you will act as the judges of the facts and I will

be the judge of the law. Although I may comment on the evidence, as judges of the facts you are the only

judges of the evidence. However, when I tell you what the law is, my view of the law must be accepted.

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NOTE:-
There is a basic principle that is fundamental to your role as jurors. In this case there is a
requirement of proof on the balance of probabilities, which means the evidence that has more
weight and is more probable must be accepted. You should then decide in favor of the party
who has presented the best evidence.
Before calling on the Plaintiff ’s Counsel to give his opening statement, I will tell you about
criminal law which effects the outcome of this case. A duty of care is an obligation accepted by
the law and everyone must conform to a particular standard of conduct for the protection of
others against unreasonable risks.
What is “reasonable care”; will be decided on the facts and the surrounding circumstances of the
case. If you find on the facts that the defendant was aware of the consequences of his act then he
is guilty. I now call upon the Plaintiff to make an opening statement.
Plaintiff ’s Counsel stands.]
PLAINTIFF’S
COUNSEL: My Lord, we intend to prove that the defendant, Mr. Aziz was involved in the
homicide of Mr Umar. To support the case, we intend to call our first witness: Mr. Faisal.
CLERK: Do you swear that the evidence you shall give shall be the truth, the whole truth and
nothing but the truth so help you God?
Mr. Faisal: I do.
CLERK: Please state your full name and address for the court.
Mr. Faisal: F-A-I-S-A-L S-H-A-H. I live in Hayatabad Phase-6.
JUDGE: You may be seated.
EXAMINATION IN CHIEF:
COUNCEL OF THE PLAINTIFF: can you narrate in your own words what happened the day
Mr Umar was killed?
Mr Faisal: It was 7 am in the morning, I was going to work when I heard a dragging sound, it
intrigued me and I followed the sound. What I saw next was Mr Aziz with an axe, Mr. Umar
was still alive and Mr. Aziz kept hitting him with the axe. I got scared of what was happening
and started screaming. The defendant ran away as soon as he saw me. I went to Mr Umar tried to
help him as much as I could, I called an ambulance, he was bleeding profusely. I took him to the
hospital, where he died after a few minutes.
Counsel: That will be all.

CROSS EXAMINATION:
COUNSEL OF DEFENDANT: What do you do for a living?
Mr. Faisal: I am a salesman.
COUNSEL: What are your duty timings?
Mr. Faisal: My work timings are 8am to 5 pm.
COUNSEL: Why were you going to work so early?
Mr. Faisal: My workplace is quite far away from where I live.

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COUNSEL: How do you know the person with the axe was the defendant?
Mr. Faisal: I know Mr Aziz as he lives in my neighborhood and it was broad daylight and I could
see his face quite clearly. Also, Mr. Umar mentioned his name and mentioned his relation to the
defendant before he died in his dying declaration in front of me.
COUNSEL: Why didn’t you stop Mr Aziz?
Mr. Faisal: I got scared of the whole situation Mr.Aziz had an axe and I feared for my life. Counsel:
That will be all.
RE EXAMINATION:
COUNSEL OF PLAINTIFF: Did you witness Mr Umar die?
Mr. Faisal: I took him to the hospital in an ambulance. The doctor on duty tried to save his life, but he
died right in front of my eyes after clearly telling who killed him.
Judge: Thank you. You may be seated (to the plaintiff ’s counsel)
CLERK: My Lord I have noted down the statements. JUDGE: You may proceed again (to the
plaintiff ’s counsel)
PLAINTIFF COUNSEL: With your permission i would like to call my second witness, the doctor on
duty. CLERK: Do you swear that the evidence you shall give shall be the truth, the whole truth
and nothing but the truth so help you God?
Doctor: I do.
CLERK: Please state your full name and address for the court. DOCTOR: Dr. R-A-H-E-E-M K-H-
A-N. I live in University Town JUDGE: You may be seated.
EXAMINATION IN CHIEF:
COUNSEL of PLAINTIFF: What happened when Mr Umar was brought in to the hospital the day
he died?

DOCTOR: I have it all noted down, I will read out from my notes. On the morning of 12th
October, 2020, I was the Medical Officer on duty. When Mr. Umar was brought in, he was bleeding
profusely he had injuries inflicted on his head, arms and chest by a sharp weapon. I called the other
medical officer on duty with me and we attended the patient, tried to save his life. But he died
shortly after his arrival to the hospital.
Counsel: Did you do something else as well at that time?
Doctor: Yes I noted down the patient’s dying declaration. His last words.
Counsel: Can you please narrate in Mr. Umar’s own words what he said before dying?

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Doctor: Mr Umar right before he died said Mr Aziz owed him some money and asked him to meet on the
morning of 12th October, 2020 before going to work, as he went to meet him at the specified place it was
deserted and all of a sudden Mr. Aziz started hitting him with an axe. He was caught by surprise and
wanted to run but he found himself unable to do so because of his bleeding wounds.
Counsel: That will be all.

CROSS EXAMINATION:

Defendant’s councel: Did you attend Mr Umar when he was brought to the hospital the day he
died? Doctor: Yes, I did.
Counsel: What was he wearing that day? Doctor: A dark grey dress of shalwar kameez.
Counsel: Dr Raheem are you sure it was Mr Aziz who killed Mr Umar?
Doctor: Yes, I am sure as Mr Umar was conscious and well oriented when he clearly said Mr Aziz was the
person who attacked him.
Counsel: While on duty why did you make notes? Isn’t your duty just attending to ill patients?
Doctor: As I work in a Government Hospital, I have a habit of noting down every important detail about
my patients that may be helpful in medico legal cases any time in the future.
Counsel: That will be all.

RE EXAMINATION:

COUNSEL of Plaintiff: What did you do after the patient expired?

Doctor: I wrote down the deceased’s dying declaration signed it and forwarded it to the medicolegal police
officer on duty.
COUNSEL: That will be all.

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 B. Medico Legal Certificate
Medicolegal Certificate
It is a certificate issued by a duty medicolegal officer (DMLO) after examination of the injury. It is an
opinion of an expert.

What is a medico-legal case?

A medicolegal case is a case of injury or ailment where attending doctor after taking history and clinical
examination of the patient thinks that some investigations by law enforcing agencies are essential so as to
fix the responsibility regarding the case.

Example: Consider a case of suicidal poisoning. Suicide is an offence u/s 309 Pakistan Penal Code
(PPC). Patient insists he does not want an MLC. If the doctor agrees to the patient's request, it is like
agreeing to a criminal requesting him not to give evidence regarding his crime to the police. Doctor's
MLC with relevant history from the patient is a piece of evidence that a crime u/s 309 PPC has been
committed. If the doctor does not inform the police, and does not hand over the MLC to the police,
he may be sued u/s 201 PPC (causing disappearance of evidence of an offence). However, consent
for examination would still be required because the patient is not arrested at that point in time.
Thus a possibility exists, when a person reports to a doctor after, say, failing in an attempt to commit
suicide → insists that he does not want an MLC → the doctor however proceeds to inform the police
Patient begins to leave → Doctor cannot legally stop him → Since in this situation, the doctor has not
treated him, nor has he collected any evidence from this person, he is now a member of general
public and must act in accordance with s39CrPC, and may not inform the police. If, however, the
patient stays on and the doctor collects evidence from this person (gastric lavage etc.), it becomes his
duty to pass on this evidence to the police (s201 PPC).

Delay-If delay has occurred initially in labeling a case as MLC, it can be so labeled at any later
date and time - even after the patient has been admitted in the ward (but not after death of
patient; For guidelines for making MLCs in wards, please see below.
1. Private practitioners (PPs) - can make MLC. The practice by Private Practitioners of sending
patients to Government hospitals for getting registered as MLC cases is wrong. If the patient
is serious, and dies on the way to Government hospital, the Private Practitioner can be sued
u/s304A PPC.
2. Treatment in serious cases must take precedence over completion of the injury report. Injury
report can be completed after patient has stabilized.
3. Referral to a second hospital - If a case has been labeled as medicolegal, and has been referred
to another hospital, it is in second doctor’s interest to make a fresh MLC (second MLC), so as
to record meticulously his own findings. It is because when he is summoned in the court, he
has to go by his own findings.
4. Dead on arrival (“brought dead” cases) - All cases which are pronounced dead on arrival at
hospital must be labeled as MLC and police be informed.

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 Case of a 70-year-old man who was brought dead to the hospital and sent to the mortuary with a
request merely to keep the body for 1 day, because his son had to arrive from the US. The family
also produced a death certificate made by a private practitioner (PP), who last saw the patient. The
certificate stated the cause of death (COD) as myocardial infarction (MI). The CMO wanted to know
if the police needed to be informed or not. It was advised that all cases "brought dead" must
be informed to the police, even if they had a death certificate. A postmortem was conducted,
and the cause of death was determined to be strangulation. The old man had changed his will, and
because of that, his son had strangled him. After strangling him, he called the PP and informed
him that his father had a sudden chest pain and had become motionless soon after. The PP without
examining the patient and in good faith made out a death certificate. Had the police not been
informed, this murder would have gone undetected. The son was charged u/s 302 PPC. The police
refrained from charging the PP for issuing a false certificate, although he was certainly guilty u/s
197 PPC.
5. Patient admitted as non-MLC; suspicion raised by relatives after death - such cases keeps
occurring in hospitals, especially when death is allegedly due to medical negligence. MLCs
are not made in such cases as a routine. Instead, the patient lodges a complaint with the
police. Police arrives in the hospital, seizes the body and if after inquest thinks that there is
a necessity of postmortem, sends the body to autopsy surgeon.
6. Medicolegal case after death - (i) Principle-Legally doctor-patient relationship starts when
the doctor agrees to treat a patient (Point A) and ends when the patient dies and a death
certificate has been issued (Point B). Legally, the patient is in doctor’s custody during the
period AB and in police custody during BC (Point C being the point when the body is buried).
From Point C onward (if the body is buried), the law is silent on the custody of the body.
What is an injury report?
An injury report (wound certificate, medicolegal certificate, medicolegal case [MLC]) is a
document prepared by the doctor in all medicolegal cases. Injury report is a kind of medicolegal
report.
Salient Features of Medicolegal Case
Consent for examination
(1) Patient arrested by the police –
i. If the patient has been arrested and brought by the police, no consent need be taken. The
doctor can proceed with examination u/s 53CrPC.
ii. The doctor must still first try to take consent upholding the principle of human rights. If the
consent is not given, examination must then be proceeded u/s 53CrPC.
iii. Essential components of examination u/s 53CrPC - (a) Person should be arrested. (b) Request
should be from a police officer not below the rank of sub-inspector or any person acting in
good faith in his aid and under his direction. (c) If person resists, reasonable force can be
used to restrain him. (d) If the arrested person is a female, her examination can be performed
only by or under the supervision of a female doctor (s53 (2) CrPC). (e) What must be
examined - “examination” shall include the examination of blood, blood stains, semen,
swabs in case of sexual offences, sputum and sweat, hair samples, and fingernail clippings
by the use of modern and scientific techniques including DNA profiling and such other tests
which the registered medical practitioner thinks necessary in a particular case (s53(2)[a]
CrPC).

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 (2) If the patient reported directly to the doctor, and the doctor suspecting some foul play
informed the police, he would still need patient’s consent for examination until and unless the
police official has arrested him.
Remember: For labeling a case as medicolegal, the doctor does not need patient’s consent (even
if he is a victim, and does not want a police case), but for examination he would still need his
consent, if the police official has not arrested him.
Case studies
(i) Examination of an arrested person u/s 53CrPC –
A case of a prisoner who escaped from Adyala jail. The Adyala police chased him and shot at him,
due to which his right leg received a bullet wound. He however managed to reach Gujjar Khan,
where he reported to a local private hospital with a history that he had received an accidental bullet
wound while cleaning his gun. However, the wound was on the posterior aspect of the leg, and also
it did not show any near discharge phenomenon. The author labeled the case as medicolegal and
informed the police. Before proceeding with an examination, the author explained the patient his
legal rights that he could refuse an examination. Quite predictably he refused to consent, so the
examination could not be carried out. When the police arrived, the author advised the police to
arrest him, and after his arrest proceeded with examination u/s 53 CrPC. The patient later
revealed the entire story, and he was handed over to the District police.
(ii) Consent of the victim is not necessary for informing the police.
In another case, a 54-year-old male (M) presented to the casualty with his 52-year-old wife (W).
The latter had 3 rd degree patchy burns over both her hands. The story was that there was some
fight between the two and the husband - in a fit of anger - burnt his wife. Both W (victim) and
M (perpetrator) did not want a police case. CMO reported the matter to the police. During
police investigation, it turned out that both of them had burnt their daughter-in-law (D) over a
dowry dispute and had secretly disposed of her body. In the process, W had sustained burns,
which needed medical attention immediately. A plan was hatched between M and W. It was
planned that W would present herself as victim and M as perpetrator, and both would request
they did not want a police case. Had the matter not been reported to police, it is doubtful if this
crime would have been uncovered with such convincing evidence (both hands burnt). The doctor
must always keep in mind that the so-called «victim» who is not wanting a police case, may be a
«perpetrator» posing as a «victim».
How to communicate with police
(1) Government doctors - All government hospitals and large nursing homes have a police official
posted there. Information is given to that police official, who passes it on to the respective police
station (of the area where crime was committed). (2) PPs - Must ring up the local police station,
or better still police control room (100) because all calls made to police control room are recorded.
The doctor should ask the police official on the phone the daily diary number (DD no), and
should record it in his injury report to save himself from harassment later. The date and time of
making a call, as also the name and number of the police official informed should be noted.

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Special situations
(1) If the death occurs during treatment, the police must be informed, and body handed over to
him. It should never be handed over to the relatives. (2) In case dead body has been brought for
initial examination, and the doctor finds some injuries, he must inform the police, and hand over
the body to him.
Making medico-legal cases in wards
(1) Forensic specialist would many times receive calls from wards to examine a suspected MLC case.
(2) All these cases are admitted cases because immediate medical attention was required.
However, on detailed history taking and closer examination, doctor suspects foul play and sends a
call to the forensic specialist. (3) These cases are different from cases which come straight to casualty
and are designated as MLC cases right from the beginning. (4) Differences (i) Involves labeling the
case as an MLC and informing the police from the ward.
(5) Some cases such as (i) Gunshot wound - (a) suspected to be self-inflicted to implicate an
adversary, (b) inflicted during police firing as the suspect escape from prison. Reported as
occurring during gun cleaning
(ii) Stab wound - suspected to be self-inflicted; reported as being caused by some adversary (iii)
Hanging
- (a) suspected attempted suicidal or homicidal hanging (iv) Starvation - suspected to be cases
of child neglect (v) Child abuse - suspected, while parents alleged fall from stairs etc.
Following Guidelines must be followed;
Guidelines for MCL Cases In Words;
Consent - (i) Intensive Care Unit (ICU) - If the patient is in ICU and there is no relative, do not
proceed with an examination. While treatment can be done without consent in emergency
(s92PPC), medicolegal examination cannot, certainly when treatment has already been started,
and medicolegal examination has no bearing on treatment. (ii) Minor - If the patient is minor,
insist on consent from parents only. If they are not present in hospital, doctor must insist that
they be called. Doctrine of loco parentis applies in emergency treatment only and not in
medicolegal examination; thus aunt, uncle, etc., present in the ward cannot give consent for
medicolegal examination. (iii) Witness - If consent is available, ask a ward sister to act as a
witness to the consent.
In daily routine it was experienced that, ward sisters are always reluctant to sign as witness as
they fear court appearance later. They can be politely explained that this is a medicolegal duty of
all medical and paramedical staff. If still she insists on not signing, a resident doctor from ward
may be asked to be a witness. They never have a problem in signing as witnesses, especially as
they get to learn the methodology of medicolegal examination.
Marks of Identification - Generally not necessary because the patient is already identified and
admitted. But it is preferable to note two identification marks.
Always write in duplicate with carbon paper - (i) There is generally no MLC register in wards
as one has in casualty. All history, observation, notes, etc., should be written on loose papers. (ii)
Make a request to sister-in-charge to give several papers with carbon papers. (iii) The papers
should not be blank A4 sheets, but official hospital papers with its names, etc., on the top. Blank A4
sheets can be challenged later in court as having been made outside.
Numbering of pages - (i) Ask sister-in-charge for case sheet. See if all pages in the case sheet are
numbered. If not, ask sister-in-charge to number all pages. (ii) The numbering should be at top
right and signed by sister-in-charge below the numbering. (iii) Forensic doctor’s observations
would start next to the last numbered page. If, for example, the case sheet has 36 pages, your own
notes should start from page 37 in duplicate. (iv) Original copy should be affixed to the case

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sheet. Carbon copy should be brought back to the department for filing. This will be useful for a
later appearance in court.
Sign all pages - to prevent anyone adding pages later.
Examination - Make a complete body examination, even if you have been specifically called only
for local examination.

A case study emphasizing importance of complete examination:

A forensic expert was once called to the ear, nose, and throat (ENT) ward to opine upon
whether a given ligature mark was causing by hanging or not. Patient was married since 1 year
and was accompanied by his wife, father-in-law, mother, and sisters. Tracheostomy had been
performed so he could communicate only through writing. His wife said that he had hanged
himself while the patient wrote saying that his mother-in-law had tried to forcibly hang him.
On examination, the ligature mark was discontinuous and oblique. There were neither any
injury marks on exposed portions of the body, nor did anyone (including the patient himself)
mention about any beating, nor had any doctor in the ENT ward mentioned about any other
injury, although the patient had been admitted for 2 days. The patient was fully clothed, was
unable to move about easily and there was a tracheostomy tube in-situ, which made unclothing
very difficult. It was very tempting in such a situation to be just satisfied with local examination
only. The forensic expert (DML) however insisted on patient taking off the clothes. On the
back and buttocks there were innumerable railroad bruises and scratches. On enquiring about
those injuries, the patient immediately started weeping inconsolably. It turned out that as he was
living with his wife in his in-law’s house, one day there was some fight between him on one side
and his wife and her relatives on the other, and he was severely thrashed. Taking all factors into
account, the DML opined that a possibility of attempted homicidal hanging could not be ruled
out. Without the examination of the back, the opinion would have been undoubtedly in favor of
suicidal hanging.
Diagrams - Labelled diagrams indicating location, size, and shape must be
made. Take photographs - For better recall during court hearings, etc.
Information to Police - This will almost always be required. Sister-in-charge usually has a ward
book/call book, etc., through which doctors are called to visit wards. On the same book, an entry
can be made for police. The ward boy can take it to the casualty outside which policeman is
normally posted. He signs the register and keeps a copy of doctor’s request.
Be polite - Many staff members grudge nitty-gritty’s of medicolegal examination and frequent
requests made by doctor for papers, scale, etc., Being polite can solve the matters a great deal.
Q&A
Q1: Can private practioner issue MLC?
Q2: What are 4 types of consent?
Q3: What is valid consent?
Q4: What are the legal requirements of informed consent?
Q5: What skills do you need to be an interrogation officer?

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 GENERAL INSTRUCTIONS FOR CONDUCTING
MEDICOLEGAL EXAMINATION
COMPONENTS OF MEDICO-LEGAL EXAMINATION:
The Medico Legal Examination includes Medico Legal Certificate for: injury/ Hurt,
intoxication, Determination of age, Sexual offences, postmortem Examination & Exhumation.
METHOD OF CONDUCTING MCL EXAMINATION:
The Medico Legal Examiners are all the Male & Female doctors of Govt. of the Provincial
Health Department working on Regular/ Contract basis in the casualty departments of Rural
health centers, Tehsil Headquarter hospitals, District Headquarter hospitals & Teaching
hospitals.
The Medico legal / Postmortem Register/ Medicolegal certificate / Postmortem report should be
given only on the prescribed Performa notified by the Government of the Punjab and be
maintained in the form of proper register, should be page marked, certified by the controlling
authority, proper binding using tough card board should be done & only one medico legal & one
post mortem register should be used by all the doctors of the same health facility. All the
doctors should have name stamp on their signatures and must draw the findings on pictorial
diagram also. All the columns should be filled in clearly and must be easily eligible to everyone.
These should not be filled hurriedly. No column should be left blank. If un- applicable, the
particular column should be crossed.
The Performa of Medico legal / Postmortem Examination should be completed in every case in
triplicate. The 1st copy is kept as record, 2nd copy is handed over to the investigation agency/
examinee & the 3rd copy is sent to the controlling authority / District Medico legal officer.
In emergency cases of medico legal nature, the medico examination can be done while the injured
person is being managed for life saving procedures. Moreover the doctors involved in
emergency treatment of injured person are required to maintain comprehensive record of injuries
and treatment given and provide it to the medico legal examiner after wards. (Injured person
medical aid act 2004). According to section 3 of the same act it is directed that the injured person
should be treated on priority basis without any delay, over other Medicolegal formalities.
Duty Roster should be strictly followed and any amendments must be made through the
controlling officer. However in case of emergency, any medical / paramedical staff can be called
any time for duty.
Suitable environment is a must for medico legal examination. This includes proper examination
room, sufficient lights, proper instruments required for examination, proper stationery for
documentation, privacy / confidentiality, availability of containers etc for collection and dispatch
of specimens. Medical Superintendent / In charge of the health facility is responsible for
providing all the facilities required to do the medico legal work properly.
The Medico legal examiner should carefully read the Court orders / Police request / Police papers
/ Case record etc& see if He / She is authorized to do the medico legal examination of the case.
(Certain cases can be done by standing medical boards only). Any discrepancies regarding
number / description of injuries in police papers should be pointed out.

