Forensic Medicine and Jurisprudence Notes

Table of Contents
Introduction ....................................................................................................................................................................2
Identification ...................................................................................................................................................................3
Parameter....................................................................................................................................................................3

Primary – age and gender .......................................................................................................................................3

Secondary Characteristic .........................................................................................................................................4
Comparative data ....................................................................................................................................................4
Autopsy ...........................................................................................................................................................................5
Thanatology.....................................................................................................................................................................5
Early .............................................................................................................................................................................5
Cooling aka Algor mortis .........................................................................................................................................5
Post Mortem Hypostasis (pale) aka livor mortis or Lividity ....................................................................................5
Rigor Mortis .............................................................................................................................................................6
Late ..............................................................................................................................................................................6
Decomposition aka Putrefaction.............................................................................................................................6
Adipocere ................................................................................................................................................................6
Mummification ........................................................................................................................................................6
Wound Interpretation .....................................................................................................................................................7
Mechanical (based on force) .......................................................................................................................................7
Traumatology ..................................................................................................................................................................8
Asphyxia ..........................................................................................................................................................................9
Asphyxia ......................................................................................................................................................................9
Types ...........................................................................................................................................................................9
Hanging ...................................................................................................................................................................9
Strangulation ...........................................................................................................................................................9
Drowning .................................................................................................................................................................9
Infant death ...................................................................................................................................................................11
Definition ...................................................................................................................................................................11
Live, still or dead born? .............................................................................................................................................11
Viability......................................................................................................................................................................12
Duration of life ..........................................................................................................................................................12
Causes of death .........................................................................................................................................................12
Natural death ........................................................................................................................................................12

Unnatural death – accidental or criminal .............................................................................................................12

Introduction
OBA (40%) + OSPE (60%) → 20% Overall
LO
History, Sub classification → role in medicine health
History
Post mortem staining – determine the post mortem changes → time death
Sub branch
1) Toxicology
– Study of adverse effect of chemicals on living organism (dose, route, environment, target)
- Urine (drug presence, X infection), Blood (profile of substance influencing target), hair (rough timeline
of drug, racial bias), others
2) Forensic pathology – determine the cause of death, manners through histology, gross anatomy
3) Forensic biotechnology – DNA finger print (identification)
4) Forensic anthropology – analyse the ICTM based on remains
5) Odontology – similar to anthropology + bite mark identify
6) Serology – detect blood (Hemastix, Kastle-Meyer test, Takayama Crystal Assay, luminol test), semen and
saliva
7) Ballistic – bullet and mechanic (firearm)
8) Entomology – bug related (cycle – trace time, maggots → toxin)
9) Forensic Psychology – credit the witness
10) Forensic engineering – building and structure causing death
11) Radiology
Role
 Assist police personal to resolve medical issue (causes of death → murdered)
Identification
LO – Method to identify + forensic pathologist in mass disaster
Identification – for criminal (murder case), civil case (relationship) and after natural disaster or accident (flight)
Complete Identification - Personal, physical, family and social

Parameter
Primary – age and gender
Age
 Dentition
 Ossification of bone

Sex/gender
Cytology - Barr bodies in side of nucleus and Davidson body in neutrophil

Pelvic Girdle – female (pelvic arch angle larger in women, pelvic inlet larger)
Secondary Characteristic
1) Clothes – brand, pocket
2) Articles – accessories, watches, identity card
3) Others – hair, scar, tattoo, occupational stigmata, external particulars
4) Facial recognition – less reliable if decomposed
5) Race – using cephalic index, religion,
Comparative data
1) Dental – extraction, filling, false teeth, congenital defects, hygiene
2) Finger prints – epidermal distinct pattern (Loop, whorl, arch, composite – common to rare)

3) Lips Prints
4) DNA
Autopsy
LO
Medico-legal autopsy objectives + how to ensure and perform
Autopsy – identity, causes, time and manner
4 type
Forensic – police request – ICTM
Pathologic, fetal – family request – CTM
Academic – for educational + family consent – CTM

