Tattoo mark

A wet mount specimen of a piece of skin showing

a black coloured tattoo depicting a hindu god

• Tattoos are designs created by multiple small puncture wounds

made through the skin with needles or penetrating tool dipped in
dye
• Permanency depends on depth of puncture and type of dye used
• They are visualized by UV light or by magnifying lens and can be
removed by dermabrasion, LASER or cryosurgery
• Commonly used dyes - India Ink and carbon(black), Vermillion and
Cinnabar(Red), Chromic acid(Green), Prussian blue & cobalt (blue)
• Medico legal importance:
1. Identification: name, race, religion, etc
2. Drug addicts may use tattoo marks to hide needle marks
3. Political affiliations
4. Sexual orientation- eg. blue bird tattoo in homosexuals and
obscene tattoos.
 Foetus

A wet mount specimen of a foetus ( Length 38cms)

• Viability of the foetus needs to be ascertained. This can be done by

estimating the Gestational Age (GA) by
• Hasse’s rule: when the length of the foetus (crown heel length)
is less than 25 cm
▪ GA (lunar months) = Square root of Crown heel length
• Morrison’s rule: when the length is greater than 25cm
▪ GA (lunar months) = Crown heel length / 5
• Medico-legal significance
1. To establish if the foetus is viable or not.
2. To calculate the gestational age of the foetus
3. To ascertain the cause of death
4. To establish the identity of the foetus
 Foamy liver

A wet mount specimen of the cut surface of the liver showing

honey comb appearance suggestive of foamy liver

• Putrefactive change seen in liver is due release of lecithinase enzyme

by clostridium welchii thereby digesting the liver parenchyma resulting
in a vesicular, foamy or honeycombed appearance
• Medicolegal importance
1. Suggestive of a late putrefactive change
2. Approximate time since death can be estimated (36-48 hours)
 Adipocere

Wet mount specimen of the hand showing yellowish,cheesy

appearance suggestive of adipocere
( modification of putrefaction)

• Adipocere (grave wax: saponification) is due to hydrolysis and

hydrogenation of body fats resulting in cheesy rancid appearance of
the body with a peculiar sweetish but disagreeable smell
• Prerequisites - abundant body fat, humid climate, still air, warm
tempreature, bacteria producing fat splitting enzymes like clostridium
welchii
• Sites – cheeks, breasts, buttocks, abdomen

• Medico-legal importance
1. Estimation of the time since death ( 3 weeks – 3 months)
2. Identification possible as facial features are preserved due to
arrest of putrefaction
3. Wounds preserved without much alteration thereby helping in
identifaction of the offending agent
 Grazed abrasion

A wet mount specimen of the skin showing grazed abrasion

• Multiple, linear, parallel placed marks with minimal spacing in

between and piling of epithelium at one end suggestive of striking
against a rough broad surface as in a road traffic accident
• Caused to due friction of the skin resulting in loss of the superficial
layers also known as brush burns
• Medico-legal significance
1. Caused due to blunt force impact
2. Direction of force applied can be ascertained based on the
piling of the epithelium
3. Foreign bodies found in the wound can be matched with the
alleged site of the incident
4. Time since injury can be known based on the healing
 Rupture of liver

A wet mount specimen of the liver showing multiple

lacerations over the superior and anterior surfaces

• Liver is involved quite commonly due to its large size, relatively

fixed position and solid consistency. Anterior and lateral
aspects are most commonly affected due to blunt force trauma
to the abdomen
• Causes – blow or kick to abdomen, crushing motor accidents
• Types of liver lacerations
1. Transcapsular
2. Subcapsular
3. Non-communicating central lacerations
4. Coronal laceration over the superior surface
5. Laceration over the inferior surface
6. Contre coup lacerations
• Medico-legal importance
• Death is usually due to haemorrhage
• Caused due to blunt force impact over the abdomen.
 Spleenic laceration

A wet mount specimen of the Spleen showing multiple

lacerations over the superior and anterior surfaces

• Spleen may be injured by compression or traction forces.

compression forces produce lacerations and rupture is usually
seen in the concave surface
• Transcapsular lacerations are more common resulting in
patterns of Y, H, or L shapes
• Death results from profuse haemorrhage
• Spaontaneous rupture seen in a diseased spleen in malaria,
kala azar, leukaemia, typhoid , etc or with associated mild
trauma
MLI – suggestive of blunt force trauma to abdomen
 Rupture of Kidney

A wet mount specimen of the kidney with

multiple lacerations over the surface

• Different types of lacerations in kidney include

1. Transcapsular
2. Subscapsular and
3. Trans renal ( tear extending from capsule to renal pelvis)

• Causes – falls, crush injury to abdomen, runoverinjuries

• Bleeding results in perinephric contusions, renal thrombosis
• Medicolegal Importance
1. Due to blunt force trauma
2. Site of impact is posterior or lateral aspect of the kidneys as
from blow to the loins
 Stab injury to the heart