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Written consent for medico legal examination should be taken from the examinee / guardian (in
case of children under 12 years of age and in insane Persons) in every case with signature/ thumb
impression.
No un-authorized person should be allowed to be present during examination including police
employees.
This does not include attendance of medical students for academic purposes.
Identity of every examinee should be recorded by writing the personal data, 2 permanent
identification marks, thumb impression and national Identity card no. (Keep a photo copy of
NIC if available).
Medico legal examination should be detailed, searching and thorough. All the positive as well as
important negative findings / observations should be recorded at the time of the injuries may
have to be kept under observation for certain period for investigation / specialist opinion /
treatment notes etc.
The injuries kept under observation should be declared within three weeks. It is the duty of the
initial medico legal examiner to collect the relevant reports required to declare the KUO
injuries within time framework notified by the Government i.e. within three weeks.
Brief history of the incidence should be recorded. Time of the incidence, nature of weapon
used and number of persons involved should be clearly mentioned.
General physical examination of the person should be performed and observations recorded e.g.
apparent age, physique, mental status, orientation, obvious deformities, pathology, vital signs i.e.,
pulse rate, blood pressure, respiratory rate, temperature, level of consciousness, light reflex etc.
Examination of clothes including cap and shoes etc should be done in each and every case in
detail and minutely. Use hand lens if required. Any tears, cuts, holes, burns, or stains should be
noted and evaluated for comparison with the underlying injuries. After the examinations, clothes
should be marked, signed and handed over to the police as case property under proper receipt.
Injury statement given by the police should be read carefully and if any extra injury found on the
body, not mentioned in the police docket must be written with a note that this injury is not
mentioned in the receipt.
Opinion of relevant Specialists / experts like Radiologist ENT specialist, EYE specialist,
Surgeon, Gynecologist, Orthopedic Surgeon, Dental Surgeon etc should be obtained by the
Medico legal examiner whenever necessary and the results / opinion of the experts should be
incorporated while finalizing the Medicolegal report. Photocopies of the reports should be
retained; the original report should be forwarded to the investigation officer of the concerned
police station.
Opinion should be given in simple language, clearly stating the legal nature of the offence, the
duration, causative agent and the manner of causation. Opinion regarding the fabrication should
be given there and then.
Chain of custody of all the articles, documents, samples, reports, registers etc. relating to the
Medico legal work should be maintained and should be kept in safe custody under lock and key.
The samples should be collected by the doctors, sealed properly and handed over to the police
under supervision of the doctor. The samples should not be given to the relative or the party.
The report submitted to any officer should be clear the photocopies provided should be of good
quality and attested. Copies of Medico legal reports can be issued as per rules to the concerned
persons only. In Police torture cases, where police are involved as a party, the medico legal

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 examination is to be conducted by the notified standing medical board of the district concerned.
All the record of medico legal and postmortem examinations should be preserved for a period of 12
years. In case of loss of record, F.I. R. should be lodged with the concerned police station.
A receipt should be issued to the examinee showing amount of fee received for medico legal
examinations. Such fee should be entered on the relevant receipt registers. State cases are
exempted from medico legal fees. The state cases include: Unknown/ Unattended / Unidentified
cases, Blast / Road transport accident cases, Prisoners / Police custody case, poisoning cases and
cases with more than 50% burns on the discretion of M.S. / in charge of the concerned health
facility.
There is no provision / terminology of External postmortem in Forensic medicine wherein the
term used in autopsy / postmortem which means thorough examination of the body after death.
This requires examination of dead body from head to toe and includes opening of all the three
body cavities i.e. skull, chest and abdomen. No autopsy is complete until all parts of the body
have been examined and dissected in detail. The external postmortem examination is an
incomplete procedure. Cause of death should not be given without full, internal examination of
the body (Instructions 2004 regarding medico legal and postmortem work 2004 - part-3 Para
No. 18).As per police rules 1981, section 25-36 (2) an investigating officer is empowered by law
with the direction to dispense with a surgical examination of the body. (a) If he is fully satisfied
that the cause of death is established beyond doubt. (b) If he thinks that necessary samples have
to be collected. (c) If he did not find any suspicious foul play and find it necessary to send it
for autopsy. (d) If he needs expert opinion to know the circumstances and cause of death.

Q&A

Q1: What are the general instructions for conducting a medicolegal examination; enlist them?

Q2: What is checked during a physical examination?

Q3: What are the steps of a physical examination?

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 SPECIFIC INSTRUCTIONS FOR VARIOUS
MEDICOLEGAL EXAMINATIONS IN THE
LIVING CASES:
PHYSICAL ASSAULT / TRAUMA:
Brief history, General physical examination and Examination of clothes should be written as mentioned
in part 1.
All the injuries should be recorded and numbered. Its site, size, shape, condition of margins, discoloration
around and in the wound, presence of bleeding, characteristics of tissues inside the wound, condition of
hairs and hair follicles, restriction in movements etc should be observed minutely in good light using all
the tools required and mentioned in detail in the report.
The duration of injury should be carefully calculated keeping in view the color changes in superficial /
deep bruises and natural process of healing / repair. Consideration must be given in cases of infected
wounds, treatment given before medico legal examination and nutritional status of the injured.
Pre-Existing conditions like congenital or acquired deformities, skin lesions, or pathology should be
mentioned apart from the injuries.
If nature of injury is not clear and requires further investigations / expert opinion of specialist / re-
examination of the injured person, then the injury may be kept under observation for some time to obtain
such reports. The Medicolegal report should be finalized as early as possible according to the
Government notification No. SO (H&D) 5-5/2002, dated 28-10-2004 & no case should be left pending
without valid reason for more than 21 days. Any investigations advised / expert opinion requested should
be clearly mentioned in the report.
The medico legal certificate should be issued by the first examining doctor who has seen and treated the injured
in the first place and must not declare any KUO injuries which has been interfered with surgically
unless treatment notes are received from concerned hospital.
Description of Injuries:
Nature of injuries should be given in accordance with Qasas and Diyat act stating the names of the
injuries as described in the act e.g. Shajjah, Jurh, Jaifa etc.
Opinion regarding facial and Dental injuries should be given preferably after consultation with Dental
Surgeon.
Manner of causation of injuries should be given as homicidal, accidental and self-inflicted or manipulated.
Cartilage of ear is not a bone and its injury / exposure comes under section “ShajjahKhafifa.
Broken teeth come under disfigurement. It is “Itlaf-I-SalahiyyatUzw” for the equivalent no. of tooth
broken. If there is fracture of more than twenty teeth, it is Attaf-Uzw.

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If any injury is such that the periosteum becomes visible, it should be declared as “Bone Exposed” injury.
A wound treated through any surgical intervention e.g stitching, shall be declared only on receipt of
operation notes / hospital record. “Complain of Pain” is not an injury. It should be written under the
caption of “History”. However in suspicious cases, investigation should be carried out to find the
cause of pain. Hair line Fracture / Chip Fracture are considered as fracture under Qisas and Diyat
Act.

Q &A
Q1: How will you examine a case of physical assault?

Q2: What is Qisas and Diyat Act?

Q3: Draw a table and Classify Hurt Injuries according to Qisas and Diyat Act?

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 Practical No.1
(a) Examination of FEMALE VICTIM OF SEXUAL ASSAULT:

Examination of female victim should be undertaken only on the request of police or judicial order, after
the permission from the court.
Examination is to be conducted by female medical officer.
Expressed Consent of victim / Guardian should be taken by the medical Examiner.
History of incidence should always be written with date and time of incidence.
Past history pertaining to marital status, number of issues, date of last menstrual period, change of clothes,
bath taken etc. should be written.
Detailed examination of the clothes worn at the time of incidence should be included in the report
mentioning all relevant tears / stains.
General physical examination should be detailed. Particular emphasis should be on apparent age, mental
status, physique, sexual development, any disease, deformity or injuries on the body.
Local examination should be detailed including inspection, bilateral traction, digital and speculum
examination.
All positive as well as negative findings should be noted down in observation, any injury recent or old,
signs of inflammation, discharge or stains on Mons Pubis, Labia majora, Labia minora, hymen and vagina
should be noted.
Digital examination should be performed to assess the capacity, size, tone and characteristics of vaginal
canal.
Speculum examination should be performed to visualize the findings and also to take swabs.
Specimens should be taken form appropriate sites for confirmation of allegation. Swabs are made from
pre hymeneal area, posterior fornix of vagina or cervix. These swabs should be dried, sealed and sent to
Forensic Science Agency for determination of semen and blood.
Clothes worn at the time of incidence if showing any stains should be sent to Forensic Science Agency
preserved by drying and sent in a sealed cover. Similarly, loose foreign hair or blood / tissue under the
nails of the victim may be collected and sent for examination.
The report submitted to the court / police should be brief, concise stating about recent or old loss of
virginity as well as occurrence of recent sexual intercourse per vaginum.

Q&A

Q1: What are the steps of examination of rape victim?

Q2: Discuss medicolegal certification of a female victim of Zina-Bil-Jabar with special reference to
legal obligations of the doctor dealing with such a case?

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 Case No 1
A 16 years old female was brought for medico-legal examination by the police. Her cloths were torn
and ragged. A duty medico-legal officer after scrutiny of the Police document and fulfilling all the legal
formalities started examination. On examination he found that she had multiple bruises on face, bleeding
from lips, bite mark on Right breast, multiple abrasions on the back near shoulder girdle. She had received
multiple injuries (abrasions, lacerations, tear and bruises) on thigh around perineum region. DML also
found vaginal tear and fresh bleeding. He also performed per vaginal examination and collected samples.
1. What is the case?
2. Discuss who should perform the examination?
3. Write a medico-legal report?
4. What is opinion of an expert?
5. Who many samples will you take from perineum?
6. What is paps smear?
7. Who will you preserver the sample?
8. Who will you label the samples?
9. To whom will you send the samples?
10. How will you collect samples from the clothes?
11. How will you mark the clothes?
EXAMINATION OF SEMEN
It is the most extensively studied material. Semen coagulates immediately after ejaculation and then liquefy
in next 15 minutes.
Both these processes are dependant upon different enzymes in semen.
The medico-legal importance of study of semen is in cases of SEXUAL ASSAULTS
Sexual assaults
a) ZINA
b) ZINA-BIL-JABAR
c) SODOMY
d) OTHER SEXUAL PERVERSIONS
Sources of Collection
1. External
. On the Body
. On the Clothing
. At the Scene of Crime

2. Internal
Pre-Hymenal areas
Post-Hymenal Areas

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 Collection
1. The portion of fabric having the stain is cut, dried in shade to prevent putrefaction and
preserved.
2. If pubic hair are matted together, a portion of hair is cut and preserved.
3. Dried or drying seminal stains on the body like, medial aspects of thighs; are collected on soaked
cotton swab in saline and then dried.
4. Dry stains on smooth surface is scrapped with a blunt scalpel into a glass container.

Swab collection
From the Genital Area, total 5 swabs are collected,
a) Pre-Hymenal Area,
3 swabs are taken
b) Post-Hymenal Area, 2 swabs are taken
Guidelines for Collection of Swabs
Swabs must be taken before the digital examination and before the urine sample. Check for the
AUTHORITY
Take the CONSENT
UNDRESS the patient
Place the patient in LITHOTOMY position.
First take Pre-Hymenal Swabs
Which are 3 in number?
(a) One is taken from medial sides of thighs.
(b) Second from the area around vulva.
(c) Third from pre hymenal area in the introitus.
Then take post hymenal swabs, which are two in number.
Vaginal Swabs
PRECAUTIONS
If the hymen is intact, do not attempt digital examination; Do not attempt the use of vaginal speculum,
so if hymen is intact no swabs are taken.
When the patient is in lithotomy position, gently separate labia and introduce vaginal speculum.
After that cotton swabs are passed through the opening in the speculum, and collect two swabs from high
up.
Preparation of Slide
From one vaginal swab which we have collected, slides are prepared as follows;
Swab is rubbed in the middle 1/3 of the slide, two slides are prepared, slides are dried in air,
then they are placed facing each other with placing match sticks in between them, so that they should not
rub with each other.

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Pippette Specimen
The specimen of semen can also be collected from vagina with the help of pippette, About 20 ml of
normal saline is injected into vagina,
After some time the specimen is collected with the help of special pippette, which has a bulb in between
to avoid suction into mouth, then this specimen is transferred to test tube, for further processing.

Q&A

Q1: How do you collect sample of saliva from a scene of crime?

Q2: How many samples will you collect from a victim of rape? Enlist & Disscuss?

Q3: How do you swab (Saliva, Semen) in case of Zina-Bil-Jabar?

Q4: Who will give consent for minor?

Q5: What Medical Officer will do if patient/victim is not willing for examination?

Q6: Can you conduct examination of rape victim on the request of police?

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 Practical No.1

(b) Examination of MALE VICTIM OF SEXUAL ASSAULT:

This examination is to be conducted by Male medical officer.

Examination can be taken only on request of police or judicial orders, after permission from the
court. Expressed consent should always be taken by the medical examiner.
Identity of the person to be examined should be recorded in detail. Detailed history of the incidence
should always be recorded.
Past history of forced or consenting sexual intercourse should be recorded.
Examination of the clothes worn at the time of incidence for suspected stains of semen or blood
should be incorporated in the report.
General examination and personality traits should be recorded including apparent age, physical and
sexual development, mental status and any injuries present on the body.
Local examination should be in knee-elbow position noting any local deformity or pathology.
Note any injuries, bruises, lacerations, stains, inflammation present around the anus.
Bimanual lateral traction should be performed to check the sphincteric reflex. In habitual passive
agents (Catamite) relaxation of sphincter and dilatation of anal opening occurs instead of
contraction.
Digital examination is performed to assess the size / capacity of the anal canal. Presence / absence
of signs of venereal disease should be noted.
Appropriate specimens should be taken to be sent for further examination i.e. anal swabs and clothes
worn at the time of incidence for detection of semen and blood to the Forensic Science Agency .
Case Study
A 12 years old boy was brought in medico-legal clinic for examination by parents. On history taking it
was found that the boy was abused by an adult.
1. How will you pursue the case?
2. Write steps of examination?
3. Enlist findings?
4. What is catamite and passive?
5. What is sodomy?
6. CRPC Sections for sodomy and rape?
7. Who will give you permission to examine case of abuse in police custody?

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EXAMINATION OF ALLEGED / SUSPECT ASSAILANT OF SEXUAL ASSAULT FOR
POTENCY:
Before commencing the examination, insist on a court order / police docket.
Expressed written consent is a must in such medico legal examinations.
Examination of the male assailant for sexual potency should be conducted by the male Medical
officers. Identity of the examinee should be confirmed.
Age of alleged suspect / assailant should be assessed in every case as a child below the age of puberty
anda very old person may be sexually impotent.
History if furnished by the examinee should be incorporated in the report.
Detailed physical examination should be conducted in every case, noting mental status, addiction
/ intoxication, manner of clothing; old/ recent bodily injuries particularly scratch marks on face,
neck and hands.
Presence of physical deformity, mental defect or systemic diseases e.g. Diabetes, Hypertension etc, as
well as the treatment taken for them should be written.
Clothes examination should be complete mentioning any stains of blood or semen. Physical
development and presence or absence of sexual characteristics should be noted.
Local examination should be detailed noting size, deformity / disease of penis, scrotum, testis,
evidence of any venereal disease, presence of any local pathology e.g. tumor, hernia etc.
Cremesteric reflex should be checked in every case bilaterally and the results noted.
Assistance of other specialist e.g. Urologist, Psychologist, Physician, Surgeon or Ultra serologist
should be taken in appropriate cases.
In normal person report / opinion should be given in an indirect way i.e. “on the basis of clinical
examination there is nothing to suggest that the examinee is physically incapable of performing
sexual act.”

Q&A
Q1: Write points of examination?
Q2: What is a cause of impotency?
Q3: Marriage is illegal or can be dissolute if after sometime, wife revealed that husband is a victim
of sexual assault?
Q4: What are homosexuality test?
Q5: Is there any recommended test to check homosexuality?
Q6: What does it mean to be pansexual?
Q7: What is the xq28 gene?

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 Practical No.2
MEDICOLEGAL EXAMINATION OF SEXUAL OFFENDER
• Law differentiates between legal and illegal sexual inter course.
• Zina both male and female accused equally.
• Zina-bill- Jabar either victim or assailant.
• A female maybe violated at vaginal and anal orifices, even in the mouth.
• The medical examination should not be limited to one region and will depend upon the
allegation.
• Medico legal investigation: Joint responsibility of law enforcement and medical authorities.
• Victims / assailant are the only witnesses; statements should be listened to carefully.
i. Allegation can be false
ii. Consent maybe devised after giving it because of fear
iii. Or after pregnancy
• NO age is immune for the victims.
• Even if consented, injuries may be present on other parts of body and genital region in virgin
females.
• A woman used to intercourse, injuries may not be present in genital region. Presence of
semen is important. In case of change of clothes or washing of genitals, sample will be
negative.
• Attitude and behavior of the victim is important.
• Evaluation of mental status as trauma is more psychological than physical trauma.
Examination of sex organ in:
Male: Inspection, Palpation
Female: Inspection, Palpation, speculum examination
Steps of Examination
1. Authorization : Police / Judge/ Magistrate
2. Fully informed written consent
3. Presence of third party.
4. Preliminary data
5. History (general+ obstetric ) :
• Drugs in last 24 hours, previous sexual experience+ marital status+ menstrual status+
cycle+ dates+ child birth with dates
• Inquire regarding change of clothes+ washing of genitals + bath

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6. Statement of victim + accompanying person :

• Time, Place and who removed clothes

• Pain during / after the act, any violence
• Penile penetration partial or full ejaculation outside or inside
• Zina –bil-Jabar: victim scarred, depressed, withdrawn, may refuse to narrate, help and
encouragement + support
7. Examination of Clothes:
• Make examinee stand on plain white cloth.
• Undressing by examinee.
• Collect all data, inspect for damage, derangement, staining.
• Type+ extent of damage+ mark stains with permanent marker.
8. General examination of the body:
• Height, weight, built, vital signs
• Skin of the whole body inspected while still on white sheet.
• Locate injury, stains, loose hair, and other trace evidence.
• Bruises, abrasions (Nail scratches on face, genitals), bite marks, stains (Semen blood saliva),
loose hair (entangled in intact pubic hair, loose head hair)
9. Systemic Examination:
• Rule out presence of any physical inability.
10. Genital Examination:
Vaginal Examination:
Requirements:
Dichotomy position / table, gloves, pedestal lamp, surgical gloves, glass rods.
Steps
Inspection: Labia minora, majora, mons pubis (redness, swelling, lesion, bleeding, discharge,
hair, soil / matted)
Bilateral Traction: Of labia makes hymen visible. Look for any sign of inflammation,
discharge, lesions, bleeding. Use Glaister Keen rod (a glass / plastic rod having a globe on one
end, used for close examination of hymen or degree of its rupture) if available.

Speculum Examination: To visualize findings more clearly and to collect swabs.

Digital Examination: to assess size, tone, laxity of vaginal canal with the help of one or more
fingers.

(In a Virgin, digital + instrumental examination must not be performed)

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 Q&A

Q-1 What are the steps of examination?

Q-2 How will you preserve samples?
Q-3 How many samples are to be collected and from where?