Only forensic pathologist at Forensic Mortuary (microscopy, radiology, dissection) with permission
HX → External examination (cloth, surface, lesion) → Internal examination (Y shape – prevent disfigured and
strangulation → skulls coronal → Ribs → Removal as whole or parts) → chemical examination
Limit X answer all question and X definite diagnosis

Thanatology
Lo – Changes after death → estimate time

Immediate Early Late

 Cool (Algor mortis)
 Pale  Mummification
 Insensibility
 Loss elastic  Putrefaction
 Loss voluntary power
 Post mortem lividity  Adiopocere formation
 Rigor mortis

Early
Cooling aka Algor mortis
- Lack of cooling mechanism → body same OC as surrounding
- Loss heat by (1) Radiation (2) Conduction (3) Convection
𝑁𝑜𝑟𝑚𝑎𝑙 𝐵𝑜𝑑𝑦 𝑇𝑒𝑚𝑝.−𝑅𝑒𝑐𝑡𝑎𝑙 𝑇𝑒𝑚𝑝
- Can estimate time of death by = 𝐷𝑢𝑟𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝐷𝑒𝑎𝑡ℎ
𝑅𝑎𝑡𝑒 𝑜𝑓 𝑇𝑒𝑚𝑝 𝐹𝑎𝑙𝑙𝑖𝑛𝑔 𝑝𝑒𝑟 𝐻𝑜𝑢𝑟
- Affected by (1) Built (2) posture (3) surroundings (4) covering

Post Mortem Hypostasis (pale) aka livor mortis or Lividity

- Capillary venous dilatation → blue/red discolouration at dependable superficial area
Segmented/mottled patches Uniform distribution Fixed
Absent Present Absent Present Absent Present
< 6 hrs > 2 hrs < 12 hrs > 6 hrs < 24 hrs > 12 hrs
- Pressurized area no staining
Colour changes (drop in water better view)
1) CO poison – cherry red
2) HCN poison – brick red
3) Nitrates poison – brown
4) Phosphorus – Dark brown

Indicates
1) Death
2) Time estimation
3) Posture
4) Cause of death (colour)
Rigor Mortis
- Muscle Stiffening due to shorten fibers (↓ATP to relax muscle)
- Primary Relaxation → Rigor Mortis → Secondary Relaxation
- Smaller muscle experience earlier than larger muscle
Rigor Mortis Secondary Relaxation
Small (Upper limbs) 2 hrs 24 hrs
Large (Lower limbs) 6 hrs 48 hrs
- Factor affecting: age, nature of death, muscular built, atmosphere
- Indicates death and time
Cadeveric spasm – rigor mortis process without primary relaxation (hold something before death)

Late
Decomposition aka Putrefaction
- Autolysis by bacterial enzyme (Clostridium Welchi, Strep, Staph, Bacillus Proteus)
- Need optimum temperature (10 – 40 OC)
Changes
1) Colour changes (Greenish discolouration)
- Due to Binding of H2S with Hb → Sulphmethemoglobin (bacteria in gut)
- Ceacum (rt iliac fossa) turn green first → spreading through venous blood (marbling of vein)
2) Liquefaction
- Colliquative putrefaction – gangrenous semi-solid fall off from bone
- Skin slippage
3) Evolution of gases
- Reduction of protein and carbohydrate by bacteria → blisters, blebs or distension
- Prostate and Uterus decompose last
Adipocere
- Extreme cold (< 0OC) + humidity
- Gradual hydrolysis and hydrogenation of fats → fatty acid → saponification with Ca2+ and ammonium
→ insoluble soap and wax (sweet scent)
Fresh Old
Soft Hard/Brittle
Moist Dry
White Yellowish
- Good Preservation → Identification, Time and Cause of death

Mummification
- Extreme hot (> 40OC) + dry
- Dehydration → Dry, thin, brittle, leathery brown

Entomology of Cadever (Maggots)

- use maggots to determine time of
death

Other methods
- Clues from pockets and
surroundings like watch, tickets, newspaper
 Wound Interpretation
Wound – break in epidermis
Ulcer – break in epidermis = wound
Injury – illegal harm to a person + break in epidermis (body, reputation, property and mind)