A wet mount specimen of the heart showing

a penetrating stab injury to the left ventricle

• Stab injuries and lacerations involving the right side of the heart
are more dangerous as this areas exposes a wide area over the
front of the chest .
• Comparatively the thick left ventricle may restrict the bleeding in
case if injury by elastic recoiling
• Common sites of traumatic cardiac rupture – right auricle, righr
ventricle, left auricle, ventriclular septum and valves
• Medico-legal importance
1. Cause of death is due to haemorrhage (haemopericardium
and cardiac tamponade)
2. Penetrating stab injury of the heart can also be seen in road
traffic accidents where fractured ends of the ribs can
penetrate the heart
 Subendocardial haemorrhages

A wet mount specimen of the heart showing

Subendocardial haemorrhage

• Subendocardial haemorrhages are multiple flame shaped, confluent

haemorrhage on the endocardial surface of the left ventricle.
• They are also seen lateral to the interventricular septum, in adjacent
columnae carnae, opposing papillary muscles.
• Produced due to increased catecholamine production in response to
stress.
• Medicolegal importance
• Seen in non-specific conditions such as intracranial
haemorrhage, arsenic poisoning, ruptured uterus, road traffic
accidents etc
 Extradural haemorrhage

A wet mount specimen of the brain and duramater showing

haematoma on its outer surface indicative of
Extradural haemorrhage

• Also known as epidural haemorrhage

• Usually associated with linear fracture of the skull bones
• Common sites include temporo-parietal area
• Source of bleeding: Rupture of middle meningeal artery (most
common because of its location), anterior & posterior meningeal
arteries, emissary veins and dural venous sinuses
• Lucid interval (period of consciousness between two periods of
unconsciousness) is seen
• Medico-legal importance
1. Presence of lucid interval requires that any case of head injury
should be placed under observation for 24 hours to avoid a
claim of negligence on the part of the doctor
2. The condition can mimic drunkenness
3. Heat haematoma due to burns resembles the condition
 Subdural haemorrhage

A wet mount specimen of the brain with haemorrhage on the

inferior surface of the duramater indicative of subdural
haemorrhage

• Commonly seen in the extremes age of life. Could be the most

common lesion in fatal child abuse (shaken baby syndrome)
• Associated with acceleration/deceleration injuries. Maybe acute of
chronic. 50 – 100ml is fatal
• Source of bleeding - rupture of bridging or communicating veins
traversing the subdural space to drain the parasagittal sinuses.
• Medico-legal importance
• Dating of the injury can be done and can help in establishing
the time since injury ( Munro and Meritt criteria )
• Alcohol concentration can be calculated from the blood in the
subdural haematoma ( conclusive proof of the quantity
consumed)
 Subarachnoid haemorrhage

A wet mount specimen of the brain showing blood

in the subrachnoid space

• Subarachnoid haemorrhage can be due to shear stress and

rotational movement of brain which tears the bridging veins or
rupture of congenital berry aneurysm, rupture of vertebral artery or
rupture at the Circle of Willis.
• Medico-legal importance
• Seen in traumatic causes- RTA, hyperextension of the neck, assault
• Seen in certain non-traumatic cases- rupture of aneurysms
• Usually associated with subdural and extradural haemorrhages
• Blood in the CSF is diagnostic: turns to xanthochromatic yellow
pigments and phenomenon is known as xanthochromasia
 Pontine haemorrhage

A wet mount specimen showing cut section of

the Pons with haemorrhagic areas

• Source of bleeding is rupture of perforating pontine branch of the

basilar artery.
• Clinical features - pinpoint pupil, pyrexia, paraplegia(paralysis)

• Medico-legal importance
1. Traumatic causes usually have peripherally located
haemorrhage
2. Non traumatic causes usually have centrally located
haemorrhage
3. Usually fatal as vital centers are situated in the pons
 Entry gunshot wound

A wet mount specimen of the skin showing gunshot entry wound

• Skin with a defect having inverted margins and surrounding burning

of the skin/blackening/peppering/fouling with grease collar/abrasion
collar suggestive of gunshot entry wound.
• Medico-legal importance
1. Range can calculated based on burning/peppering/fouling
2. Metallic residues of the projectile may be recovered from the
skin
3. Type of firearm and number of rounds fired can be assessed
 Exit gunshot wound

A wet mount specimen of the skin showing gunshot exit wound

• Skin with a single defect having everted margins is suggestive of

gunshot exit wound
• Absence of abrasion, grease and contusion collars and tattooing are
suggestive of exit wound

• Medico-legal significance
1. Metallic residues of the projectile may be recovered from the
skin
2. Type of firearm and number of rounds fired can be assessed
 Soot in the trachea