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 Practical No.3
Examination of ALLGEGED PREGNANCY / CRIMINAL ABORTION:
Medicolegal examination of females for confirmation of fact of pregnancy/ alleged cases of
criminal abortions should be conducted by female medical examiner.
Prior to conduction of such examination, Court orders should be procured. In cases reported to
police, all police papers should be read carefully.
Expressed, written consent of the subject is a must. If she is unable to give consent, consent of
guardian should be taken.
Identification of the subject should be recorded by noting down bio-data, identification marks and
thumb impression, CNIC no.
Clinically signs of pregnancy are seen as enlargement, secondary areola formation and
Montgomery tubercles in the breasts, abdominal enlargement, pigmentation of various parts of the
body and softening of cervix and ballottement of Uterus on vaginal examination.
Confirmation of pregnancy should be done on report of the expert by ultra sound/ Radiological
examination and by positive chemical test i.e. Pregnancy test on Urine.
Signs of delivery are seen as injury to the vagina, perineal damage, there may be scar of episiotomy.
Vaginal discharge (lochia) is seen; first it is blood stained, then it becomes brownish after a week or
so. Milk may be expressed from the nipple after second / third day after delivery.
On the abdomen, uterus may be palpable up to two weeks after delivery.
On the abdominal wall, stretch marks (striae gravidarum) persist as white scars.
Cervical tears heal up by scar formation which can be visualized on speculum examination.
The shape, size and capacity of the vagina is increased, hymen may be present only as small
remnants.
These changes depend upon the stage to which the pregnancy has advanced and also on the time
elapsed between delivery and medico legal examination.

Q&A
Q1: Write points of identification and examination?
Q2: What are the signs of criminal abortion?
Q-3 What are the risks of abortion?
Q4: Is miscarriage an abortion?
Q5: What is done during abortion?
Q-6 What are the Laws for abortion?

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 Practical No.4
INSTRUCTIONS FOR DENTAL STUGEONS WHILE CONDUCTING MEDICOLEGAL
EXAMINATION
Dental Examination for determining the age, number of teeth and injury
Documents
A proper referral by the CMO along with the photocopy of MLC /original.
Police docket
(Documents with victim along with policeman will be present to the Dental surgeon concerned. The
Dental surgeon should always proceed with examination after the conformation of documents). Police
man will present documents and the victim to the Dental surgeon.
Brief history
History of the incident mentioning, time, date, place General physical examination, cloth examination of
cloth should be written briefly.
Duration of Injury
Should be carefully calculated keeping in view of the color changes in superficial and deep bruises and
natural process of healing.
Pre-Existing condition
Anomalies, deformity and pathology, must be mentioned apart from the injuries.
Nature of injuries
Brief description of injuries should be mentioned in accordance to dental Traumatology.
Manner of injuries
Should be given accordance with the level of force required to inflict the injury in the specific
manner.
Bite mark
In case of bite mark, it should be recorded as early as possible. Take a photograph and alginate impression
of the bite mark and cast sent to PFSA for identification with suspected perpetrator.
X-Ray
The X- Ray reporting should be concise and specific regarding the case concerned. Proper mentioning of
the type of x-ray, serial No. and description is desired.
Medicolegal Dental opinion Form
The Medicolegal dental opinion form must be filled with the accordance to the information required. The
pictorial description of the teeth in the oral cavity must be marked accordingly.

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Note:
Dental surgeon must affix by name stamp and signature after the completion of dental examination on the
medicolegal dental opinion form.
Q&A

Q-1 Paste a dental Xray and name the teeth according to FDA?

Q-2 What is translucency and attrition of teeth? Draw a diagram?

Q-3 At what age does the 3rd molar appear?

Q-4 How can you determine age from teeth?

Q-5 At what age wisdom tooth appears?

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 Practical No.5
Estimation of Age from Radiological Examination
Estimation of age from X-Rays
Points of identification
1. Appearance of Ossification centers
2. Fusion of epiphyses
5 Months IUL
• Appearance of ossification center for calcaneum
7 Months IUL
• Appearance of ossification center for Talus
• MLI=Period of Viability (A fetus can survive independently)
a) On chest x-ray, if air in lungs infanticide
b) On chest x-ray, if no air in lungs still birth
Months IUL
• Lower end of femur
• Upper end of tibia appear just after live birth
• Air in Lungs
(IUL = Intrauterine Life , MLI = Medicolegal Injury )
WRIST JOINT
Number of Carpel Bones Determines Age In Years up to 6 years
ELBOW JOINT
• Ossification centres about the elbow
• There are 6 ossification centers around the elbow joint.
• These ossification centers and their fusion all occur at different ages
• It is clinically important to realize that the ossification centers always appear in a specific
sequence.
• The mnemonic of the order of appearance of the individual ossification centers
C-R-I-T-O-E stands for
C – Capitellum – 1year
R - Radial head – 3years
I - Internal (medial) epicondyle – 5years
T – Trochlea – 7years
Olecranon – 9years
External (lateral) epicondyle – 11years

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 • The ages at which these ossification centers appear are highly variable, but as a general
guide, remember 1-3-5-7-9-11 years
• All bones in elbow region unite at 16 years of age
SHOULDER JOINT
Head of humerus fuses with the shaft
• Female 18-20 years
• Male 20 -22 years
Clavicle Bone
• Clavicle’s lateral end calcified
• Medical end calcify as follows:
• Female 22-24 years
• Male 23-25 years
Manubrium Sternii
• Fuses with the body of sternum at 60 years

Xiphoid Sternum
• fuses at 40 years

Lower end of tibia fibula

• Fusion of distal end of tibia fibula 18-20 years

Q&A

Q1: How will you determine age of 4 year child from wrist X-ray?
Q2: At what age does the growth of long bones stop?
Q3: How will you determine age of 15 years old male by examining X-ray elbow?

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 Shoulder Joint

Knee Joint

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 Elbow Joint Tarsal Bones

Sternum

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 WRIST JOINT

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 Medicolegal Report

How to write a medico-legal report?

For many doctors the receipt of a request for a medico-legal report or statement is an unwelcome
intrusion into their practice of medicine; some may dread the prospect of also potentially having to
attend court to give evidence. Our aim is to provide guidance on:
• Writing a good medico-legal report
• Dealing with a subpoena to give evidence
• Giving evidence in court.
1. Always use the medical records to prepare your report. Do not rely solely on your memory or
the instructions from the requesting party.
2. The report should be: • factual • relevant to the request • understandable to the audience – a
medico- legal report is not a communication with a colleague. If necessary, provide definitions and
explanations of medical abbreviations or terminology, e.g. “the patient had tachycardia (rapid
heart rate)”, ”PR (rectal examination)”. Do not use legal terminology such as “grievous bodily
harm”. The provision of a clear explanation and avoidance of medical jargon may prevent an
unnecessary trip to court to give evidence.
3. Indicate the name of the requesting party (e.g. police officer), the date of the request and the
purpose of the report.
4. At the beginning of the report, outline your credentials, including your qualifications and
position at the time of the events/incident, e.g. “I obtained my medical degree, MBBS, in
2014. At the time I saw Mr ABC in the Emergency Department on 15 January 2016, I was a
second year resident medical officer”.
5. The body of the report should be organized and, if the report is long, headings should be used.
There are many ways of formatting a medicolegal report. A suggested format for a report is as
follows:
a) Patient’s name and date of birth
b) Requesting party and date of request
c) Your credentials
d) Facts in chronological order, including: - history and symptoms, e.g. “When asked what
happened, Ms Smith stated that…” - examination findings - investigations - provisional
diagnosis - treatment/ management
e) Opinion (if any)
f) Response to specific questions (if any)
g) Your signature and date the report was written/signed by you (see case history 2).

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 How should I prepare for court?
1. Before attending court, there is no substitute for good preparation before going to court. You
should review your medico-legal report and the relevant medical records. Normally, you will
be attending court as a factual witness, that is, you will be asked to give evidence about when and
where the patient was examined, your findings and any treatment given. The line between a
factual and expert medical witness can occasionally become blurred. The major pitfall to avoid
is giving an opinion beyond or outside your expertise, e.g. a DIT providing evidence about the
long term care requirements of a patient with a severe brain injury. 2. On the day know where
the court is located and how long it will take to get there. Bring to the court a copy of your
medico-legal report and the relevant medical records (if available). Dress in a formal and
conservative manner.
2. What will happen when I give evidence? Normally you will not be allowed into the court before
giving evidence. Identify the correct courtroom and wait outside at the time you have been
asked to attend. When it is your turn to give evidence, a court officer will show you into the
court and take you to the witness box. Remain standing when you first enter the witness box.
The court officer will ask you to either swear an oath or affirm to the court that the evidence you
give will be truthful. If swearing an oath, the court officer will ask you to hold a religious book
(Holy Quran, Bible) and repeat the oath. If you have no religious beliefs, you may choose to
“affirm”, that is, take the oath without associated religious words or actions. You will then be
asked to take a seat in the witness box
3. Examination-in-chief The barrister acting for the party who called you to give evidence will ask
you a series of questions to take you through the information contained in your report and/or
the medical records. Before doing this, the barrister will usually ask you to provide your
name, qualifications, position and experience. The purpose of examination-in-chief is for you
to provide your evidence to the judge and/or jury. On occasions, the judge may also ask you
some questions to clarify certain issues. Cross-examination and re-examination When the
examination-in-chief has concluded, the barrister acting for the other party will then question
you. It is generally not like the aggressive cross- examination you have seen on TV! In some
situations, there may be no cross examination and the barrister will indicate that they have no
questions to put to you. Otherwise, the barrister will ask you questions to probe particular
issues in your report and evidence.
4. Your role is to inform the court and you should remember that you are not there to represent one
side or the other. In particular, it is not your role to “defend your side”. You should try not to
anticipate the question or its purpose, but simply consider each question on its own and answer
only what is asked of you, in as few words as possible. When the cross-examination has

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 concluded, the first barrister has the opportunity to re-examine and clarify any issues raised
during the cross examination. No new matter can be raised at this time, only further questions
about those issues already examined. It is then usual for the party that has called you to ask the
judge to excuse you from court and you are then free to leave.
5. Tips on giving evidence
1. Remember you are impartial. Your role is to inform the court and to help the judge and/or
jury to better understand the evidence before it, not to assist one side or the other.
2. Listen carefully to each question. Pause and decide if you are able to answer the question.
3. Look at the person who is asking the question but provide your answer to the judge or jury. You
may need to turn your head or swivel in your chair in order to do this.
4. Answer succinctly and only what is asked of you. Do not over elaborate. If the question is not
clear, ask for an explanation. If you are unable to answer the question, say so. Do not try and guess
an answer to a question. For example, you should feel comfortable saying “I cannot remember
what the patient said” or “I am sorry, I have had no experience in that area of medical practice and
so any answer would be speculation on my part”. It is also appropriate to indicate that while you
may not have known the answer to a specific question in the past, you have subsequently
become aware of the answer.

5. If the question is ambiguous ask the barrister to rephrase the question.

6. In cross-examination, answer with a ”yes” or ”no” providing such a reply would not be
misleading. However, do not get lulled into saying ”yes” or ”no” when that is not an
accurate answer. You are entitled to be assertive and firm about any propositions with which
you do not agree.
7. If you hear the word ”objection” from either barrister, simply stop what you are saying, even
if it is mid-sentence. Wait until the matter is dealt with by the judge. If you are in doubt, ask
the judge to indicate to you when you can resume your response. If you have lost your train of
thought, ask for the question to be repeated by the barrister.
8. Remember you are not being prosecuted. Your role is to provide factual evidence, based on
your report and recollection (if any) of your involvement in the patient’s care.

Q&A
Q1: What are the key points for medico-legal report writing?
Q2: Who will you prepare for the court?
Q3: What is summon?
Q4: Who is Plaintiff?
Q5: Perform a role play?
Q6: Scenario for criminal mock trial (role play)

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 EXERCISE MEDICOLEGALCASES

MEDICOLEGAL CASE NO: 1

Scenario:
A fight erupted during a cricket match where a player sustained an injury on his right arm with bat.
How will you proceed to examine this case? Furnish medicolegal report in the instant case
Name: Gulab S/o: Ahmad Gul
Sex: Male Age: 20-25 Years
Date and hours of arrival: 28-9-2019 at 10:00 am Home & no of police constable: Gohar /
HC no: 511 Police Station : Hayatabad
Identification Marks:
A black mole on right side of face 2mm in diameter, 3cm below right eye.
A linear scar on front of left forearm 3× 0.5 cm in size lying 5cm above wrist joint.
Clinical condition:
A well built man of age 20-25 years well oriented in time and space having intact memory.
BP= 120/80 mmHg.
Condition of clothes:
Wearing white qameez shalwar and white vest. They are blood stained and are torn.
Description of injuries:
A lacerated wound situated on outer aspect of right arm, 5×3 cm in size lying 6 cm below top of
shoulder. It has irregular edges, margins are abraded and underlying muscle is lacerated. There is
bleeding from wound.
Investigation advised:
X ray right arm advised which shows no fracture or foreign body.
Re-examination notes: NO
Opinion:
Nature of injury: Jurh Ghayr JaifahMutalahimah
Type of Weapon: Blunt
Probable duration of injury: 2-3 Hours.
Name & Designation:
Signature:____________

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Medicolegal Case No 2

Name______________ Son of______________Age_______________

Sex M F Cast ________________, Occupation _________________
Residence of _______________________________________________
Name of the relatives 1. , Relation _________________
2. Relation____________
Date and Time of Arrival for examination_______/_____/202 FIR #__________________
________________________ Police Constable Name and PA #____________, Police Station
________________Date of admission / /202 Date of Discharge / /202

Particulars of the Injury / Symptoms of Poisoning

Case of
Clinical Condition: Oriented Y / N Comatose/ Drunken/ unconscious/
Irritable/ Glasgow Coma Scale Score /15, Vitals B.P / mmHg,
Pulse /min,

Temperature C/F
General Condition of Cloths _________________________________________________________________

(Torn , blood stained, semen stains, fecal urine stains, singed, dirty , bullet grease collar)
Description of Injury / Poisoning Symptoms
Injury 1
Injury 2

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Injury 3
(size (cm x cm), site, anatomical land mark, shape, edges, depth, old, fresh, healed, type of injury,
weapon
Investigation Required (X-Ray, lab test, )
Refer for Expert Opinion from
Department for examination of Teeth/ ear/ eye/ chest/ fracture
1
2
3
4
Nature of Injury according to Qisas
and Diyat 1
2
3
4
Kind of weapon / poison
1
2
Age of injury/ies (time since onset and examination)
1
2
3
Signature and Name of Duty Medico-legal
officer PMDC #
Report handed over back to Police Constable PA # Name
Checked By

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Medicolegal Case No 3

Name______________ Son of______________Age_______________

Sex M F Cast ________________, Occupation _________________
Residence of _______________________________________________
Name of the relatives 1. , Relation _________________
2. Relation____________
Date and Time of Arrival for examination_______/_____/202 FIR #__________________
________________________ Police Constable Name and PA # ____ , Police Station
________________Date of admission / /202 Date of Discharge / /202

Particulars of the Injury / Symptoms of Poisoning

Case of
Clinical Condition: Oriented Y / N Comatose/ Drunken/ unconscious/
Irritable/ Glasgow Coma Scale Score /15, Vitals B.P / mmHg,
Pulse /min,

Temperature C/F
General Condition of Cloths _________________________________________________________________

(Torn, blood stained, semen stains, fecal urine stains, singed, dirty, bullet grease collar)
Description of Injury / Poisoning Symptoms
Injury 1
Injury 2

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Injury 3
(size (cm x cm), site, anatomical land mark, shape, edges, depth, old, fresh, healed, type of injury,
weapon
Investigation Required (X-Ray, lab test, )
Refer for Expert Opinion from
Department for examination of Teeth/ ear/ eye/ chest/ fracture
1
2
3
4
Nature of Injury according to Qisas
and Diyat 1
2
3
4
Kind of weapon / poison
1
2
Age of injury/ies (time since onset and examination)
1
2
3
Signature and Name of Duty Medico-legal
officer PMDC #
Report handed over back to Police Constable PA # Name
Checked By

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Medicolegal Case No 5

Name______________ Son of______________Age_______________

Sex M F Cast ________________, Occupation _________________
Residence of _______________________________________________
Name of the relatives 1. , Relation _________________
2. Relation____________
Date and Time of Arrival for examination_______/_____/202 FIR #__________________
________________________ Police Constable Name and PA #_____________, Police Station
________________Date of admission / /202 Date of Discharge / /202

Particulars of the Injury / Symptoms of Poisoning

Case of
Clinical Condition: Oriented Y / N Comatose/ Drunken/ unconscious/
Irritable/ Glasgow Coma Scale Score /15, Vitals B.P / mmHg,
Pulse /min,

Temperature C/F
General Condition of Cloths _________________________________________________________________

(Torn, blood stained, semen stains, fecal urine stains, singed, dirty, bullet grease collar)
Description of Injury / Poisoning Symptoms
Injury 1
Injury 2

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Injury 3
(size (cm x cm), site, anatomical land mark, shape, edges, depth, old, fresh, healed, type of injury,
weapon
Investigation Required (X-Ray, lab test, )
Refer for Expert Opinion from
Department for examination of Teeth/ ear/ eye/ chest/ fracture
1
2
3
4
Nature of Injury according to Qisas
and Diyat 1
2
3
4
Kind of weapon / poison
1
2
Age of injury/ies (time since onset and examination)
1
2
3
Signature and Name of Duty Medico-legal
officer PMDC #
Report handed over back to Police Constable PA # Name _____________________
Checked By

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Medicolegal Case No 6

Name______________ Son of______________Age_______________

Sex M F Cast ________________, Occupation _________________
Residence of _______________________________________________
Name of the relatives 1. , Relation _________________
2. Relation____________
Date and Time of Arrival for examination_______/_____/202 FIR #__________________
________________________ Police Constable Name and PA #_____________, Police Station
________________Date of admission / /202 Date of Discharge / /202

Particulars of the Injury / Symptoms of Poisoning

Case of
Clinical Condition: Oriented Y / N Comatose/ Drunken/ unconscious/
Irritable/ Glasgow Coma Scale Score /15, Vitals B.P / mmHg,
Pulse /min,

Temperature C/F
General Condition of Cloths _________________________________________________________________

(Torn, blood stained, semen stains, fecal urine stains, singed, dirty, bullet grease collar)
Description of Injury / Poisoning Symptoms
Injury 1
Injury 2

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Injury 3
(size (cm x cm), site, anatomical land mark, shape, edges, depth, old, fresh, healed, type of injury,
weapon
Investigation Required (X-Ray, lab test, )
Refer for Expert Opinion from
Department for examination of Teeth/ ear/ eye/ chest/ fracture
1
2
3
4
Nature of Injury according to Qisas
and Diyat 1
2
3
4
Kind of weapon / poison
1
2
Age of injury/ies (time since onset and examination)
1
2
3
Signature and Name of Duty Medico-legal
officer PMDC #
Report handed over back to Police Constable PA # Name
Checked By

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Medicolegal Case No 7

Name______________ Son of______________Age_______________

Sex M F Cast ________________, Occupation _________________
Residence of _______________________________________________
Name of the relatives 1. , Relation _________________
2. Relation____________
Date and Time of Arrival for examination_______/_____/202 FIR #__________________
________________________ Police Constable Name and PA #_____________, Police Station
________________Date of admission / /202 Date of Discharge / /202

Particulars of the Injury / Symptoms of Poisoning

Case of
Clinical Condition: Oriented Y / N Comatose/ Drunken/ unconscious/
Irritable/ Glasgow Coma Scale Score /15, Vitals B.P / mmHg,
Pulse /min,

Temperature C/F
General Condition of Cloths _________________________________________________________________

(Torn, blood stained, semen stains, fecal urine stains, singed, dirty, bullet grease collar)
Description of Injury / Poisoning Symptoms
Injury 1
Injury 2

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Injury 3
(size (cm x cm), site, anatomical land mark, shape, edges, depth, old, fresh, healed, type of injury,
weapon
Investigation Required (X-Ray, lab test, )
Refer for Expert Opinion from
Department for examination of Teeth/ ear/ eye/ chest/ fracture
1
2
3
4
Nature of Injury according to Qisas
and Diyat 1
2
3
4
Kind of weapon / poison
1
2
Age of injury/ies (time since onset and examination)
1
2
3
Signature and Name of Duty Medico-legal
officer PMDC #
Report handed over back to Police Constable PA # Name
Checked By

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 Part 2 Medico-legal Autopsy

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 Medico-legal Autopsy
An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a
surgical procedure that consists of a thorough examination of a corpse by dissection to determine the
cause, mode and manner of death or to evaluate any disease or injury that may be present for
research or educational purposes. (The term “necropsy” is generally reserved for non-human
animals; see below). Autopsies are usually performed by a specialized medical doctor called a
pathologist. In most cases, a medical examiner or coroner can determine cause of death and only a
small portion of deaths require an autopsy.
Purposes
Autopsies are performed for either legal or medical purposes. Autopsies can be performed when
any of the following information is desired:
• Determine if death was natural or unnatural
• Injury source and extent on the corpse
• Manner of death must be determined
• Time since death
• Establish identity of deceased
• Retain relevant organs
• If infant, determine live birth and viability
For example, a forensic autopsy is carried out when the cause of death may be a criminal matter,
while a clinical or academic autopsy is performed to find the medical cause of death and is used
in cases of unknown or uncertain death, or for research purposes. Autopsies can be further
classified into cases where external examination suffices, and those where the body is dissected
and internal examination is conducted. Permission from next of kin may be required for internal
autopsy in some cases. Once an internal autopsy is complete the body is reconstituted by sewing it
back together.
Types
There are four main types of autopsies:
Medico-Legal Autopsy or Forensic or coroner’s autopsies seek to find the cause and manner of
death and to identify the decedent. They are generally performed, as prescribed by applicable law, in
cases of violent, suspicious or sudden deaths, deaths without medical assistance or during surgical
procedures.
Medical or Clinical or Pathological autopsies are performed to diagnose a particular disease or
for research purposes. They aim to determine, clarify, or confirm medical diagnoses that remained
unknown or unclear prior to the patient›s death.
Anatomical or academic autopsies are performed by students of anatomy for study purpose only.
Psychological autopsy it is third party interview to know the circumstances and psychological
status of the diseased.
Latest innovation: Virtual or medical imaging autopsies are performed utilizing imaging
technology only, primarily magnetic resonance imaging (MRI) and computed tomography (CT).