Type – mechanical, chemical, thermal and electric

Mechanical (based on force)
1) Abrasion – destruct skin involve superficial layer (scratch - assault, pressure, grazed, imprint)

Graved – movement with skin heaped up at end → indicate direction (face → alcoholics)

Shoe print → assault

Pressure – crushing superficial layer Impact – perpendicular impact with object (marks) → pressure
Fresh (current) → bright scab (1-2 days) → reddish brown scab (2-3 days)

2) Contusion – effusion of blood into tissue (trauma)

affect by age, gender, and skin colour
- Imprinting/impact contusion
- Anterior cranial fossa
(periorbital ecchymoses), posterior cranial fossa (battle signs), middle
cranial fossa (ear bleed)

Time Fresh 2 hrs – 3 day 4 day 5-6 day 7-12 day 2 weeks

Substances OxyHb DeoxyHb Hematosiderin Hematodin Bilirubin Normal

Colour

3) Laceration – blunt force tear (loss elastic) from epidermis until muscle
 Irregular tearing and irregular depth → less bleeding
 Split laceration – skin crushed between two objects → avulsed (severe
loss of epidermis)
4) Incised wound – clean cut with sharps → length > depth
 Smaller area → stab wound (asc with knife length & depth, shape)
 Penetrate into cavity → penetrating wound
 Penetrate across body → Perforating wound
 Superficial at accessible parts of body → hesitant cut (suicidal)
 Area protect body → defence wound
 Superficial and scratch like → fabricated wound (stopping and extension
of superficial wound – person falsifying wound)
 Chop – long weapon cut on skull
 5) Ballistic science
- Rifling (use diameter of barrel, bullet have stripes), shotgun (use gauge/pellet, multiple hit)
- Ballistic wound (burnt abrasion collar – entry, bleeding – exit)
- Irregular wound (contact) → circular + stripling/tattooing (around entry – rifling, dispersed – shotgun)
→ circular clean surround (distant/wide dispersed for shotgun)

Traumatology
LO
1) Skull fracture and types
2) Injuries on different parts
3) Manners of injuries – physical, electrical and thermal

Skull fracture type

1) Fissure – crack on skull
2) Sutural – fissure at skull suture line
3) Mosaic or comminuted – multiple pieces
4) Depressed – indent fracture
5) Ring – usually at base of posterior fossa around foramen magnum + compression fracture (jumping)
6) Pond – wide indentation
Intracranial hemorrhages
1) Extradural hematoma – damaged middle meningeal artery + lucid interval
2) Subdural hematoma – Damaged bridging veins (between dura and skull)
3) Subarachnoid haemorrhage – Circle of Willis (Berry aneurysm)/arteriovenous malformation (need lumbar
puncture to confirm)
4) Intracerebral haemorrhage – damage of intracerebral arteries by HTN

Manner of injuries
1) Motor Cycle Injuries – double injury (head + brachial plexus torn + sprain)
2) Boxers Injuries – punch-drunk syndrome (repeated cerebral concussion) + intracerebral haemorrhages
3) Fall from height (laceration and fracture on dependable site)
4) Train – decapitation + oil and grease stain
5) Road traffic accident
- primary and secondary impact injuries
- Whiplash injuries – sudden brake driver → excessive flex or extend neck → torn intervertebral
ligament and compressed spinal cord
- Concussion of brain – primary impact (coup) and secondary impact (countrecoup)
- Diffuse axonal injuries – altered behaviour and mental status
- Seat belt injuries – imprinting abrasion
6) Burns – Calculate burned area by summation and rules of nines
- Classified using Dupuytren’s classification for adult
- Heat fracture (post mortem) + trachea with soot particle, inflammation of skin, curling ulcer (person
alive during burn)
- Scalds (hot water burn) → abuse children

7) Electric Injuries – Joule burn (hardening with darken entry, reddish exit) → flash burn(crocodile
appearance), Fern pattern/filigree burn (lightning) → mostly cardiac death (coagulated protein by heat and
electric → affecting muscle shortening (flexion > extension)
Asphyxia
LO
1) Signs, types and mechanism of asphyxia
2) Manual Strangulation vs Hanging
3) Drowning