A wet mount specimen of the trachea, larynx and part of both

bronchi, with the tracheal and bronchial lumen exposed
showing soot particles on the tracheal mucosa

• Medico-legal importance
1. It indicates that the person was alive and actively breathing the
fire or when the fire occurred (along with elevated CO
saturation).
2. Presence of soot particles should be beyond the terminal
bronchioles is a conclusive proof of antemortem burns
3. Soot may be absent even if the person was alive at the time of
fire in case of laryngeal spasm or instantaneous death
4. Helps to arrive at the cause of death
 Electrical injury of the hand

A wet mount specimen of the hand with small oval craters with
pale base and rolled out margins suggestive of joule burn
injury

• Also known as endogenous burn.

• Medico-legal importance:
1. Indicative of contact with an electrical conductor. Usually
corresponds to the entry wound.
2. Should be differentiated from the thermal burns by acro-
reaction and scanning electron microscope.
3. May be absent in cases where the skin is wet leading to
decreased resistance.
 Cirrhosis of the liver

A wet mount specimens of the cut section of the liver showing

multiple nodules indicative of cirrhosis of the liver

• Cirrhosis of the liver is seen in chronic alcoholics ( most common),

infections – Hepatitis B,C,D; biliary cirrhosis, auto immune
cirrhosis - galactosemia, certain drugs & toxins – acetaminophen,
tylenol poisons, non alcoholic fatty liver disease
• A massive haemorrhage can also follow the rupture of
oesophageal varices complicating cirrhosis of liver
• Medico-legal importance
1. Cirrhosis of liver will be evidence for cause of death due to
complications of hepatic failure
2. Sudden death
 Septic abortion

A wet mount specimen of a uterus with greenish black

discolouration and an abortion stick perforating the wall of the
suggestive of criminal or septic abortion

• Usually an adopted method to terminate illegal pregnancy involving

unskilled, semi skilled people or methods or instruments
• Abortion stick (15 – 20cm long) dipped in toxic abortifacient pastes
are used like calotrophis,nerium and plumbago roscea.
• Other illegal methods followed may be instrumentation with enem
syringe,dilatation and curettage,vaccum aspiration,electric current
passage, etc
• Organisms commonly involved are Clostridium welchii and
Clostridium tetani resulting in deaths due to
perforation,sepsis,heamorrhage etc
• Other complications – vagal inhibition, air embolism,amniotic fluid
embolism,DIC

• Medico-legal importance
• Related IPC sections 312-316
 Scorpion

Scientific name : mesobuthus tamulus ( Red scorpion)

palamnsus swammerdami ( black scorpion)

Parts – cephalothorax, abdomen, 6 segmented tail,

terminates in a bulbous enlargement called telson containig
the stinger and venom apparatus
Venom – predominantly neurotoxic, partly hemotoxic
Action – autonomic stimulant resulting in catecholamine release
Symptoms - severe pain at the bite site, hypertension, priapism
pulmonary edema, myocarditis like picture

Medicolegal Importance
1. Cause of accidental death
2. Doctor should rule out myocarditis and patent kept for
observation otherwise can be sued for negligence
 Russel’s Viper

Scientific name: Vipera russelli

Brownish, stout snake, triangular head with ‘V’ shaped mark
(apex pointing forwards), small scales on the head, rows
of diamond shaped patches, belly scales covering the
entire belly
Fangs – relatively long, channelised, hinged, erected at the
time of striking
Venom – predominantly vasculotoxic and haemotoxic
Features – local swelling with pain and tenderness immediately’
Persistent bleeding from the bite site with bleeding from gums,
heamturia, epistaxis, Spontaneous systemic hemorrhage
Death due to cardiac arrythmia and renal failure
 Common Cobra

Scientific name: naja naja Common name ( Indian cobra)

Features – Hood with monocle or spectacle mark,

3rd supralabial shield touches connects nose and eyes,
small grooved fangs, belly scales extending over the entire
abdomen
Venom – predominantly neurotoxic
Symptoms – ptosis ( earliest), drowsiness, dysarthria,
dyaphagia, convulsions, respiratory failure

Polyvalent anti snake venom – manufactured at King’s

Institute chennai,Central research Institute, Pune; Haffkin’s
Institute, Mumbai; Bengal pharmaceuticals
 Krait

Scientific name: Bungarus caeruleus

Common name ( Indian krait)

Features – bands or half rings on the back, central row

of hexagonal scales on the back, 4th infralabial
largest, undivided subcaudals, relatively small fangs
Venom – predominantly neurotoxic

Features
Local – burning pain and swelling, blood stained discharge
Systemic
preparalytic stage – vomitting, unconsciousness
Paralytic stage – ptosis, convulsions,
opthalmoplegia