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External examination
At many institutions the person responsible for handling, cleaning, and moving the body is called a
diener. After the body is received, it is first photographed. The examiner then notes the kind of
clothes and their position on the body before they are removed. Next, any evidence such as residue,
flakes of paint or other material is collected from the external surfaces of the body. Ultraviolet light
may also be used to search body surfaces for any evidence not easily visible to the naked eye.
Samples of hair, nails and the like are taken, and the body may also be radiographically imaged. Once
the external evidence is collected, the body is removed from the bag, undressed, and any wounds
present are examined. The body is then cleaned, weighed, and measured in preparation for the
internal examination.
A general description of the body as regards ethnic group, sex, age, hair color and length, eye color
and other distinguishing features (birthmarks, old scar tissue, moles, tattoos, etc.) is then made. A
voice recorder or a standard examination form is normally used to record this information.
Internal examination
If not already in place, a plastic or rubber brick called a “head block” is placed under the
shoulders of the deceased, hyperflexing the neck making the spine arch backward while
stretching and pushing the chest upward to make it easier to incise. This gives the APT, or
pathologist, maximum exposure to the trunk. After this is done, the internal examination begins.
The internal examination consists of inspecting the internal organs of the body by dissection for
evidence of trauma or other indications of the cause of death. For the internal examination there are
a number of different approaches available:
• a large and deep Y-shaped incision can be made starting at the top of each shoulder and running
down the front of the chest, meeting at the lower point of the sternum (breastbone).
• a curved incision made from the tips of each shoulder, in a semi-circular line across the
chest/ decolletage, to approximately the level of the second rib, curving back up to the
opposite shoulder.
• a single vertical incision is made from the sternal notch at the base of the neck.
• a U-shaped incision is made at the tip of both shoulders, down along the side of the chest to
the bottom of the rib cage, following along it. This is typically used on women and during
chest-only autopsies.
There is no need for any incision to be made, which will be visible after completion of the
examination when the deceased is dressed in a shroud. In all of the above cases the incision then
extends all the way down to the pubic bone (making a deviation to either side of the navel) and
avoiding, where possible; transsecting any scars which may be present.
Bleeding from the cuts is minimal, or non-existent, because the pull of gravity is producing the only
blood pressure at this point, related directly to the complete lack of cardiac functionality. However,
in certain cases there is anecdotal evidence that bleeding can be quite profuse, especially in cases of
drowning.
At this point, shears are used to open the chest cavity. The prosector uses the tool to cut through the
ribs on the costal cartilage, to allow the sternum to be removed; this is done so that the heart and
lungs can be seen in situ and that the heart, in particular the pericardial sac is not damaged or
disturbed from opening. A PM 40 knife is used to remove the sternum from the soft tissue which
attaches it to the mediastinum.

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Now the lungs and the heart are exposed. The sternum is set aside and will be eventually
replaced at the end of the autopsy.
At this stage the organs are exposed. Usually, the organs are removed in a systematic fashion.
Making a decision as to what order the organs are to be removed will depend highly on the case in
question. Organs can be removed in several ways: The first is the en masse technique of Letulle
whereby all the organs are removed as one large mass. The second is the en bloc method of
Ghon. The most popular in the UK is a modified version of this method, which is divided into
four groups of organs. Although these are the two predominant evisceration techniques, in the
UK variations on these are widespread.
One method is described here: The pericardial sac is opened to view the heart. Blood for
chemical analysis may be removed from the inferior vena cava or the pulmonary veins. Before
removing the heart, the pulmonary artery is opened in order to search for a blood clot. The
heart can then be removed by cutting the inferior vena cava, the pulmonary veins, the aorta and
pulmonary artery, and the superior vena cava. This method leaves the aortic arch intact, which
will make things easier for the embalmer. The left lung is then easily accessible and can be
removed by cutting the bronchus, artery, and vein at the hilum. The right lung can then be
similarly removed. The abdominal organs can be removed one by one after first examining their
relationships and vessels.
Most pathologists, however, prefer the organs to be removed all in one “block”. Using dissection
of the fascia, blunt dissection; using the fingers or hands and traction; the organs are dissected
out in one piece for further inspection and sampling. During autopsies of infants, this method is
used almost all of the time. The various organs are examined, weighed and tissue samples in the
form of slices are taken. Even major blood vessels are cut open and inspected at this stage. Next
the stomach and intestinal contents are examined and weighed. This could be useful to find the
cause and time of death, due to the natural passage of food through the bowel during digestion.
The more area empty, the longer the deceased had gone without a meal before death.
The body block that was used earlier to elevate the chest cavity is now used to elevate the head. To
examine the brain, an incision is made from behind one ear, over the crown of the head, to a
point behind the other ear. When the autopsy is completed, the incision can be neatly sewn up and
is not noticed when the head is resting on a pillow in an open casket funeral. The scalp is pulled
away from the skull in two flaps with the front flap going over the face and the rear flap over the
back of the neck. The skull is then cut with a circular (or semicircular) bladed reciprocating saw
to create a «cap» that can be pulled off, exposing the brain. The brain is then observed in situ. Then
the brain›s connection to the cranial nerves and spinal cord are severed, and the brain is lifted out
of the skull for further examination. If the brain needs to be preserved before being inspected, it
is contained in a large container of formalin (15 percent solution of formaldehyde gas in
buffered water) for at least two, but preferably four weeks. This not only preserves the brain, but
also makes it firmer, allowing easier handling without corrupting the tissue.
Q&A

Q-1 Discuss medical-legal Autopsy incisions?

Q-2 How will you dissect intestines and stomach and collect samples?
Q-3 Why we use formaldehyde solution?
Q-4 How will you dissect neck region in case of hanging and strangulation?

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Reconstitution of the body
An important component of the autopsy is the reconstitution of the body such that it can be
viewed, if desired, by relatives of the deceased following the procedure. After the examination, the
body has an open and empty thoracic cavity with chest flaps open on both sides, the top of the skull is
missing, and the skull flaps are pulled over the face and neck. It is unusual to examine the face, arms,
hands or legs internally.
In the UK, following the Human Tissue Act 2004 all organs and tissue must be returned to the body
unless permission is given by the family to retain any tissue for further investigation. Normally the
internal body cavity is lined with cotton, wool, or a similar material, and the organs are then placed
into a plastic bag to prevent leakage and are returned to the body cavity. The chest flaps are then closed
and sewn back together and the skull cap is sewed back in place. Then the body may be wrapped in
a shroud, and it is common for relatives to not be able to tell the procedure has been done when
the body is viewed in a funeral parlor after embalming.
INSTRUCTIONS REGARDING POSTMORTEM EXAMINATION
1. All the doctors employed by Govt Health Department, working at any teaching hospital,
district headquarter hospital, tehsil headquarter hospital and some Rural health center are
authorized to conduct postmortem examination. Doctors working at Basic health units are not
authorized to conduct postmortem examination.
2. Postmortem examination should be conducted on the written request of Superintendent of
Police.
3. Date and time of arrival of the dead body at the hospital should be recorded.
4. Scrutiny of the papers, Police record, request form, FIR, Police docket, injury statement
should be read very carefully by the examining medical officer before commencing postmortem
examination.
The postmortem examination should not be delayed after receiving the complete police papers.
During postmortem examination, police officials accompanying the dead body are not allowed in
the mortuary.
5. The Performa of postmortem examination should be filled completely, starting from the
identification of the deceased.
In known dead bodies, name, father’s name, age, sex, address, caste etc. should be noted.
Name of two (2) identifiers should be noted by the medical examiner with their father’s name, address
and relationship with the deceased. These persons should identify the body in the presence of the
doctor. (3rd party identification)
If the body is unidentified, maximum information’s pertaining to identification should be noted, e.g.
age, sex, length, complexion, color of hair and eyes, tattoos, deformities etc should be recorded.
6. Chain of Custody: Names of the Police constables accompanying the dead body should be
recorded with their numbers.
Postmortem examination is conducted to determine the cause of death which may be due to ante
mortem trauma, diseases and poisoning.
Presence of decomposition / putrefaction cannot be accepted as a plea for not performing a
complete postmortem examination. External examination of the body should be detailed noting.

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IMPORTANT
1. Identification General characteristics of the dead body including face, hands, eyes, nostrils,
mouth and other body orifices.
2. Clothes and other personal effects present.
3. Postmortem changes, e.g. Hypostasis, Rigor mortis, Decomposition, mummification etc.
Hands should be examined for cadaveric spasm and anything grasped in them.
4. Injuries present on the body particularly any marks of ligatures etc.
Length, breadth and depth of injuries, presence of any foreign body in them. All the bones should
be examined for fractures.
Presently, the postmortem examination at night is permitted by the Government if sufficient
artificial light is present / available. For this purpose the number of tube lights should be equal to
distance in feet between the autopsy table and the source of light.
Internal examination should be thorough. All three cavities i.e. Head, chest and abdomen should be
opened and examined in every case.
The chest cavity and abdomen should be opened by chin to pubes incision. The scalp should be
opened by ear to ear incision.
External postmortem examination is an incomplete procedure. Cause of death should not be given
without full, internal examination of the body.
In suspected deaths due to asphyxia, dissection of the neck should be undertaken after examination of
the chest and skull cavities to avoid postmortem artifacts.
The organs of the body should first be examined in situ, noting any Pathology, injury, collection of
blood / fluid etc. Afterward each organ should be dissected separately.
In case of Fire arm injuries, Radiological examination of the body should be conducted (if
facilities are available) for record, and to facilitate the search for the bullet / Pallets, after external
examination.
Special precautions should be taken in cases where the history of the case suggests death due to
embolism (e.g. in criminal abortion or Pneumo thorax e.g. in blunt chest trauma).
To determine the cause of death as suspected poisoning, appropriate specimens should be sent to
PFSA, Lahore for detection of poison.
To determine cause of death from pathology, or to differentiate ante mortem trauma from
postmortem injuries appropriate specimens should be sent to Histopathologist to PFSA, Lahore.
Instructions for collection, preservation and dispatch of various specimens to respective
Laboratories are given under separate heading which should be followed.
Cause of death should be commented upon clearly, in simple language stating the underling mode
of death. Accidental, homicidal and self inflicted injuries should be commented.
If multiple injuries are present, it should be stated which of the injury / injuries has lead to the
death of the person individually or in combination.

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Time elapsed between injury and death should be assessed form site and gravity of trauma,
vital signs present in the injury etc.

Time between death and postmortem examination is to be calculated from postmortem changes
observed in the dead body.

After completion of postmortem examination, dead body along with signed police papers,
carbon copy of postmortem examination report and clothes of the deceased should be handed
over to accompanying police officials and receipt should be taken by the medical examiner on
the postmortem register.

Body after postmortem examination is to be handed over to the relatives by the Police officials.

In case where there is a material difference in the description of external wounds on a dead body as
stated by the Police in the injury statement and those observed by the Medical examiner or
where there are no marks of injury observed on the body where as marks have been described by
the Police, the matter should be reported to the District Police and District and Session Judge.

In cases of female dead bodies, the postmortem examination should be conducted by female
medical officer who should beside other examination must look for evidence of physical and
sexual assault, evidence of pregnancy or any interference with it.

In relevant cases, the female genital tract may be sent for Toxicology / Histo pathologist
examination if indicated.

In cases of new born / infants intra uterine age should be assessed. Signs of still or live birth
should be noted down.

Medical students / under training doctors should be allowed to see the postmortem examination
with the permission of the head of institution.

NOTE:

Postmortem examination must always be conducted with respect and most

dignity manner.

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 EXHUMATION
Exhumation means digging out a dead body from its grave and its postmortem examination for
various medicolegal reasons, e.g. identification, cause of death etc.
Exhumation is carried out on Judicial Orders under section 176- (2) Cr.P.C. Presence of
Magistrate is required during the procedure.
Exhumation may be a first or repeat examination.
Valuable information can be gained from postmortem examination of the dead body in exhumations
even a long time after burial.
Before starting the procedure, paper scrutiny by medical examiner / medical board should be done
minutely and in detail.
The grave should be identified by the relatives/ undertakers in the presence of Magistrate,
Medical examiner (or medical board) and the complainant.
Traditionally exhumations are planned at early morning.
Police contingent should be present to guard the grave and the area around it to minimize public
interference. During disinterment and medical examination, the grave and the area around it
should be covered with shamiana and qanat.
After digging the earth and removal of body from the grave by the orders of Magistrate (Date and
time of both should be recorded), the body is handed over to the medical examiner (or Medical
Board) for postmortem examination. Medical examination starts from that point onwards.
Body may be removed to proper mortuary for examination or a make shift mortuary may be
established in the grave yard. Usually the second opinion is followed.
The postmortem examination is performed in the usual manner.
Examination should be as detailed and thorough as the condition of the body allows.
If possible, visual identification of the remains by the relatives should be done.
Shroud and grave clothes should be noted.
Detailed description of the body should be written including condition of the deceased, extent of
postmortem changes, presence of insects / maggots or fungal infestation, evidence of injuries etc.
In cases of Re-examination, evidence of initial postmortem examination should be mentioned.
All soft tissues, viscera and organs of body should be examined individually for pathology
injury/foreign bodies.
All the bones of the body should be examined for trauma, particularly skull and facial skeleton, long
bones and Hyoid bone for fractures, pathology and foreign bodies e.g. bullets.
In appropriate cases, bones and soft tissues should be retained for Radiological/ Histo
pathological examination.

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In cases of suspected poisoning, available specimens should be collected for Toxicology
examination.
Control specimens of earth may have to be taken in cases of suspected Arsenic poisoning to
rule out postmortem inhibition of the naturally occurring Arsenic compound into the body
from surrounding earth. This specimen should be collected from a remote corner of grave yard.
Though exhumation cannot be as satisfactory as examination of a fresh dead body, it may be
helpful in cases of death due to strangulation, fire arm injuries, and blunt trauma leading to
injuries for bones and in various poisoning.
After completion of exhumation, the body should be handed over to the Magistrate who arranges
for its re-burial.
If any samples are collected for further examination, they should be sealed (there and then) on
the spot.
The report submitted in such cases should be confined to scientific observations and conclusions
drawn
from them. The medical examiner should never exceed the limits of medical knowledge.

NOTE:
Exhumation should be conducted in most respectfully and dignified
manner. Important Cases to be discussed with students:
1. Firearm injuries
2. Stab wound
3. Physical assault
4. Case of putrefaction
5. Head injury
6. Case of fracture
7. Multiple injuries
8. Case of rape
9. Case of poisoning

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EXERCISE MEDICOLEGAL AUTOPSY CASES
Case No 1 Road Traffic Accidents
Scenario:
A dead body has been received in the mortuary with alleged history of road traffic accident to be
the cause of death. According to FIR victim was hit by vehicle On GT road. He sustained severe
injuries on head and chest. The lower limbs were run over leading to avulsion. How will you
proceed to conduct autopsy in this case?
Police must provide inquest report & injury sheet before you conduct autopsy on the
deceased Name of deceased:
S/o:
Sex:
Age:
Caste :
Address:
Police Station:
Body brought by:
Body Identified by:
Date & hour of Arrival:
Date & hour of PM examination:
External examination:
a. General physical examination: A man of age 30-35 years having stout built wearing white
qameez, shalwar and vest. Clothes are blood stained and torned shalwar has tire marks.
b. Condition of Postmortem changes: Postmortem lividity is patchy in appearance and is
present on the back of the body. Rigor mortis has started developing in the facial muscles.
c. Injuries:
d. (1) Abrasion situated on Right Side of face 10x7cm in size,2cm infront of ear and 3cm from
midline.
(2) Various bruises located on front of chest having different sizes lying over an area of 20x16cm in
size.
(3) Laceration situated on right side of scalp 8x4cm in size with the underlying bone exposed(not
fractured),6cm from midline and 4cm above right ear.
(4) Avulsions situated on front of right thigh 25x10cm in size lying5cm below groin and 2cm above
knee joint. The underlying muscle of thigh is exposed.

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Internal Examination:
1. Cranium & spinal card: Scalp, skull & intracranial structure are injured.
2. Thorax: right lung is injured and heart is healthy.
3. Abdomen: All abdominal viscera are healthy. Stomach is empty.

Opinion:
Cause of Death:
Probable time elapsed between:
1. Injury and death:
2. Death & PM Examination:

Name & Designation:

Signature:

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 POSTMORTOM CASE NO 2
Scenario: A dead body has been received in the mortuary with alleged history of fire arm
injuries to be the cause of death. According to FIR two persons had a dispute on property. Today
early in the morning it resulted in a scuffle and the accused shot the deceased with a 9mm pistol.
How will you proceed to conduct autopsy on this case?
Police must provide inquest report & injury sheet before you conduct autopsy on the
deceased Name of deceased:
S/o:
Sex:
Age:
Caste :
Address:
Police Station:
Body brought by:
Body Identified by:
Date & hour of Arrival:
Date & hour of PM examination:
External examination:
a. General physical examination: A man of age 30-35 years having stout built wearing white
qameez, shalwar and vest. Clothes are blood stained and have fire arm defects corresponding to
the injuries.
b. Condition of Postmortem changes: Postmortem lividity is patchy in appearance and is
present on the back of the body. Rigor mortis has started developing in the facial muscles.
c. Injuries: (1) A firearm entry wound situated on left side of front of chest, 1×0.8 cm in size,
6cm from midline and 2.0 cm below nipple. It is rounded in shape with inverted margins and
surrounded by collor of abrasion.
(2) A firearm exit wound on the back of left side of chest, 2×3 cm in size, 8cm from midline and 10
cm below top of shoulder. It is irregular in shape with everted margins.
Internal Examination:
Cranium & spinal card: Scalp, skull & intracranial structure healthy.
Thorax: left lung and heart are injured.
Abdomen: All abdominal viscera are healthy. Stomach is empty.
Opinion:
Cause of Death:

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Probable time elapsed between:

Injury and death:

Death & PM Examination:

Name & Designation: ________________________

Signature: ____________________________________

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 POSTMORTOM CASE NO 3

Scenario:
An average built male about 20-25 years of age wearing light blue colour shalwar kameez. A
brownish coloured ligature mark is present on the front and left side of neck, single turn. 2 cm in
width and 40 cm in circumference, situated above the thyroid cartilage going upwards and
backwards to the nape of neck. Neck is stretched and head is inclined towards the left. Impression
of knot is on right side of neck below the ear. Hands and nailbeds are cyanosed, eyeballs are
prominent. Tongue is protruded and is dark in colour. Saliva is dribbling from left corner of
mouth. Post mortem lividity is present on hands, forearms and legs but it is not fixed. Face is
congested. Petechial hemorrhages are present in the eyes and on the face. Rigor mortis has
developed upto upper limbs.
The ligature mark is dry and hard. Minor abrasions and bruises are present in the bed/groove of the
mark. Hyperemia and few ecchymosis are present along the edges of the ligature mark. On
dissection fibres of patysma and sternocleidomastoid are torn and posterior horn of thyrroid
cartilage fractured. Hyoid not fractured.
Hyperemia of trachea and glottis. Lymph nodes above and below ligature mark show congestion
and hemorrhage. There are internal tears of carotid arteries. Under the ligature mark dry and
compressed band of subcutaneous tissue is present. Lungs are congested. No other marks of
violence present on the body.
Police must provide inquest report & injury sheet before you conduct autopsy on the
deceased Name of deceased:
S/o:

Sex:

Age:
Caste:
Address:
Police Station:
Body brought by:
Body Identified by:
Date & hour of Arrival:
Date & hour of PM examination:

External examination:
a. General physical examination:
b. Condition of Postmortem changes:
c. Injuries:
(1)
(2)

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Internal Examination:
1. Cranium & spinal card:
2. Thorax:
3. Abdomen:

Opinion:
Cause of Death:
Probable time elapsed between:

Injury and death:

Death & PM Examination:

Name & Designation:

Signature:

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 POSTMORTOM CASE NO 4

Scenario:
Police must provide inquest report & injury sheet before you conduct autopsy on the
deceased
Name of deceased:
S/o:
Sex:
Age:
Caste:
Address:
Police Station:
Body brought by:
Body Identified by:
Date & hour of Arrival:
Date & hour of PM examination:

External examination:
a. General physical examination:
b. Condition of Postmortem changes:
c. Injuries:
(1)
(2)

Internal Examination:
1. Cranium & spinal card:
2. Thorax:
3. Abdomen:

Opinion:
Cause of Death:
Probable time elapsed between:
1. Injury and death:
2. Death & PM Examination:
Name & Designation: ______________________

Signature: ________________________________

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 POSTMORTOM CASE NO.5

Scenario
Name S/O
Husband Name Caste Sex M/F Age years
District Brought By
Body Identified By 1 2
Body brought on Date and Hour / 202 Time

External Findings
1. examination of clothes
2. General Physical Examination

Front Back
Scalp
Face
Neck
Thorax
Abdomen
Perineum
Rt upper limb (arm)
Left upper limb(arm)
Left lower limb
Right lower limb
Rt foot
Left foot

Description:

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3. Internal Findings
a. Skull
b. Neck
c. Thorax
d. Abdomen
e. Pelvic

Viscera Condition
Skull
meninges
brain
Eyes
Ear
Nose
Mouth
Trachea
Lungs
heart
Liver
Spleen
kidneys
stomach
Large and small intestines
bladder
Testis , ovaries
Uterus, prostate
Musculo skeleton
Skull
Vertebras
Ribs
Upper limb
Lower limb
Any other

Opinion of an expert:
Time since death:

Cause of death:

Signature:

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 POSTMORTOM CASE NO 7:

Scenario:
Name of deceased:

S/o:

Sex:

Age:
Caste :
Address:
Police Station:
Body brought by:
Body Identified by:
Date & hour of Arrival:
Date & hour of PM examination:

External examination:
a. General physical examination:
b. Condition of Postmortem changes:
c. Injuries:

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(1)
(2)
Internal Examination:
1. Cranium & spinal card:
2. Thorax:
3. Abdomen:
Opinion:
Cause of Death:
Probable time elapsed between:
Injury and death:
Death & PM Examination:

Name & Designation: ________________________

Signature: _________________________________

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 EXPERT OPINION IN MEDICOLEGAL AND POSTMORTEM EXAMINATIONS

It is once again clarified that all the authorized medical officers doing Medicolegal and
postmortem examinations can get expert opinion of any medical expert specialist of the
Government of the Punjab as and when required for finalization of their report.
1. In Potency cases, medico legal examiner may give his opinion in indirect way as under.
“There is nothing to suggest that he is able to perform the sexual act, not able to perform the
sexual act”.
2. Permanent loss of vision or deafness can be considered as “Itlaf-l- Salahiyat UDW”. Moreover
in cases of permanent disfigurement it may be considered as “Itlaf-I- UDW” and if the
organ is reunited it becomes as “Shajjah-l- Khafifah”.
3. Cartilage is not a bone and becomes under “Shajjah-I-Khafifah” and it is not bone deep.
4. Broken teeth come under disfigurement. It is “Itlaf-l- Salahiyat” UDW.
5. If peritoneum becomes visible it should be declared as Bone.
6. Opinion of the concerned Specialists, wherever necessary must be obtained to strengthen the
final declaration.
7. All Medicolegal examiners must write their full name or affixed their by Name, Stamps
under the signatures to facilitate the courts while issuing the summons etc.

Q&A

Q-1 What is the punishment of disfigurement?

Q-2 What is the diyat for broken tooth?

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 Some Important Definitions in Qisas & Diyat Ordinance

ADULT
It means a person who has attained, being a male the age of 18 years or being female age of 16
years or has attained puberty which is earlier.
ARSH
It means compensation specified in the chapter XVI of Qisas & Diyat Ordinance to be paid by
the offender to the victim or his heirs.
AUTHORISED MEDICAL OFFICER
It means a medical officer/ medical board howsoever designated, authorised by Provincial
Government.
DAMAN
It means compensation determined by court to be paid by the offender to the victim for causing
hurt not liable to Arsh.
DIYAT
It means compensation specified in section 323, payable to the heirs of the victim by the
offender.
QATL
It means causing death of a person.
TAZIR
It means punishment other than qisas, diyat,arsh or daman.
WALI
It means person entitled to claim qisas.

Sec 300. Qatl-I-Amd

Whoever with the intention of causing death or with the intention of causing bodily injury to a
person,by doing an act which in ordinary course of nature is likely to cause death, or with the
knowledge that his act is so imminently dangerous that it must in all probability cause death, causes
of death of such an individual is said to commit qatl-I-amd.
Punishment: whoever commits qatl-I-amd shall subject to

• Punished with death as qisas.

• Punished with death or imprisonment for life as ta’zir.
• Punished with imprisonment of either description for a term which may extend to 25 years,
where according to the Injunctions of Islam of qisas is not applicable.

Sec 315. Qatl Shibh-I-Amd

Whoever with the intent to cause harm to the body or mind of any person causes the death of that
or of any other person by means of a weapon or act which in the ordinary course of nature is not
likely to cause death is said to commit qatl shibh-I-amd.

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Punishment: whoever commits qatl shibh-I-amd shall be liable to Diyat and may also be
punished with imprisonment of either description for a term upto 14 years as ta’zir
Sec 318. Qatl-I-Khata
Whoever without any intention to cause the death of or cause harm to, a person , causes death of
such a person either by mistake of act or by mistake of fact, is said to commit qatl-I-khata .
Punishment: whoever commits qatl-I-khata shall be liable to Diyat provided that, where qatl-I-
khata is committed by any rash or negligent driving, the offender may in addition to Diyat be also
punished with imprisonment of either description for a term which may extend to 5 years as
ta’zir.
Sec 321. Qatl-bis-Sabab
Whoever without any intention to cause death of or cause harm to, any person does any
unlawful act which becomes cause of death for another person, is said to commit qatl-bis-
sabab.
Punishment: whoever commits qatl-bis-sabab shall be liable to Diyat.
• Court shall be subject to Injunctions of Islam s laid down by Holy Quran and Sunnah and
keeping in view the financial position of the convict and heirs of the victim, fix value of diyat
which shall not be less than 170,610 ( one hundred, seventy thousand, six hundred and ten
rupees) being value of 30.630 gm of silver.
• For the purposes of above section federal government by notification in the official Gazette,
declare value of silver on first day of july each year.
Sec 332. HURT
Whoever causes pain, harm, disease, infirmity or injury to any person or impairs, disables or
dismembers
any organ of the body or part thereof of any person without causing his death, is said to cause
hurt.
• Itlaf-I-udw
• Itlaf-I-salahiyat-I-udw
• Shajjah
• Jurh
• All kinds of other hurts.
Sec 333. Itlaf-I-udw
Whoever dismembers, amputates, serves any limb or organ of another person is said to cause Itlaf-I-
udw.
Punishment: whoever by doing an act, with the intention of thereby causing hurt to any
person or with the knowledge that he is likely thereby to cause hurt to any person or with the
knowledge that he is likely thereby to cause hurt to any person cause itlaf-I-udw of any person
shall in consultation with the authorised medical officer, be punished with qisas and if the qisas
is not executable keeping in view principles of equality in accordance with Injunctions of Islam,
the offender shall be liable to arsh and may also be punished with imprisonment of either
description for a term which may extend to 10 years as ta’zir.

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Sec 335. Itlaf-I-salahiyat-I-udw
Whoever destroys or permanently impairs the functioning power capacity of organ of the body by
another person, or causes permanent disfigurement is said to cause Itlaf-I-salahiyat-I-udw.
Punishment: Whoever by doing an act with the intention of causing hurt to any person, causes
itlaf- I-salahiyat-I-udw of any person, shall in consultation with the authorised medical officer,
be punished with qisas and if the qisas is not executable keeping in view principles of equality in
accordance with the Injunctions of Islam, the offender will be liable to arsh and maybe punished
with imprisonment of either description for a term which may extend to 10 years as ta’zir .
Sec 337. Shajjah
Whoever causes, on the hand /face of any person, any hurt which does not amount to Itlaf-I-udw
or itlaf- I-salahiyat-I-udw is said to cause Shajjah. Following are the kinds of shajjah:
• Shajjah-I-khafifah
Shajjah without exposing bone of the victim
• Shajjah-I-mudihah
Shajjah by exposing bone but without causing fracture.
• Shajjah-I-hashimah
Shajjah by fracturing the bone of victim without dislocating it.
• Shajjah-I-munaqqilah
Shajjah by causing fracture of the bone of the victim and dislocating it.
• Shajjah-I-ammah
Shajjah by causing fracture of the skull of the victim so that the wound touches membrane of the
brain.
• Shajjah-I-damighah
Shajjah by causing fracture of the skull of the victim and the wound rupture the membrane of the
brain.
Sec 337-B. Jurh
Whoever causes any part of the body of a person, other than the head or face , a hurt which leaves a
mark of the wound, whether temporary or permanent is said to cause jurh. It is of two kinds:
Sec 337-C. Jurh Jaifah
Whoever causes jurh in which the injury extends to the body cavity of the trunk, is said to cause jurh
jaifah.
Sec 337-E. Jurh Ghayr Jaifah
Whoever causes jurh which does not account to jaifah, is said to cause ghayr-jaifah. Following are the
kinds of ghayr jaifah:

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Damiyah in which skin is ruptured and bleeding occurs.
Badi’ah by cutting /incising flesh without exposing bone.
Mudiha ___________ by cutting / incising flesh with exposing bone.

Mutalahimah by lacerating the flesh.

Hashimah by causing fracture of a bone without dislocating it.

Munaqilah by fracturing and dislocating the bone.

Punishment of other

Hurt Sec 337-L1.

Whoever causes hurt, not mentioned here which endangers life or which causes sufferer to
remain in severe bodily pain for 20 days or more shall be liable to daman and also be punished
with imprisonment of either description for a term which may extend to 7 years.

Sec 337-L2.
Whoever causes hurt not covered by sub-section shall be punished with imprisonment of either
description for a term which may extend to two years or with daman or with both.

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 D. Death Certificate

INTERNATIONAL CERTIFICATE OF CAUSE OF DEATH

Introduction: A death certificate is either a legal document issued by a medical practitioner
which states when a person died, or a document issued by a government civil registration office,
that declares the date, location and cause of a person's death, as entered in an official register of
deaths.

Importance: The death certificate is an important legal document. In addition to providing the
decedent's family with a cause of death, it has critical administrative and epidemiologic
applications. Death certificates may be required to settle decedents' estates and obtain insurance
or other pensions/benefits.

Scenario 1
Adult dying of peritonitis resulting from perforation of a duodenal ulcer, an epithelioma of the
skin is also present.

Cause of death Approximate interval

between onset and
death
I disease or condition directly leading to death* a) ....................... due to .........................
(or as a consequence of )
Antecedent cause morbid conditions, if any, b) ....................... due to .........................
giving rise to the above cause, stating the (or as a consequence of )
underlying condition last
c) ....................... due to .........................
(or as a consequence of )
d) ....................... due to .........................
(or as a consequence of )
II Other significant conditions contributing ......................... .........................
to the death, but not related to the disease or
condition causing it
......................... .........................
*This does not mean the mode of dying, e.g. heart failure, respiratory failure.
It means the disease, injury, or complication that caused death.

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Scenario 2
Elderly man dying of hypostatic pneumonia after being bed ridden owing to the fracture of neck of
femur caused by fall from ladder at home

Cause of death Approximate interval

between onset and
death
I Disease or condition directly leading to death* a) ....................... due to .........................
(or as a consequence of )
Antecedent cause morbid conditions, if any, b) ....................... due to .........................
giving rise to the above cause, stating the (or as a consequence of )
underlying condition last
c) ....................... due to .........................
(or as a consequence of )
d) ....................... due to .........................
(or as a consequence of )
II Other significant conditions contributing ......................... .........................
to the death, but not related to the disease or
condition causing it
......................... .........................

Scenario 3
Adult dying of shock following removal of gall bladder for cholecystitis arising from gallstones,
chronic nephritis also being present.

Cause of death Approximate interval

between onset and
death
I Disease or condition directly leading to death* a) ....................... due to .........................
(or as a consequence of )
Antecedent cause morbid conditions, if any, b) ....................... due to .........................
giving rise to the above cause, stating the (or as a consequence of )
underlying condition last
c) ....................... due to .........................
(or as a consequence of )
d) ....................... due to .........................
(or as a consequence of )
II Other significant conditions contributing ......................... .........................
to the death, but not related to the disease or
condition causing it
......................... .........................

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 Section 2

Forensic Serology

A. Trace Evidence
B. Visiting a Scence of Crime
C. Examination of Blood, Semen, Saliva
D. Collection, Preservation, Dispatch of Samples

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 Forensic Serology

Trace evidence
Any small piece of evidence that has to be collected and places a suspect at the scene of a crime.

Contact Trace evidence may be defined as

“The physical evidence left at the scene of crime or exchanged between assailant and the victim when
they come in contact with each other.
It means any leftover material at scene or, on the body of victim or assailant or, anything left over
which acts as an evidence and tells about the tell-tale.” is contact trace evidence
It helps in the recognition of that evidence and its association with a particular
1. Person

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 2. Thing or
3. Place
And is the clue for the identity of that source.
Triad of Evidence is based upon the principal known as,
Locard’s Exchange Principal
Sir Edmond Locard gave two principals
(1877 – 1966)

1. Every contact leaves a trace,

2. Exchange of trace is usually a two way process.
Comparing this trace with a control taken from the source where it is suspected to have come , will
confirm the character of a trace and its association is established.
Classical examples of the trace evidence is a case of,
a) Sexual Assault
b) Physical assault
c) Hit and run accident
a) Sexual assault
In which transfer of biological material such as semen and blood occur from, Assailant to victim
and,victim to assailant and also from assailant & victim to the scene of crime, and non-
biological material from the scene to both assailant and the victim.
Trace evidence may be grouped into,
1. Biological Evidence
2. Non-Biological Evidence
1. Biological Evidence
These originates from human or animal source and it includes,
a) Body fluids
b) Body tissues
a) Body fluids
Includes blood, semen, saliva, urine, vomit, cerebro-spinal fluid, etc;
Such fluids may be found in the form of stains at the scene, clothes, and body of victim or
assailant.
Other Biological materials are, human hair from head and pubes, scrapings from the under
surface of nails which contains, epithelium of skin of assailant or victim deposited during physical
or sexual assault.

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2. Non-Biological Evidence

These comprise of
a) Items of Personal Use
b) Other Materials found in the Environment.
These personal Items are clothes, spectacles, purse, wristwatches, or other things in use.
The environmental materials are fibers from carpet, vegetation in the garden, and grit particles
from the road. Other non-biological materials consists of bottles, tablets, bullets or pellets,
weapons of offence or any other thing used in the crime.

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 Visiting a Scene of Crime

1. Collection of evidence
a. Biological
b. Non biological
2. Preservation (dry or wet)
a. Blood
b. Urine
c. Semen
3. Dispatch
a. Labelling
b. Chain of custody
4. Blood detetion
a. Screening test
i. Benzidine test
ii. Phenolphthalein test
iii. Spectroscopic examination
b. Confirmatory test (crystal)
i. Takayama
ii. Teichmann
c. Origin of blood (human ,non human)
i. Precipitin Test
ii. Microscopic examination of blood cell size

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 d. Male/ female blood
i. Davidson bodies
ii. Bar bodies (only in somatic cells)
e. Blood grouping
i. Forward
ii. Reverse
5. Examination of hair
i. Animal
ii. Human
iii. Fiber , wool
6. Examination of Semen / saliva
7. DNA finger printing
i. Extraction and isolation
ii. Gel electropherosis
8. Latent fingerprinting
9. Dispatch of samples
a. Histopathologist
i. Preparation of 10% formalin
b. Chemical Examiner
i. Preparation of saturated saline solution (33% NaCl)
1. Search for Evidence
In order to pull as much information from the scene be observant – take a look around Where
things are – any structure??? overturned.
What is the cause death – what information was taken from the 1st call - natural & violence.
Once you know what kind of scene you are responding to then you go through your mental
check list.
Sometime because of the state of decomposition, the caller – makes it suspicious – because of
the odor and state of decomposition – treat all cases as homicides.
Do not be afraid to take photos.
Make sure your information is complete because others will rely on your report.
If more information to follow make sure people are aware of this.
It all depends on what type of scene you are investigating on homicides – mention or show
with police that the fragile evidence may be lost in transport.

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In suicides – same as above: Some cases where you may have to collect evidence
For chain of custody the police should be the ones submitting evidence.
Relationship of evidence with a crime scene
Summary Trace Evidence
Contact Trace Evidence
Locard’s Exchange Principal
Remember things to do at crime scene
4 Methods of Searching
Evidence that should not be missed

2. Analytical Laboratory

The study of these specimen pre-requires,

1. Collection of Material

2. Preservation

3. Dispatch

The procedures involved in collection of material in such conditions are different from those
involved in the clinical labs.

The study of trace evidence specimens is divided into,

1. Pre-Lab work

2. Lab Work

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Pre-Lab
Pre-Lab Work is further divided into,
a) General Instructions, which are applicable to all specimens, and
b) Special Instructions, which are specific instructions for each specimens.

Pre-Lab Study
A) General Instructions
1. Consent for collection
2. Identification of Person
3. Source of Specimen
4. Collection of Specimen
5. Labelling
6. Packing & sealing
7. Safety & Storage
8. Information to be Sent
9. Transportation
10. Chain of Custody
1. Consent for Collection
Consent means to say ‘YES’. In living persons request is made by Police or Magistrate in
writing.
Consent is always in writing, with signature or thumb impression. If the person refuses to give
consent, then note it down and send the person back to authority.
In dead the specimens are collected by police.
2. Identification Of Person
Identification is important in both living or dead, which is done by,
a) Subjective
b) Objective
c) Third Party
Two identification marks are noted.
3. Source of Specimen
The following things are important regarding the source of specimen,
a) Complete history of the case
b) Identification of specimen (What is to be collected?)
c) Proper site of collection (From where to be collected)
d) Honesty of collector (How & How much is collected)

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“Unavailable specimen”

If the due care is not given for the identification, type, amount, procedure of collection and
preservation of the specimen, then specimen is there but practically it becomes unavailable because
it is not fulfilling the objective of the examination.

It means that the examiner should know. What specimen is to be collected, from where it is to
be collected, what is the procedure in involved in collection and its preservation, and how
much amount.

If he doesn’t follow these principals, then the specimen is there but it becomes “Unavailable”

4. Collection of Specimens

To ensure that the collection is proper, it is advised that the process of collection should be
divided into various stages and each phase has its own goals.

These phases are overview phase search phase phase of recovery phase of review.
a) Overview Phase

In this phase the examiner should go through the history of the case, study the documents and
visit the scene of crime and should have an overall view of the scene of crime, position of
body, location of objects, etc;
b) Phase of Search

In this phase the examiner should concentrate on the areas of interest and should search for the
evidence, move the things, move the body to look underneath body etc;
c) Phase of Recovery

Specimens are collected and each item should be identified, noted for its location and if possible
be photographed. Each item is collected labelled preserved and packed.

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 d) Phase of Review

In this phase go through all the above three phases and ensure that nothing is left, because if
left then it will be left for ever and you may miss some important evidence.

1. The collector should have complete knowledge of,

Choice of specimen
Site of collection
Procedure of collection
Preservative
Container

2. The specimen may be present in three forms,

Dry form
Wet Form
Mixed with other articles.

A) Dry Form

Following procedure is adopted to collect the specimen when it is in dry form,

Scrap the specimen and place in a funnel of glazed paper, or soak the cotton swab in normal
saline and apply it over the dry stain, dry this swab in air and use this swab as specimen.
B) Wet Form
Dry the specimen and scrap it or wipe it with wet cotton swab.
C) Mixed Form

Cut that portion and separate it.