Asphyxia
- Physical barrier prevent air enter lungs → lack of oxygen
- ↑Effort to breathe, face congest and cyanosed → depth breathe + chest heave → loss conscious +
stool and urine incontinence → shallow rapid breathing → Permanent brain damage (pupil dilate)
- Sx – Cyanosed, Petechial haemorrhages, blood fluidity – X clotted (oedema), organ congestion
Types
Suffocation - ↓O2 in inspired air
Smothering – Blocked external orifices
Gagging/ Chocking – Blocked internal airway (drunk gasping)
Traumatic Asphyxia – Restricted chest movement (earthquake)
CO poisoning – impaired O2 transport
Cyanide Poisoning – impaired O2 utilized (intentional or accidental)
Hanging
- Ligature strangulation which body act as weight
- Cause of death
1) Airway obstruct
2) Venous congestion
3) Cerebral hypoxia
4) Fracture/dislocation of cervical vertebrae
- X bleeding in strap muscle
Complete/Judicial Hang Partial/Suicidal Hang
Highly suspend from the ground Low point of suspension (touch ground)
Sloping and round Oblique ligature mark
Judicial Suicidal
X asphyxial changes Asphyxial changes (less)
Cervical spine fractured Rarely fractured
Strangulation
- Classical asphyxia changes can be seen early
- Cause of death
1) Jugular vein and carotid arteries compressed → carotid sinus simulation
2) Larynx and tongue → airway obstruct
Manual/Throattling Ligature
Homicidal (Strong to weak) Constricting band around neck
External abrasion, disc finger-tip bruises and linear Abrasion (Struggling), mark of material, head &
nail scratches neck oedema, cyanosed, petechiae
neck bleed, laryngeal injury on thyroid cartilage and Localized injuries and haemorrhages, cartilage less
hyoid bone horns (less in carotid sinus death) likely injuries
1) Cerebral Hypoxia
2) Anoxic Anoxia
Reflex Cardiac Inhibition

Drowning
- Not necessary death of drowning if found
- Immersion signs – wrinkled pale finger (Washerwomen finger) → maceration and peeling (1-2 weeks),
cutis anserina (erector pili contract), decomposition (floating)
- (Hypotonic water) Water enter lung, alveoli then blood → RBC lyse → ↑K+ → Sudden death;
(Hypertonic water) Water in alveoli draw plasma → ↑Na+ & K+ + hypovolemia
- Examination: Mouth, nostril, trachea and bronchi froth, distended spongy lung, pleural and pulmonary
edema and bleed, Inner ear bleed, cadaveric spasm
Dry drowning aka submersion
- Cardiac arrest → fall into water → simulation of sensitive area → reflex mechanism → larynx
pharyngeal close → X water in lung
MMS
Postmortem – chicken fat, easily srubbed
Antemortem – line of Zans and fibrin
Sudden natural death – die within 24 hours without previous episode
Declaring death → certification of causes of death (medical officer or autopsy) → death certificate
Life born – lung expand, floating,
Death born – maceration of fetus
Spalding sign
𝐿
Haase rule (<25 cm √𝐿, >25 cm 𝑆 ) → > 28 wks abortion is illegal as count as viable baby

Infant death
Definition
Infanticide – illegal destruction of child < 1 y/o
Foeticide – kill foetus before birth
Filicide – child killing by parents
Neonaticide – killing of child <24 hrs after birth

Question to explore for infant death

1) Live/Still/dead borne
2) Viability
3) Duration of live
4) Causes of death

Live, still or dead born?