Container for Preservation.
The material of the container should be appropriate, which means it should be chemically inert,
generally a glass container is recommended. But as glass being fragile, plastic containers
with lid are preferred.
The size and shape of the container should be appropriate, so that material should be easily
placed in it.

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 Practical No.6
Preservation
How will you preserve a sample & how will you make a preservative? The
preservation of specimens is done normally by two processes,

a) Desiccation or Dehydration,

b) Freezing

Preservation in Different Situations

In Histo-pathological examinations we need a preservative which should preserve & prevent

autolysis and harden the tissues.

For Chemical examinations we only require preservation.

For Serological Examinations we also need anti-coagulative activity.

A GOOD PRESERVATIVE

It should be Cheap

It should be Easily Available

It should be also Chemically Inert

It should be Effective for the purpose

It should not react with the container & specimen

Normally used Preservatives are,
For Chemical Analysis, Super-Saturated Saline is used. It acts by de-hydration ie; extracts
water from the tissues & they get preserved.

For Histo-pathological Examinations 10% normal Saline ( ie; 10% formalin in saturated
saline) or 95% Alcohol is used.

For Serological Examinations anti-coagulants used are, Ca. Oxalate, Heparin, etc;

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 Practical No.7

Dispatch of Sample

A. Labelling
Each container should be labelled indicating,
Number of jar, 1, 2, 3, ….. Should be mentioned
Name of specimen, site of collection
Preservative used
PMR / MLC No.
Date & Time
Name of Person
Examination required
Name of Doctor, Signature & Official Seal should be affixed.
B. Sealing of Specimens

All the specimens should be sealed with sealing wax to avoid tempering and to maintain secret
chain of custody.
All the containers or jars should be packed in one box, and the box should be labelled
indicating,

Address to be sent.

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Arrow showing Upside Box should be sealed
Box should accompany a forwarding letter
C. Information To Be Sent Along
The following information is to be sent along-with the Specimens,
a) Copy of MLR / PMR
b) Examination required
c) Request letter containing the bio-data, name of specimen, etc;
d) Copy of FIR
e) Copy of Inquest Report
f) Specimen of the Seal
D. Despatch of The Specimens
Specimens should be collected, preserved, and despatched immediately after autopsy.
The only condition in which the specimens are allowed to be kept is that when the autopsy is
conducted at odd hours, when the lab is closed.
E. Safe Storage
The specimens should be kept in lock and key in the freezers.
The specimen should be registered
The seal should be intact, it should be compared with the specimen of the seal provided.
F. Transportation
The specimens should be transported through Police
Through Railway Parcel
Through Postal Parcel
Through Special Messenger by hand.
CHAIN OF CUSTODY
“ Any and all who handle the specimens at a particular instant should be able to certify the
extent of handling, i.e.;
What was collected?
Why it was collected?
To whom it was handed over?
When it was handed over?
For how long it remained in custody?

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Chain of custody should be maintained to avoid adulteration and tempering,
Chain of custody should be maintained till the specimens are presented in the court
Handling should be certified i.e.; It must be written or receipt
Principals of chain of Custody
Secrecy should be maintained
Shorter the chain, Better it is
Surer the chain, Better it is.
A GOOD PRESERVATIVE
It should be Cheap
It should be Easily Available
It should be also Chemically Inert
It should be Effective for the purpose
It should not react with the container & specimen
6.Labelling
Each container should be labelled indicating,
Number of jar, 1, 2, 3, ….. Should be mentioned
Name of specimen, site of collection
Preservative used
PMR / MLC no.
Date & Time
Name of Person
Examination required
Name of Doctor, Signature & Official Seal should be affixed.
CHAIN OF CUSTODY
“Any and all who handle the specimens at a particular instant should be able to certify the
extent of handling, i.e.;
What was collected?
Why it was collected?
To whom it was handed over? When it was handed over?
For how long it remained in custody?
Chain of custody should be maintained to avoid adulteration and tempering,
Chain of custody should be maintained till the specimens are presented in the court
Handling should be certified i.e.; It must be written or receipt.

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 Examination of Blood

Practical No.8
Collection of Blood from a Crime Scene

1.External

On clothes

On the body

At the scene of crime

(As stains or clotted blood)

2. Internal

Peripheral veins

Direct from heart at autopsy

Special Instructions for Blood collection

1. In cases of dry stains scrap it off with the scalpel and collect on a glazed paper.
2. In cases where stain is wet, it can be collected as,
a) Let the stain be dried then scrap it.

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 b) A wet cotton bud in normal saline is rolled on the stain, dry this bud in air and then put it
in a clean glass test tube, with the care that it should not touch the walls.

1. When the blood is on plaster or wood, cut that portion of wood and chip off the plaster.

2. When the blood is on the soil or ground, collect the sufficient amount of soil.

3. When the stain is on clothes, dry it in air, not in heat or sunlight, then pack them in plastic
bags separately.

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 Practical No.9
Blood Detetion

1. Screening test
i. Benzidine test
ii. Phenolphthalein test
iii. Spectroscopic examination
1. BENZIDINE TEST

Principle
The peroxidase activity of hemoglobin decomposes hydrogen peroxide releasing nascent
oxygen which in turn oxidizes benzidine to give blue color.

Reagents
A. Saturated solution of benzidine in glacial acetic acid
B. Hydrogen per oxide

Method
Take 2 ml of solution in a test tube.
Add 2ml of 1% benzidine solution an acetic acid.
Shake well.
Add 2ml of hydrogen peroxide.
Mix and observe for a change in colour.
A blue or green color within 5 minutes indicates a positive reaction, indicating blood presence in
urine.

2 Presumptive test

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2. PHENOLPHTHALEIN TEST
Principle
It relies on the peroxidase-like activity of hemoglobin in blood to catalyze the oxidation of
phenolphthalin (the colorless reduced form of phenolphthalein) into phenolphthalein,
which is visible as a bright pink color.

Materials
• Kastle-Meyer solution
• 70 percent ethanol
• distilled or deionized water
• 3 percent hydrogen peroxide
• cotton swabs
• dropper or pipette
• a sample of dried blood

Perform the Kastle-Meyer Blood Test Steps

1. Moisten a swab with water and touch it to a dried blood sample. Do not rub hard or
coat the swab with the sample. You only need a small amount.
2. Add a drop or two of 70 percent ethanol to the swab. Do not soak the swab. The
alcohol does not participate in the reaction, but it does serve to expose hemoglobin in
blood so that it can react thoroughly to increase the sensitivity of the test.
3. Add a drop or two of the Kastle-Meyer solution. This is a phenolphthalein solution,
which should be colorless or pale yellow. If the solution is pink or if it turns pink when
added to the swab, then the solution is old or oxidized and the test will not work. The swab
should be uncolored or pale at this point. If it changed color, start again with fresh Kastle-
Meyer solution.
Add a drop or two of hydrogen peroxide solution. If the swab turns pink immediately, this
is a positive test for blood. If the color does not change, the sample does not contain a
detectable amount of blood. Note that the swab will change color, turning pink after about
30 seconds, even if no blood is present. This is a result of hydrogen peroxide oxidizing the
phenolphthalein in the indicator solution.

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 Practical No.10
CONFIRMATORY TEST:
SPECTROSCOPIC EXAMINATION OF BLOOD
The spectroscopic test is one of the confirmatory test for blood. Its sensitivity is about
1:5,000. This is therefore considered one of the best tests for identification of blood stains. In
Medicolegal practice, a special type of spectroscope, known as a micro spectroscope is used.
Principle:
This is based on the principle that hemoglobin and its derivatives give characteristic
absorptions bands when viewed through a spectroscope. When white light passes through a prism,
it is broken into spectrum, consisting of its constituent colors. When such a spectrum is viewed
through blood, certain colors are absorbed. The absorbed colors appear as dark bands known as
absorption bands and the full spectrum is known as absorption spectrum. It varies with the type
of blood pigment.
Observation:
If the sample contains fresh oxygenated blood i.e. oxyhemogobin, two dark absorption bands will
be seen between the D and E lines in the yellow green region of the spectrum, the one nearer the D
being half the breadth of the other and is more defined. Addition of reducing agent like
ammonium sulphide will cause these bands to coal see into one broad band of reducing
hemoglobin between D and E. An oxidizing agent will reverse the change. An addition of alkali to
reduced hemoglobin will form hemochromogan and this compound may be crystallized out as
already described. Hemochromogen presents two absorption bands, one dark and sharply
defined in the yellow almost midway between D and E lines and the other fainter in the green part
of the spectrum. If these 3 spectra are obtained from the same stain, it is conclusive proof of
presence of haemoglobin and so of blood.
If the stain is blood or has been exposed to any extent, a certain amount of met hemoglobin
will have been formed. It is a darker pigment which is formed when the blood is decomposing.
It may occur due to poisoning such as nitrites, phanactin, sulphonal etc and in enterogenous
cyanosis. The spectrum show four bands, one in the red, two similar in position to
oxyhemoglobin and fourth faint band in the green. A reducing agent will change methemoglobin
to hemoglobin.
Carboxyhemoglobin has a spectru much like that of oxyhemoglobin. It behaves like
oxyhemoglobin For spectroscopic examination, a sizable stain, about a sq cm is required.

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 Practical No.11
2. Confirmatory test (Microcrystalline Tests)
i. Takayama
ii. Teichmann
Microscopic examination.The Takayama (Hem chromogen) test is specific for hemoglobin and is
based on the formation of insoluble, pink, needle-shaped crystals of hemochromogen.

2a. TAKAYAMA TEST (II- Hemochromogen)

Principle:
It is specific for hemoglobin & is based on the formation of insoluble, pink, needle shaped
crystals of hemochromogen resulting from a series of reactions involving the components of
takayama’s reagents.

Takayama Reagent:
• Sodium hydroxide (10% W/V)

• Pyridine

• Glucose (100mg/ 1000 ml)

• GDW (water distilled by using all glass apparatus)

Apparatus:
• Glass slides and covers slip.

• Spirit Lamp

• Light microscope

Procedure:
1. Put a suspected blood stain on microscopic slide cover with a cover slip add a drop of
takayama’s reagent and allow to flow under cover slip.
2. Warm on plate 65c° for 10-20 sec.
3. Cool the slide
4. Observe under 100× on microscope.
5. Pink needle shaped crystals of pyridine Hemochromogen.

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 Practical No.12
2b. MICROSCOPIC EXAMINATION OF BLOOD
Adequate examination of the blood cells requires that a thin film of blood be spread on a
glass slide, stained with a special blood stain & examined.

TEICHMANN TEST (1- HEMATIN)

1. This test determines if there is blood present on suspected dried blood stains.

2. The hematin crystals begin to form when heated blood is mixed with glacial acetic acid
where there is salt.
3. The positive result is caused by the combination of a halogen with ferriprotoporphyin
(red- brown to blue- black crystalline salt contain iron).
4. This test produces pink crystals that can reach up to 10 micrometers in size.

Tekhmanns reagent:
• Potassium chloride = 0.1 gm

• Potassium Bromide = 0.1 gm

• Potassium Iodide = 0.1 gm

• Glacial acetic acid = 100 ml

Apparatus:
• Slide and cover slip

• Spirit Lamp

• Light microscope

Procedure:
1. Suspected stain + a drop of teichmann reagent.

2. Heat the slide covered with in cover slip on low flame.

3. It produces dark brown color & rhombic shape & about 10µ in size.

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 Practical No.13

3 Origin of blood (human, non-human)

3a. Precipitin Test

Principal

Antigen antibody reaction → formation of anti bodiesagains human injected serum in

rabbit blood.

Procedure:

Take a rabbit and inject few micro liter human serum. Repeat this exercise for 8-10 times in a
week. Now take a human blood sample place it on slide or in test tube. Add few drops of
rabbit serum into it. Resulted blood will clot immediately due to antigen antibody reaction.

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 Practical No.14
3b. Microscopic examination of blood cell size

Bird and reptiles’ RBCs are oval and nucleated. Human RBC is 7.8um

Human Mammal Bird Amphibian

Size 7.8 micron 7.2-7-6 5.5 6-6.5
Shape Circular Except
Circular Oval Oval
camel oval
Nucleus Non nucleated Non nucleated Nucleated Nucleated

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 Practical No.15
SEX DETERMINATION

4. Male/ female blood

i. Davidson bodies
Principle: Are present as an appendages in nucleus of neutrophils (Drumstick bodies) in
female’s 80% and 20% males.

Procedure:
Make a blood slide and observe the neutrophils shape showing an additional lobe
(Drumstick)
Barr bodies (only in somatic cells) are only present in females. Take a sample from oral
mucosa and observe under microscope. Under UV light a tiny condense chromatin will be
seen in nucleus.

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 Practical No.16
1. Blood grouping
1. Blood Grouping

2. Blood groups. There are four main blood groups (types of blood) based on the
presence and absence of antigens A and B on RBC surfaces.

3. – A, B, AB and O.

4. Blood group is determined by the genes inherited from parents.

5. Each group can be either RhD positive or RhD negative, which means in total there
are eight main blood groups.
6. A+, B+, AB+ and O+

7. A-, B-, AB- and O-

5a. Forward

5b. Reverse
2. Reverse typing refers to the testing of a patient’s serum for the presence of ABO
antibodies. The patient’s serum is mixed with known red cells in a test tube.
A specified number of drops of patient serum are placed into each of three properly labeled
tubes. No agglutination will mean same blood.

Reverse blood grouping is used for blood testing in blood banks.

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 Practical No.17
Examination of Semen / saliva
Semen Detection Test,
P30 Antigen.
Prostate-specific antigen (PSA) is produced in the prostate and secreted into the seminal fluid
and other male body fluids such as urine and blood.
The PSA test works like a pregnancy test, one bar is negative and two bars is positive.

SEMEN/ SEMINAL STAINS

Physical Examination:
Grayish appearance may be due to semen
UV Lamp:
The fluorescence of seminal stains is of a bluish white color.
Chemical Exam:
Acid Phosphates Test:
A high cone of acid phosphates is found only in the semen of human and monkeys.
Florence Test:
A drop of watery solution of the stain is placed on a glass slide and allowed to dry. A cover
slip is placed over this and a drop of Florence reagent, which contains potassium iodide and
iodine in distilled water, is run under it. If seminal matter is present, dark brown crystals
resembling semen crystals will form in a short time.
This is due to the formation of choline per iodide. A negative result may be obtained when
the choline content is low on the stain decomposed. Vaginal secretion does not give a
positive test.
Barberio Test:
The reaction depends upon the presence of specimen in semen. A few drops of barberio reagent
when added to spermatic fluid produces crystals of sperm in Picrate which are needle shaped
rhombic and of a yellow color. This test is positive even without the presence of
spermatozoa. The disadvantage of this test is the pleomorphic nature of crystals, which
sometimes take the form of a deposit without any structure.

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 Practical No.18

Examination of hair
• Hair is a filamentous biomaterial that grows from follicles found in the Dermis
• Found exclusively In mammals, hair is one of the defining characteristics of mammalian
class.
• Hair has a structure consisting oseveral layers.
a. Cuticle
b. Cortex
c. Medulla

Cuticle:
Cuticle is the outer layer of hair shaft consisting of several layers of flat, thin cells without
overlapping one another.

Cortex:
The region of hair located between cuticle and medulla containing pigment granules is
known as cortex.

Medulla:
Central part of the hair is made up of large loosely connected cells which contain keratin.
Sometimes medulla may be absent in some species.

Animal Hair:
• Broad continuous Medulla
• Cutecular Pigmentation
• Homogenous Distribution
i. Animal
ii. Human
iii. Fiber , wool

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Examination of Hair
The Medico- legal importance of examination of hair is important
in cases of, Identity
Physical
Assaults
Sexual
Assaults
Poisoning, especially chronic heavy metal poisoning
1. Identification from Hair
a. For identification from hair very useful information can be gathered regarding
i. AGE
ii. RACE
iii. SEX
iv. SITUATION
2. Examination of Hair
In examination of hair points to be noted are,
a. NATURE
i. HAIR
ii. FIBRE

Nature
Hair is an appendages of skin that grows from the hair follicle.
A hair has Root shaft Tip.
Hair root lies in the follicle, which lies in the dermis.
The shaft grows from the skin and projects out.
The distal end is known as tip.
Both Human & Animal consists of,
a) Cuticle
b) Cortex
c) Medulla
The Cuticle is the outer zone which consists of scales of keratin. The scale pattern of
animal & human hair is characteristic.

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The Cortex is the middle zone of varying thickness and consists of longitudinal thickness
and varying amount of pigment.
The Medulla is the inner zone. It is known as medullary canal.
MEDULLARY INDEX is the ratio of diameter of medulla to the diameter of the shaft.
Fibres are devoid of cuticle, many fibres especially the synthetic ones are quite homogenous.

Source
From the appearance of Cuticle & Medulla, the relative size of Medulla & Cortex on cross
section gives an idea about the source.
Human hair are fine and thin with narrow medulla & thick cortex.
Animal hair is course & thick with broad medulla & thin cortex.

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Age from Hair
a) The lanugo hair of new born are fine, soft, downy , non- pigmented, non- medulated and with
smooth edge.
b) This is replaced by hair which is comparatively less fine, pigmented, medulated with a scale
pattern.
c) Age sequence of appearance in various body areas.
d) Changes in pubic and axillary hair in adolescence.
e) Old age changes

Sex from Hair

Sexing from hair is possible by studying the sex chromosome ( X& Y ) from hair root cells.
The hair of the scalp, beard, moustache are the only hair from where sex can be determined with
accuracy. The distribution and pattern of hair also help in determining sex of the individual.
male hair are generally thicker and courser than females.

Special Features
Examination of hair is of importance in identification.
From a single hair we cannot say that a hair came from a particular individual but careful
examination can reveal identity.
Debris, grease etc. adherent to the hair may give a valuable information.
Shades of hair are difficult to find out in one hair unless considerable number is available.
ABO blood groups and other blood group substances can be determined even from a single hair.
In dead bodies hair resist putrefaction, so can be helpful in identification.
Heavy metal poisons can be detected in case of poisoning.
Evidence About Crime
A careful examination of hair, and stains on hair may provide valuable clues regarding the
nature of offence and cause of death.
According to Locards’ Exchange Principal, animal hair may be found on human body & vice
versa in Bestiality.
In Sexual offences the pubic hair of the assailant may be found on the body of victim& vice versa.
Injuries to the hair show characteristic changes,
The sharp edge weapon will cut the hair,
Blunt weapon willcrush them
The Flame of Fire-Arm Weapon will cause the singeing of hair
The hair bulb will be present if forcibly extracted
If hair fall off naturally then the root is atrophied

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In case of Homicide, some portion of hair belonging to the assailant may be found clutched
in the hands of the victim
In Cases of Poisoning
In cases of poisoning, especially chronic poisoning, the hair retains traces of poisons for a
considerable time.
For Chemical examination in such cases, hair should be plucked with their roots intact.
A minimum of 15 hair is desirable.
The analysis of successive short lengths of hair from base to the tip gives an appropriate
indication of dose and intermittent period of such examination.
Time Since Death
Hair cease to grow after death but due to shrinkage of skin, there is apparent growth of
hair of face. The rate of growth of hair is about 0.4 mm per day.
An approximate idea of time since death may be obtained from this, if time of last shave is
known.
Loosening of hair occurs due to decomposition of skin in 48-72 hours after death.
In Exhumation if the body is buried in a shallow grave, scalp hair change colour in about
1-3 months, however in deep grave it occurs in 6-12 months.
EXAMINATION OF HAIR
Objectives:
To learn the technique of mounting, examining and characterizing human hair and
mammalian hair.
Apparatus:
• Light Microscope
• Glass slide
• Transparent liquid adhesive such as transparent nail polish.
• Human as well as mammalian hair.
Procedure:
1. Place two hairs from different mammals on glass slide.
2. Spread a transparent adhesive liquid on a slide e.g. transparent nail polish.
3. Pull four hairs on the slide and let it dry.
4. Pull the hairs upward without dragging and see/ compare the impressions formed the hairs
under the light microscope.

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Observation:

Under the microscope, human hair appears with a narrow discontinuous medulla. It contains
a non- pigmented cuticle but the Peripheral pigmentation may be present. Medulla is either
fragmented or maybe absent.

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 Practical No.19
DNA Finger Printing
1. Extraction and isolation
2. Gel electropherosis

DNA EXTRACTION
DNA extraction is done for:
• Test newborn for genetic diseases
• Analyze forensic evidence
• Study genes involved in cancer
• Paternity determination
• Development of drugs

Procedure:
Breaking cells open to release DNA:
The cells in a sample are separated from each other, often by a physical means such as grinding or
vortexing and put into a solution containing salt.

Positively charged Na+ ions in the salt help protect negatively charged phosphate groups that run
along the backbone of DNA.
A detergent is then added. The detergent breaks down the lipids in the cell membrane and nuclei.
DNA is released as the membranes are disrupted.
Filter out cellular Debris.
Precipitate the DNA with alcohol. Ice-cold alcohol is carefully added to the sample. DNA is
soluble in water but insoluble in presence of salt and alcohol.
A stringy white precipitate of DNA can be seen.
a). Take 20ml of Distill Water and Add 1 gram of salt. Make a Solution.
b). Gargle The solution for Few Minutes.
c). Add Lysosomal Enzyme Or Detergent So That The Cell membranes are broken and DNA is exposed
c) Centrifuge 350/ votexand addcolour.
d) Add Cold alcohol by sliding.
e). Let the solution settle.
g) Wait
h) DNA: white string like structure appears.

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Case Disputed Paternity or Maternity
If the specimen is to be collected for disputed paternity or maternity, then is collected from
peripheral vein with syringe.
No preservative is added except anti-coagulant e.g.; Ca. Oxalate, Heparin
The samples of blood are collected in front of all the consenting parties.
The sample of father is signed by mother.
The sample of mother is signed by father.
The sample of child should be by both father and mother.

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 Practical No.20

LATENT FINGER PRINTING

Principle:
A fingerprint left on a surface by deposits of oil and / or perspiration from the finger. It is not
usually visible to the naked eye but may be detected with special techniques such as dusting with
fine powder and then lifting the pattern of powder with transparent tape.
Types:
1. Simple
2. Rolling
Types of finger prints:
1. Arch
2. Loop
3. Whorl
4. Composite
Material:
Lead powder, dusting brush, piece of glass, stamp pad, piece of paper, gloves.
Method:
Put on gloves and mark out the area to be examined. Take a brush and tap some finely powdered

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lead into the area. Brush off excess powder using a dusting brush, to make the finger print
visible. Use a piece of tape to transfer the fingerprint onto a blank white paper.

TRUE BITES
A mark caused by the teeth either alone or in combination with other mouth parts. Its
impression help in identification of the person.
LOVE BITES
It’s a pressure suction between tongue and teeth, there appear tiny areas of haemorrhages. They
are usually found over neck, breasts, chest wall, medial sides of thighs.
Collection of stains
Soak the cotton swab in normal saline and role it over the stained area, dry it in air and put in
test tube.
Collection of Control
The most important thing is to collect control specimen of saliva from
the suspect.
Procedure of Collection
First ask the patient to wash the mouth with normal saline, then with plain water,
Now ask the individual to chew some inert material, piece of paraffin, non- sugar coated
chewing gum, Then ask the person to loosen his facial and oral musculature,

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Tickle the inner walls of mouth with glass rod,

Tilt the mouth on one side, the saliva will start flowing to the angle of mouth,

Collect it in a glass test tube.

Amount to be Collected
50 – 60 ml

Preservation of Saliva

a) First place the sample test tube in hot water bath for 10 minutes, The enzymes will be
inactivated

b) Then Centrifuge the specimen at 1500 rev/min for three minutes, Cell debris will settle
down and the supernatant is preserved

c) No preservative is added.

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 Practical No.21
Dispatching of samples
1. Histopathologist
i. Preparation of 10% formalin
2. Chemical Examiner
i. Preparation of Saturated Saline Solution (33% NaCl)

COLLECTION, PRESERVATION & DISPATCH OF MATERIAL FOR

TOXICOLOGY EX- AMINATION AT P.F.S.A [PAKISTAN FORENSIC
SCIENCE AGENCY]
Whenever confirmation of poisoning / intoxication is required, appropriate material should be
sent to the PFSA.
From the living, following specimens may be collected for toxicological analysis in cases of
suspected poisoning:-
Blood from peripheral vein in a vacutainer containing 1% sodium, Floride and citrate (without
spirit being used on the skin).
Urine 30 CC in a glass bottle nothing being used as preservative.
Stomach washes 30-50 CC in a glass bottle. The first washing without any antidote or
preservative being added.
Clipping of Nails / Hair, in a clean glass tube / envelope with no preservative used.

COLLECTION, PRESERVATION AND DISPATCH OF MATERIAL TO PUNJAB

FOREC- SIC SCIENCE AGENCY LAHORE
Whenever confirmation of poisoning / Intoxication is required, appropriate material should
be sent to the Forensic Toxicology Department of the Punjab Forensic Science agency
Lahore which is the section for Medico legal investigation of death, poisoning drug abuse.
Forensic Toxicology Department provides facilities for identification of drugs and poisons in
ante mortem and postmortem cases. Both qualitative and quantitative tests are performed.
COLLECTION OF SPECIMENS
Collection of Specimens is essentially necessary in the cases of intoxication, sexual
assaults and any other case requiring collection of blood for grouping etc. The success of the
investigation depends upon proper collection and preservation of right material from the
body of victim or assailant. The procedure of collection and custody of medicolegal
specimens differs from that of collection of samples in clinical practice.
In clinical practice, both patient and laboratory and placed in one building either the patient
is referred to laboratory or laboratory technician comes to the ward to collect the sample
from the patient. There is no chance of substitution, except an error of labeling, as the
interest of both is the same, i.e, to achieve correct results quickly. Contrarily , in Medicolegal

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practice , the place of collection of sample and the place of examination are miles apart and
the interests of the parties to interfere with them in the form of addition or substitution are
immense. Such an interference may take place at the place of collection, during transit of the
sample to the laboratory and finally in the laboratory, where the samples are processed and
examined. The persons possessing the evidence from the chain of custody and a short chain is
preferable. All are required to certify the extent of handling. The evidential material should be
handed over only after obtaining a receipt.
Instruction for collection of specimens: that should be kept in mind are divided in two:

• General instruction
• Special instruction
General instructions: are applicable to all the specimens and they are as follows:

1. The source of the specimens should be beyond doubt.

2. The authorized staff should only collect the specimens.
3. After collection, the specimens should be stored in a freezer temperature till processing.
4. The container of the specimen should be adequate in relation to the specimen.
5. The size of the container should be impervious, clean and free from contamination.
6. The mouth of the container should be appropriately wide to admit the specimen.
7. The stopper of the container should be screw-tight to avoid leakage.
8. Every container should bear a label with the following entries:
Name of the specimen
From whom and from where it is collected?
Type of examination required
Name and designation of person who collected specimen.
9. The specimen should be sealed properly before dispatch.
10. A forwarding letter containing the request of examination required in the laboratory
should be sent along with these specimens.
11. If the samples are more than one, then each specimen should be identified with an
identity number and the schedule showing identity numbers allotted to each specimen
should be enclosed with the laboratory letter.
12. The transportation of specimens to the laboratory should be done through the police
official
responsible for the investigation of the case.
13. If the specimens are to be sent by post or rail, they should be registered to sent through
prepaid railway parcel.
14. At the time of receipt of samples in the laboratory, it should be ensured that the seals are
intact and the related papers are complete in all respects.

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15. The analyst should sign the register to maintain the chain of custody.
16. The registration of container or the sample should be done with the following entries:
Serial number of the year
Date of receipt of the sample
Bio date of the victim
Date of Medicolegal / autopsy examination
Number and the name of sample
Place from where dispatched
Special Instructions are applicable to individual specimens, which vary with the type of
specimen and the objective of collection, whether for chemical analysis, histopathology,
Serology or as a museum specimen. The instructions for various types of specimens are as
follows:
Blood is either collected for determination of its source or for the estimation of a drug or
poison in it. When it is collected from the scene, the quantity should be sufficient and in case
of an individual, it should be 10-cc. Blood is collected from a peripheral vein of the person.
Blood for grouping in cases of paternity disputes should be collected simultaneously from
the child and the parents who should verify their identity. Skin should not be cleaned with
spirit while taking a sample for alcohol estimation. In dead bodies 100 cc. of blood is
collected from the right heart. It is the specimen of choice in deaths due to carbon
monoxide poisoning. The container should be special having a stopper to avoid loss of
poison by evaporation. It should be chemically clean. No preservative is used. Delay in
dispatch should be avoided in the cases of poisoning with alcohol and carbon monoxide and
bacteriological infection. The samples must reach the laboratory within a few hours and must
be examined immediately, before they start decomposing.
Urine is the easiest of all the specimens to be collected and is usually taken for estimation of
alcohol and other poisons such as morphine, barbiturates, amphetamines and metallic
poisons. It is also collected in cases of sexual assault to detect spermatozoa and gonococci in
it. The entire quantity available is taken. When it is collected for the presence of gonococci,
it should be preserved in a chemically clean, sterile container and the sample should be sent
to the bacteriologist immediately after collection no preservative is used.
Semen is generally collected on a slide or on a swab to detect spermatozoa in cases of
sexual assaults. When present on clothes, the body of the victim or assailant or at places
other than the vagina and rectal canal, it is usually in dried state. It should be either scraped
with a dry scalpel or collected first on a glazed paper and then passed into a special container
avoiding loss of the sample, or the area may be moistened with saline and the material taken
on a swab attached on the end of an applicator.
From vaginal or anal canal, it is taken before taking the urine specimen and before digital
rectal examination. The material is received on a cotton swab attached to an applicator with
the help of a suitable sized, sterile, non-contaminated speculum. Careful withdrawal is
necessary to avoid loss of specimen due to rubbing on the inner side of the speculum. Three
swabs are generally prepared of which two swabs are air dried and preserved in separate test

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tubes for dispatch to the laboratory for further examination. While it is still wet, the third
swab is used to prepare three slides, which should be both, clean as well as clear.
Immediately after withdrawal from the vagina or anal canal, it is gently rubbed only once
over the central portion of the slides. The film should be thin. Slides are air-dried. The best
two are packed having smeared surfaces facing each other with two matchsticks between
them placed near the free margin of the slides. The slides should be wrapped with adhesive
tape to avoid displacement and loss of specimen. Both swabs and slides duly labeled are
placed in a container, duly sealed.

Saliva is required for grouping purposes. After thorough mouthwash, about 5cc of saliva is
collected by instructing the person to loosen his mouth and let the saliva dribble in a test
tube. If necessary, the mucus membrane may be tickled with a glass rod. The food particles
that are present in the saliva should be separated and the enzyme amylase inactivated before
its dispatch to the laboratory. The enzyme is inactivated by indirectly heating the test tube
containing the sample after placing it in the water bath for about 10-15 minutes. After
cooling, the specimen is centrifuged at 2000-3000 revolutions per minute for 10 minutes.
The food particles get settled at the bottom of the tube and the clear supernatant fluid is
collected in a clean test tube, which is then sent.
Stomach wash is the material of choice in all cases of poisoning. The entire quantity or the
least 500 cc is collected in a chemically clean class container. The capacity of the container is
about 1000 cc. Container should be filled to two thirds of the capacity leaving the upper one
third of the space free for collection of gases. The stopper should be of screw type. No
preservative is used.
Hair is commonly required in cases of chronic heavy metal poisoning and sexual assaults.
In case of chronic heavy metal poisoning especially with arsenic or antimony, large number
of hairs are cut from different parts of the scalp and put in an envelope. In sexual offences,
if any loose hair is present on clothes, or body including the pubic region, it should be
isolated. If public hair is exuberant, the area is combed to isolate loose hair. Additionally
two or three hair is also plucked with roots intact with the help of a tweezers to act as control.
Sandwiching them separately between glass slides and transparent adhesive tape preserves
both loose and plucked hairs.
Bone and bone marrow are required in heavy metal poisoning and drowning respectively.
Two to three gm. Of bone marrow is collected in a container from the central part of a long
bone, especially femur. It is collected, in case of drowning to detect the presence of diatoms.
In cases of chronic poisoning by heavy metals like lead, arsenic and radium, 3-5 cm. of
central segment of the shaft of a long bone is taken after dissecting the soft tissues. The
segment is preserved in rectified spirit.
Nail clippings and scrapings are collected in cases of poisoning with heavy metals and in
cases of sexual assault or drowning respectively. In cases of sexual assault, when a non-
consenting female inflicts scratching with her nails on the body of the aggressor, blood
mixed with portions of the cuticle of his body gets deposited under her nails. In case of
drowning, contents of the water medium may get deposited under the nails. Such nail
scrapings are collected from the undersurface of the free ends of nails usually with the help
of sharp pointed scissors or a scalpel and are placed directly in a test tube. Nail clippings of
free ends of nails are collected with a nail-cutter into an envelope. Label should mention the

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finger from which the specimen is collected.
Clothes are preserved in cases of both physical and sexual assaults especially when
damaged by the weapon or stained by blood or semen. The clothes should be air dried by
putting them on hangers. The damage of knife cut or bullet hole is encircled, signed and
photographed. The clothes and the photographs are placed in separate envelopes and finally
dispatched in a plastic bag.
Internal organs are collected at the time of autopsy and dispatched to the laboratory for
further examinations like histology and toxicology. The procedure of their collection would
be discussed in the chapter of autopsy.
Formulation of opinion is a very important duty of the medical examiner and the
conclusion should be based on the observed facts. It is stressed that the opinion should not
go beyond the knowledge of the medical examiner. In case of difficulty or inability to
appreciate or elicit a finding or frame an opinion, the matter should immediately be referred
to a senior colleague, who is trained in the specialty for advice. Delay in seeking advice may
be detrimental and may add limitations in the evaluation of the case even by a specialist either
due to loss of evidence or onset of inflammatory and repair processes or decomposition.
Sentiments, sympathy or any personal theory must not influence formulation of the opinion.
The conclusion should contain comments about the nature of the causative agent along with
estimation of time lapsed and The gravity of damage inclusive of incapacity produced by
trauma or intoxication. Opinion should also take into consideration the allegation by the
examinee. In case of physical assaults, the possibility of injury being self-inflicted, homicidal
or accidental should also be recorded. In cases of sexual assaults it is necessary to record in
remarks whether the findings are consistent with sexual intercourse or they are otherwise. In
industrial poisoning, the casual relationship is based upon preponderance of evidence
rather than an absolute proof. Such inferences are vital for information and administration of
justice.
Documentation of findings is mandatory. All the findings should be documented as
written record, sketches and photographs, wherever necessary. Close-up of injuries, damages
and staining of clothes and full view of the injured or intoxicated are essential. Fractures
should be recorded on X-rays. Beside, the findings observed, it should include results of
investigations. Reports on collected material and all other relevant documents such as
receipts and dispatches must be placed in order and indicated by labels. In case the injured is
admitted in the hospital, the treatment notes, duration of the stay in the hospital and the date of
the discharge should be obtained from the ward and this information the incorporated in the
medical certificate so that the full facts of the case can be certified.
Forensic medical certificate is prepared in triplicate on specific Performa depending upon
the type of case, by the medical practitioner in his own hand writing and signed.

Of the three certificates made the original stays in the register. One of the copies is handed
over to the investigating police after obtaining signatures on the original and the other is sent
to statistical section for compilation of criminal data.

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 Practical No.22

Examination of Blood under Ultra Violet light

Blood does not fluoresce by applying UV or visible blue light. ... Although blood does not
fluoresce, certain other physiological fluids will. UV alternate light sources can reveal the
following: seminal fluid, saliva and urine stains. Also, certain narcotics will fluoresce as
will bone and teeth fragments.

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 Section 3

Analytical Toxicology
A. Steamdistillation

B. Stass Otto
C. Reinsch Test
D. Thin Layer Chromatograpgy
E. Spectrophotometry

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 Analytical Section

Introduction
A solution is a homogenous mixture of two or more substances that exist in a single phase and
has, depending on the relationship between solute and solvent, different concentrations. To
determine the concentration of a given solution, you can use a few different methods. Here
we are going to use colorimetry to measure the transmittance and determine the solution’s
concentration, thus applying the Beer-Lambert law. This law states that the concentration of a
solute is proportional to the absorbance. The colorimeter allows light to pass through a cuvette
containing a sample of the solution which absorbs some of the incoming beam. When the ray
of light of a given wavelength and intensity (I0 ) comes into contact perpendicularly with the
solution of a tinted chemical compound, the compound will absorb part of the light radiation
(Ia ). The remaining light (Ib ) will pass through the solution and strike the detector. As such,
the following equation is demonstrated.
0 = Ia + Ib
The absorbance of light is related to the number of molecules present in the solution
(concentration of the solution). The Beer-Lambert law defines the relationship between the
concentration of a solution and the amount of light absorbed by the solution:
A = εdC
Where: A = Absorbance ε = Molar absorptivity (L mol-1 cm-1) d = Path length of the cuvette
containing the sample (cm) C = Concentration of the compound in the solution (mol L-1)
Transmittance is the relationship between the amount of light that is transmitted to the detector
once it has passed through the sample (I) and the original amount of light (I0 ). This is
expressed in the following formula. T = I / I0 Where I0 is the intensity of the incident light
beam and I is the intensity of the light coming out of the sample. Transmittance is the relative
percent of light that passes through the sample. Thus, if half the light is transmitted, we can say
that the solution has 50% transmittance.
What is Photo colorimeter?
A colorimeter is a light-sensitive device used for measuring the transmittance and absorbance
of light passing through a liquid sample. The device measures the intensity or concentration of
the color that develops upon introducing a specific reagent into a solution
• Analytic toxicology involves the application of the tools of analytic chemistry to the
qualitative and/
or quantitative estimation of chemicals that may exert adverse effects on living organisms.
• Forensic toxicology involves the use of toxicology for the purposes of the law; by far the
most common application is to identify any chemical that may serve as a causative agent in
inflicting death or injury on humans or in causing damage to property.
• The toxicologic investigation of a poison death involves (1) obtaining the case history in as
much detail as possible and gathering suitable specimens, (2) conducting suitable
toxicologic analyses based on the available specimens, and (3) the interpretation of the
analytic findings.
• The toxicologist as an expert witness may provide two objectives: testimony and opinion.
Objective testimony usually involves a description of analytic methods and findings. When

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 a toxicologist testifies as to the interpretation of analytic results, that toxicologist is
offering an “opinion.”
With its roots in forensic applications, analytical toxicology involves the application of the
tools of analytical chemistry to the qualitative and/or quantitative estimation of chemicals that
may exert effects on living organisms. Forensic toxicology involves the use of toxicology for the
purposes of the law. The most common application is to identify any chemical that may serve
as a causative agent in inflicting death or injury on humans, or in causing damage to property.
There is no substitute for the unequivocal identification of a specific chemical substance that is
demonstrated to be present in tissues from the victim at a sufficient concentration to explain the
injury with a reasonable degree of scientific probability or certainty. For this reason, forensic
toxicology and analytical toxicology have long shared a mutually supportive partnership.
ANALYTICAL TOXICOLOGY
Forensic toxicologists learned long ago that when the nature of a suspected poison is unknown, a
systematic, standardized approach must be used to identify the presence of most common toxic
substances. An approach that was first suggested by Chapuis in 1873 in Elements de Toxicologie
is based on the origin or nature of the toxic agent. Such a system can be characterized as
follows:
1. Gases—Gases are most simply measured by means of gas chromatography.
2. Volatile substances—These are generally liquids of various chemical types that vaporize at
ambient
temperatures. Gas chromatography is the simplest approach for separation and quantitation.
3. Corrosive agents—These include mineral acids and bases. Many corrosives consist of ions
that are normal tissue constituents. Chemical techniques can be applied to detect these ions
when they are in great excess over normal concentrations.
4. Metals—Metals are encountered frequently as occupational and environmental hazards.
Separation involves destruction of the organic matrix by chemical or thermal oxidation.
5. Anions and nonmetals—These present an analytical challenge as they are rarely
encountered in an uncombined form.
6. Nonvolatile organic substances—These constitute the largest group of substances that must
be considered by analytical toxicologists.
Vocabulary
Absorbance: The amount of light absorbed by a sample. Colorimeter: An instrument that
measures the amount of light that passes through a sample. Concentration: The relative amount
of a given substance contained within a solution or in a particular volume of space; the amount
of solute per unit volume of solution. Incident Light: The light that falls directly on an object.
Molar Absorptivity: The molar absorption coefficient is a measure of how strongly a chemical
species absorbs light at a given wavelength. Monochrometer: An optical device that transmits a
mechanically selectable narrow band of wavelengths of light or other radiation chosen from a
wider range of wavelengths available at the input. Monochromatic Light: Light with only one
wavelength present. Path Length: The overall length of the path followed by a light ray. Solute:
The minor component of a solution. The substance dissolved in the solvent. Solvent: A liquid
capable of dissolving other substances. Transmittance: The passage of light through a sample.
% Transmittance: The manner in which a colorimeter reports the amount of light that passes
through a sample. UV Light: The wavelength of light that is used to detect colorless molecules.
Wavelength: The distance between two successive crests or troughs in a light wave.