Dead borne (dead in utero)
- Showed sign of rigor mortis, maceration, mummification
- Maceration (softening, >24hrs in utero) – Skin slipping leaving greasy area (>12hrs) →Blebbing, serous
membrane and abdomen reddish fluid → bone and skull hypermotility, detached → edematous
change of body (uterus and lung last)
- Degeneration of cerebrum → ↓space → loss of alignment → overriding of skull (Spalding sign, days to
wks yet earlier in vertex/cephalic position)
- Mummification – happened if X air, blood supply from uterus & oligohydramnion
Still borne vs live borne
- Still borne - >28 wks, X sign of living during birth; Live borne – sign of life when parts of body out from
mother but may show apnea
- Still borne will undergo putrefaction from outside due to sterile of inside and external exposure which
reversed in live birth. Still birth is caused by natural causes like prolonged labour while live borne
caused by unnatural and homicidal causes → medicolegal issues
- Both can be differentiated by signs of breathing (Below), blood, GI and umbilical cord
- Sign suggestive of live birth – expanded lung, edematous, presence of alveolar duct membrane and
contusion of lungs, pulmonary atelectasis, caput succedaneum

- Lung: volume, margin, consistency, colour, air vesicle, hydrostatic test

 - Hydrostatic test – compare floating with liver → squeeze air with weight (float with residual volume) →
rub with finger beside ear for degree of respiration (frequency + amount of creps)
- Microscopy – before 5 months (sac with amnion, columnar/cuboidal), full term (atelectics narrowed
gland like) and live (air sac)
- Blood changes – amount (↑after birth)
- Static/Fodere test (↑body wt in live), Ploucquet test (X2 lung wt in live) → ↑blood and lung air
- Gastric – X breathe (mucus), live birth (meconium, blood, bubbles, mucus), live for a time (milk)

Viability
– physical ability to live with maternal separation after birth, normally 180 – 210 days (25-30wks)
- Technically 28 weeks as in accordant with still birth definition
Duration of life
- Umbilicus cord can be used to estimate death
for after birth and manner of death in uterus
- Respiratory sound type
1) In the womb – vagitus uterinus (natural death)
2) In vagina – vagitus vaginalis (natural death)
3) Protrude from outlet
- Embryological development
1) Ductus venous – 4th day
2) Ductus arteriosus – 10th day
3) Foramen ovale – 2-3 month

Causes of death
Sign of struggle
Lung congestion/incomplete expansion (dark blood, clots → cyanosed, expanded lung due to edema, obstruction,
emphysema) → venous congestion (tardive spot in pericardium, pleura, thymus → liver congestion → bowel
distension → ascites → retroperitoneal oedema)
Natural death
1) Congenital disease – premature, mal-formation
2) Trauma – accidental separation, contusion, haemorrhage, birth trauma
3) Placental disorder – pre-eclamptic toxiaemia, placental previa
4) Infection – syphilis, neonatal infection
Unnatural death – accidental or criminal
1) Accidental
During birth – prolonged labour, pressure on cord, cord around neck, maternal injuries
Post partum – suffocation, precipitate labour (quicken delivery, may be infanticide)
2) Criminal – act of commission or omission
Act of commission – act to kill infant (suffocate, strangulate, drowning, burning, injury, poison)
Act of omission – X take precaution to save child (fail to assist in labour, fail clear air passage, fail tie cord, fail
protect from heat or cold, fail to supply food)
Repeated injury or abuse of infant – Battered baby syndrome; violent abuse by shaking – Shaken baby syndrome →
infant whiplash injuries; abuse on smallest child – Cinderella syndrome
Munchausen’s Syndrome by Proxy – parents falsify infant symptoms

Forensic Science
Blood
1) Appearance of blood – arterial/venous, height and direction (higher → larger drops, !-shape indicates
direction)
2) Collection
3) Presumption testing (TMB, Phenolphthalein, LMG, florescence – luminol/fluoresin)
4) Confirmatory test – Takayama/ Teichmann tests (crystals), spectroscopic (Hb wavelength)
5) Species – antibodies to human blood (precipitin ring test), microscopy (unnucleated, biconcave)
6) Blood grouping, gender (davidson body, barr body), age (fetal Hb)
7) Ante or post mortem (clotted vs powder) – D-dimer

DNA profiling
1) Collection of samples (mucus, semen, blood)
2) Cooling and PCR
3) Restriction Fragment Length Polymorphism/short tandem repeat
Other fluid
1) Saliva – mixed with starch → X dark blue with iodine
2) Semen – acid phosphatase → purple with alfa naphthyl (semen may mix with vaginal fluid showing positive
acid phosphatase test), microscopy for sperm, prostate specific antigen and DNA profiling
Sample of toxicology
1) Stomach content
2) Faeces
3) Biopsy from organs
4) Nair and hair (store drug a long time)