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 Practical No.23
STEAM DISTILLATION

Steam distillation is a special type of distillation for temperature sensitive materials like
natural aromatic compounds.

Principle:

The process of steam distillation separates the elements of a mixture through heating and
evaporation, as different compounds have different boiling point.

Procedure:

The organic mixture together with some water is placed in Round bottom flask which is then
connected to a steam generator on one side and of a water condenser on the other.

• Heat the mixture to avoid the condensation of steam in it.

• The vapors of the compound along with steam leave the flask from the outlet and get
condensed in the water condenser.
• It is then collected in a conical flask containing ice to solidify the liquid.

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 Practical No.24
Stass Otto

Extraction Theory

Liquid-liquid extraction is a useful method to separate components(compounds) of

a mixture Let’s see an example.
Suppose that you have a mixture of sugar in vegetable oil (it tastes sweet!) and you want to
separate the sugar from the oil.
Observe that the sugar particles are too tiny to filter and you suspect that the sugar is partially
dissolved in the vegetable oil.
What will you do?
How about shaking the mixturewith water
Will it separate the sugar from theoil?

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Sugar is much more soluble in water than in vegetable oil, and, as you know, water is
immiscible (=not soluble) with oil.
Did you see the result? The water phase is the bottom layer and the oil phase is the top
layer, because water is denser than oil.
*You have not shaken the mixture yet, so sugar is still in the oil phase.
By shaking the layers (phases) well, you increase the contact area between the two phases.
The sugar will move to the phase in which it is most soluble: the water layer.
Now the water phase tastes sweet because the sugar is moved to the water phase upon
shaking. **You extracted sugar from the oil with water.
**In this example, water was the extraction solvent;
The original oil-sugar mixture was the solution to be extracted; and sugar was the compound
extracted from one phase to another. Separating the two layers accomplishes the separation of
the sugar from the vegetable oil.

Did you get it?

The concept of liquid-liquid extraction?
Liquid-liquid extraction is based on the transfer of a solute substance from one liquid phase
into another liquid phase according to the solubility. Extraction becomes a very useful tool
if you choose a suitable extraction solvent. You can use extraction to separate a substance
selectively from a mixture, or to remove unwanted impurities from a solution. In the
practical use, usually one phase is water or water-based (aqueous) solution and the other an
organic solvent which is immiscible with water.

The success of this method depends upon the difference in solubility of a compound in various
solvents. For a given compound, solubility differences between solvents is quantified as the
“distributionco- efficient.

Partition Coefficient Kp (Distribution Coefficient Kd)

When a compound is shaken in a separatory funnel with two immiscible solvents, the
compound will distribute itself between the two solvents.

Normally one solvent is water and the other solvent is a Water-immiscible organic solvent.

Most organic compounds are more soluble in organic solvents, while some organic compounds
are more soluble in water.

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 Practical No.25
Reinsch Test
The Reinsch test is an initial indicator to detect the presence of one or more of the following
heavy metals in a biological sample, and is often used by toxicologists where poisoning by
such metals is suspected. The method, which is sensitive to antimony, arsenic, bismuth,
selenium, thallium and mercury, was discovered by Hugo Reinsch in 1841
Principle
The analysis is based on the fact that metallic arsenic, antimony, bismuth and mercury will
deposit on a copper wire placed within a sample matrix that is acidified and heated.
Procedure

• Dissolve suspect body fluid or tissue in a hydrochloric acid solution

• Insert a copper strip into the solution.

• Heat It for 1 to 2 Minutes.

• The appearance of a silvery coating on the copper may indicate mercury. A dark
coating indicates the presence of one of the other metals.

• Confirm finding using absorption or emission spectroscopy, X-ray diffraction, or other

analytical technique suitable for inorganic analysis.

Microscopic Analysis of Crystals

• Mercury = Triangular

• Arsenic = Cone shaped

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 Practical No.26
• MARQUIS TEST
Marquis Test Is a simple spot-test to presumptively identify alkaloids as well as other
compounds.
Marquis Reagent
It is composed of a mixture of formaldehyde and concentrated sulfuric acid, which is
dripped onto the substance being tested.
It is Produced By The addition of 100 mL of concentrated (95–98%) sulfuric acid to 5 mL
of 40% formaldehyde.
Principle
Marquis test is one of the most common reactions for preliminary testing of suspected
substances. It is used in analyzing the drug but also to identify the alkaloids or commonly
used drugs, which significantly reduces its selectivity.
However, its relative simplicity and especially the combination with additional tests can lead
to confirmation of suspected drug in the sample.
It is used primarily when testing narcotics and psychotropic substances. The reagent is used as
a mixture of concentrated sulfuric acid and formaldehyde.
The reaction mechanism is quite complex, it can be said that it is based on the polymerization
of molecules of the test compound and formaldehyde in the acidic environment where
charged oxonium or carbonium compounds are formed imparting the observed color.
Procedure
The test is performed by scraping off a small amount of the substance into the well of a spotted
porcelain tile and adding a drop of the clear and colorless reagent.
The results are analyzed by observing the color of the resulting mixture, and by the time taken
for the change in color to become apparent.

Results

Substance Color Change

Codeine Dark
Purple
Heroin Deep
Purplish Red
LSD Olive Black

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Methadone Light
Yellowish Pink
Methylene Blue Dark

Green
Morphine Deep Purplish Red
Opium Dark Grayish Reddish Brown
Oxycodone Pale violet.

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 Practical No.27
EXAMINATION OF A DRUNK INDIVIDUAL

Drunkenness:
It is a condition which results from excessive intake of alcohol and the person is so much under
influence that:
1. He loses control over his mental faculties
2. He is unable to perform the duties on which he is engaged at a particular time.
3. He may be a source of danger to himself or to others.
In places where there is No Prohibition it is not a crime, unless accompanied by some act of
omission or commission which would cause danger to the life or property of other people.
Charge:
Drunk and disorderly
Drunk driving
Doctor practicing or operating while being drunk
Diagnosis:
Examination may be carried out by a medical officer at the request of police even without
consent and by use of force, if necessary.
Clinical Examination:
Smell of alcohol in breath/ vomitus +combination of the following symptoms:
1. General Demeanour: Excited, Hilarious, talkative, abusive
2. Clothes: Disarranged, disorderly
3. Eyes: Suffusion (redness) of conjunctiva. Pupils vary from extreme contraction to extreme
dilatation,
maybe equal or unequal. Fine lateral nystigmus.
4. Tongue: Dry, furred, excessive salivation.
5. Speech: Slurred and incoherent. Certain test phrases like British constitution may be
asked.
6. Memory: Loss or confusion, particularly in regard to recent events and appreciation of
time. Simple sums of addition or subtraction maybe asked.
7. Co-ordination: Impaired, unable to thread a needle, button his clothes, pick up coins
dropped on the floor. Gait: uncertain, reeling or falling. Tremors of hand making writing
difficult. Signature can be compared to that on the driving license. Finger-nose test is
impaired.
8. Reflexes: Delayed or sluggish
9. Unusual actions: Hiccups, belching, vomiting, fighting.

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Laboratory Test:

Estimation of alcohol from

1. Blood

2. Urine

3. Breath

At autopsy:

1. Vitreous fluid

2. Bite

3. Other tissues, CSF

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 Practical No.28
Detection of Drug Abuse / Poisons
a. Heroin
b. Cannabis Indica
c. Methamphetamine
d. Ice
Principal of detection of poisons

Toxicology Screening
Toxicology screening is a testing used to determine the approximate amount and type of legal
and / or illegal drugs a person has taken. It is used to screen for drug abuse, monitor a substance
abuse problem, and evaluate drug intoxication for overdose.

• The best initial test in toxicology screening is the urine immunoassay (qualitative test)

Basic Principles: Basically these tests don’t measure drugs themselves. Rather, they detect how
the drug interacts with the body’s immune system and its ability to form antigen-antibody
complexes.

They are typically used for screening methamphetamine, tetrahydrocannabinol, benzodiazipines,

TCAs, PCP, alcohol, cocaine, PCP, amphetamines, and cannabinoids. Urine sceens are the most
common method of drug testing. They are painless, easy, quick, and cost-effective.

• The confirmatory test is gas chromatography / mass spectrometry, which provides

qualitative analysis and allows identification of the specific drug or its metabolites.

Procedure:
In urine testing through urine detection kit, 3 drops of urine are put on strips and control vs
testing lines are noted for any positive results.

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 Practical No.29
Thin-layer chromatography (TLC)
Thin-layer chromatography (TLC) is a chromatography technique
used to separate non-volatile mixtures. Thin-layer chromatography
is performed on a sheet of glass, plastic, or aluminium foil, which
is coated with a thin layer of adsorbent material, usually silica gel,
aluminium oxide (alumina), or cellulose.
On completion of the separation, each component appears as spots
separated vertically. Each spot has a retention factor (Rf) expressed
as:
Rf = dist travelled by sample / dist travelled by solvent
The factors affecting retardation factor are the solvent system, amount of material spotted,
absorbent and temperature. TLC is one of the fastest, least expensive, simplest and easiest
chromatography technique.

Thin Layer Chromatography Procedure

Before starting with the Thin Layer Chromatography Experiment let us understand the different
components required to conduct along with the phases involved.

1. Thin Layer Chromatography Plates – ready-made plates are used which are chemically inert
and stable. The stationary phase is applied on its surface in the form of a thin layer. The
stationary phase on the plate has a fine particle size and also has a uniform thickness.
2. Thin Layer Chromatography Chamber – Chamber is used to develop plates. It is responsible
to keep a steady environment inside which will help in developing spots. Also, it prevents
the solvent evaporation and keeps the entire process dust-free.
3. Thin Layer Chromatography Mobile phase – Mobile phase is the one that moves and
consists of a solvent mixture or a solvent. This phase should be particular-free. The higher
the quality of purity the development of spots is better.
4. Thin Layer Chromatography Filter Paper – It has to be placed inside the chamber. It is
moistened in the mobile phase.
Thin Layer Chromatography Experiment
The stationary phase that is applied to the plate is made to dry and stabilize.

• To apply samples spots, thin marks are made at the bottom of the plate with the help of a
pencil.
• Apply sample solutions to the marked spots.
• Pour the mobile phase into the TLC chamber and to maintain equal humidity, place a
moistened filter paper in the mobile phase.

• Place the plate in the TLC chamber and close it with a lid. It is kept in such a way that the
sample faces the mobile phase.

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• Immerse the plate for development. Remember to keep the sample spots well above the level
of the mobile phase. Do not immerse it in the solvent.
• Wait till the development of spots. Once the spots are development, take out the plates and
dry them. The samples spots can be observed under a UV light chamber.

Thin Layer Chromatography Applications

• The qualitative testing of various medicines such as sedatives, local anesthetics,
anticonvulsant tranquilizers, analgesics, antihistamines, steroids, and hypnotics is done by
TLC.
• TLC is extremely useful in Biochemical analysis such as separation or isolation of
biochemical metabolites from its blood plasma, urine, body fluids, serum, etc.
• Thin layer chromatography can be used to indentify natural products like essential oils or
volatile oil, fixed oil, glycosides, waxes, alkaloids, etc
• It is widely used in separating multi component pharmaceutical formulations.
• It is used to purify any sample and direct comparison is done between the sample and the
authentic sample.
• It is used in the food industry, to separate and indentify colours, sweetening agent, and
preservatives.
• It is used in the cosmetic industry.
• It is used to study if a reaction is complete.
Disadvantages of Thin Layer Chromatography:
1. Thin Layer Chromatography plates do not have longer stationary phase.
2. When compared to other chromatography techniques the length of separation is limited.
3. The results generated from TLC are difficult to reproduce.
4. Since TLC operates as an open system, some factors such as humidity and temperature can
cause consequences to the final outcome of the chromatogram.
5. The detection limit is high and therefore if you want a lover detection limit, you cannot use
TLC.
6. It is only a qualitative analysis technique and not quantitative.

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 Practical No.30
Stomach Wash or Vomitus and its Examination
The Medico- legal importance of stomach wash and vomitus & its stains is in cases of
poisoning.
The stains of vomiting may be present on the clothes & scene of crime, clothes after drying
should be packed & sent to chemical examination lab.
Stomach wash is collected in all cases of poisoning, First washings of the stomach should be
preserved. No preservative is added to it.
The detailed examination of vomitus and its stains will be discussed in Analytical Lab.
GASTRIC LAVAGE/ STOMACH WASH
OVERVEIW:
• Gastric lavage is a gastrointestinal decontamination technique that aims to empty the
stomach of toxic substances by the sequential administration and aspiration of small volumes
of fluid via an orogastric tube.
• Previously widely favoured method that has now been all but abandoned due to lack of
evidence of efficacy and risk of complications.
INDICATIONS:
• Gastric lavage should be rarely, if ever, performed.
• The amount of toxin removed by gastric lavage is unreliable and often negligible,
especially if performed after the first hour.
• There are few (if any) situations where the expected benefits of gastric lavage would exceed
the risks involved and where administration of activated charcoal would not provide equal or
greater efficacy of decontamination.

TECHNIQUE:
• Perform in an appropriately staffed and equipped resuscitation area. Do not perform in any
patient with an impaired level of consciousness unless the airway is protected by a cuffed
endotracheal tube.
• Position the patient in the left decubitus position with 20° head down.
• Measure the length of tube required to reach the stomach externally before beginning the
procedure.
• Pass a large bore 36-40 G lubricated lavage tube extremely gently down the oesophagus.
Stop if any resistance occurs
• Confirm tube position by aspirating gastric contents and auscultating it for insufflated air
at the stomach; consider CXR for confirmation of position.

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• Administer a 200 mL aliquot of warm tap water or normal saline into the stomach via the
funnel and lavage tube.
• Drain the administered fluid into a dependent bucket held adjacent to the bed.
• Repeat administration and drainage of fluid aliquots until the effluent is clear.
• Activated charcoal 50 g may be administered via the tube once lavage completes.

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 Practical No.31
Examination of Urine
Significance
The examination of urine is important in,
In Cases of Poisoning
In Cases of Venereal Diseases
(Sexually Transmitted Diseases)
Source
The urine is to be collected both in living as well as dead.
In living Cases
After authority and consent urine is collected after introducing catheter,
In Venereal Diseases
Sterilised containers are used for the culture both male & female separately,
If the bacteria are identical, it is then considered to be the evidence of transfer of disease from
one another.
In Cases of Poisoning
For example in Alcohol poisoning, urine is collected in a clean container, and after collecting
urine, it should be kept air tight to prevent evaporation.
In Dead Bodies
Either the urine is collected with the help of wide bore needle from supra-pubic puncture,
Or open the blabber and with the help of disposable syringe and urine is collected.

Nails and Nail Scrapings

Collection
The nail scrapings may be in
• Wet State
• Dry State
If wet allow it to dry,
Then carefully remove it with the help of blunt scalpel.
The other method is to cut the nails and collect the scrapings.
In Cases of Chronic Poisoning
The metabolism of poisons is close to the root of nail.

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In Living Persons
If we want to collect specimens of nails in livings, then margins are marked with special marker,
Nail is allowed to grow, when it reaches the tip of finger, then it is cut.
In Dead Body
The whole nails are pulled out.
Despatch of Clothes
The clothes must be carefully examined before despatching to the concerned lab.
They should be examined by,
Naked Eye Examination,
Examination by Hand Lens,
Examination under Ultra Violet Lamp,
The Stained area may have peculiar touch and odour,
The clothes are signed, and stained areas are marked,
Then each cloth is packed in separate plastic bag.

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 Practical No.32
MARGIN OF SAFETY

Definition:

The difference between the usual effective dose & the dose that cause severe or life-
threatening side effects is called the margin of safety.

Principle:
The margin of safety of a drug is a concept that tells you how safely we can use a drug for
therapeutic purpose without risking too many adverse effects at the same time.

Formula:

T1 = LD50 / ED 50
T1= Therapeutic index
LD50= which is the lethal dose in 50% of people
ED50= effective dose in 50% of people

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 Practical No.33
ALUMINUM PHOSPHIDE / WHEAT PILL POISONING

INTRODUCTION
Wheat pills are used as fumigant for pest control. Wheat pills and its active ingredient aluminum
phosphide is one of the emerging causes of poisoning. Mechanism of action involves phosphine gas
which is released when the pill comes in contact with moisture or stomach acid (HCL), the
resulting free-radicals damage the mitochondria. Cardiovascular system is most severely affected
with various presentations, including cardiac failure, arrhythmia and eventually shock. Other
symptoms include Acute Respiratory distress syndrome, Coma and Convulsion.

PROCEDURE
• Take 5ml of distill water and add crushed wheat pill to make a solution.
• Add few drops of HCL to this solution for reaction to happen and generation of phosphine
gas.
• Now take cotton and add few drops of silver nitrate.
• Place cotton in a lid and close it over the test tube containing the solution.
• Wait for 5 min you will notice Grayish –black discoloration of cotton.
[

• This discoloration of cotton is due to the reaction of phosphine gas with silver nitrate.
PRECAUTIONS
• Phosphine is a protoplasmic poison, if inhaled can cause serious injuries.
• Always use gloves, place should be well ventilated & Dry.
• Avoid minimal contact with the gas & discard the solution immediately.
• In case of any injury wash your eyes & hand thoroughly & immediately move to well ventilated
place.

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 Forensic Toxicology

POISONS IN FORENSIC LABORATORY

1. Nux Vomica (Strychnine)
Spinal poison, acts mainly on anterior horn cells. It causes convulsions. Death is incredibly
painful.
Fatal Dose: Undamaged seed is not fatal
Powdered Nux vomica: 2 grams
Strychnine: 15-30 mg
Fatal Period: 1-2 hours

2. Cuso4
Exhibition poison, Irritant
Metallic taste
Fatal Dose: 30 gm
Fatal Period: 12-24 Hours

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3. Red Chili powder
Plant Irritant
Road Poison, used in road poisoning
Used by Police to extort confessions

4. Seeds of Rati or Arbus Precatorius

Irritant Poison: also called Sui Poison, used to kill cattle by making needles along by
mixing other poisons.
1 Rati = 1 Seed (unit of measurement)
Fatal Dose: 1-2 seeds
Fatal Period: 3-5 days

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5. Root of Aconite
Meetha Zeher
Cardiac Poison, also causes periodic constriction and dilatation of pupil
Fatal dose: 1 gm of root
250 mg of extract
Fatal Period: 6 Hours
6. Root of Aconite
Meetha Zeher
Cardiac Poison, also causes periodic constriction and dilatation of pupil
Fatal dose: 1 gm of root
250 mg of extract
Fatal Period: 6 Hours

7. Jamal Gota
Causes purgation
Fatal dose: 20 drops of oil or 4 seeds
Fatal period: 4-6 Hours

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8. Mercury
Heavy metal
Chronic poisoning is significant
Mercuria lentis: Deposition of mercury in lens of eye
Hatter’s shake: Tremors
Erethism: Personality disorder
F.D: 1-2 gms

9. Arsenic
Heavy metal
Ideal homicidal poison
Acute poisoning: vomiting and purgation, Clinical manifestations simulate Cholera
M.O.A: Sulfhydral enzyme blocked
Chronic poisoning: skin, neurological manifestations, rain drop pigmentation, hyper keratosis
Fatal Dose: 120-200 mg
Fatal Period: 24 hours

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10. Poppy/Opium Fruit
Somniferous poison

Labored breathing

Constricted pupil
Fatal Dose: 2 gm
Morphine (extract): 200 mg

11. Methyl Alcohol

Ophthalmotoxic: Causes loss of vision, Leading to blindness, 15ml causes blindness
Fatal Dose: 60-240 ml
Fatal Period: up to 4 days

12. Marking nut

Abortificant
False bruises
Used by dhobis

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13. Nitric Acid
Toxic to Respiratory tract, causes violent coughing
Causes Xanthoproteic reaction because of production of picric acid on organic, live tissue
Also used to differentiate gold from other metals, dissolves all metals except gold.
Fatal Dose: 15-20 ml
Fatal Period: 18 hours

14. Acetic Acid

Vegetables poison
Fatal Dose: 60 ml
Fatal Period: 48 Hours

15. Sulfuric acid

Battery acid
Strong corrosive having strong hygroscopic effect used for Vitriolage (Acid attacks)

16. Oxalic Acid

Organic poison used in locally corrosive detergents also has system effects causes hypocalcaemia
because it causes calcium oxalate crystals. Seen as envelope shaped crystals in urine under
microscope.
Fatal Dose: 15-20 gms
Fatal Period: 1-2 hours

17. Chloroform:
Anesthetic
Fatal Dose: 30 ml by mouth
Fatal Period: ½ hour

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