Psychology
Symptoms
Delusion
– False belief → not fact but believe even shown to him
1) Grandeur – think he rich
2) Poverty – think he poor
3) Persecution – think he is stalked or assassinate
4) Reference – think everything is referred to him
5) Influence – think external source control his action
6) Infidelity – think spouse betray him (Othello’s syndrome)
7) Self-approach – think he responsible of everything happening
8) Nihilistic – think he has no live (He is not living)
9) Erotomania – think female is in love with them

Hallucination
- False sense of perception without source
1) Auditory → content always the same
2) Visual
 3) Olfactory
4) Tactile hallucination (formication) – in cocaine poisoning → ant crawling on body → scratch marks

Illusion
- False interpretation of reality (rope interpret as snake)

Obsession
- Involuntary Irrational idea constantly raise up in mind though he tried to throw away
- Follow with compulsion (action)
- Washers (afraid of contamination - keep wash or with pattern), checkers (keep checking something),
sinners/doubter (terrible thing happened), counters/arrangers (superstitious about number, colour),
hoarders (X throw everything away)

Impulse
- Sudden drive to persuade person to act out ??? similar to compulsion??
1) Kleptomania – drive to steal
2) Mutilomania – drive to harming animal → human
3) Dipsomania – drive to drink alcohol
4) Pyromania – drive to burn building

Phobia – irrational fear of object or situation

1) Claustrophobia – fear of crowded space
2) Agrophobia – fear of open space

Restraint of insane
1) Immediate restraint – person is critical and dangerous to self and community
2) Voluntary basis – self-admitted patient of psychiatric disorder
3) Reception of order – specialist or court order to restraint patient

Feigned insanity
1) Sudden onset
2) Has motive or planning
3) Clinical feature present when observed + can control
4) Sx keep change
5) Easily exhausted
6) Resist multiple examination
7) Good hygiene
8) Fast recovery

Civil responsibility
1) Contract, evidence, consent and testamentary capacity – person is eligible to present as witnesses (most
psychiatric disorder has normal period lucid internal)
** Mac Naughten rule – criminal only. If has mental ill (unsound of mind), nothing is offense as he is incapable to
understand his action to be right/wrong

Sexual offense
1) Natural – vaginal penetration (rape, incest)
2) Unnatural – anal or oral penetration (homosexuality, bestiality)
3) Sexual perversions – sexual action without penetration (fetishism, transvestism)

Rape (Natural)
– when sexual intercourse is done under conditions: without/invalid (forced & mentally ill) consent, against will,
under 16 yrs (involve slight penetration of vulva) → 5-20 imprisonment
**Marriage – implied consent on sexual intercourse (impotent marriage not account as consummation of marriage)
1) Gang rape
2) Prison rape
 3) Acquaintance rape
4) Statuary rape – sex with underage (<16) person
Examination of Victim
1) General procedure (police requisition, informed consent)
- Hx → medical illness, menstrual, assault (when, how, where)
- Rape trauma syndrome = post-traumatic stress disorder
2) General examination
- Clothes – struggle marks, stains, tears
- Body – external injuries (often in adult), scratches on back and forearm
- Bite mark – breast, inner thigh or back → DNA profiling
3) Genital Examination
- Cervical – semen (acid phosphatase or microscopy) → DNA profiling, confirmation of rape
4) Collection – hair, nail, skin, oral/genital, rectal/anal
Examination of accused
1) General procedure (police requisition, informed consent)
2) General examination – similar to above
3) Genital examination – development of genitalia → prove eligible to have sex, swabs (have vaginal
epithelium → +ve lugol’s iodine test)

Incest
1) Oedipus complex (mom-son)
2) Electra complex (daughter-father)
3) Pharoan complex (brother-sister)

Unnatural sexual offense (punished with 377)

1) Sodomy – anal sex → dilated, pain, laceration and bleeding (anal matter and smell on genitalia)
2) Buccal coitus – oral sex

Sexual Perversion
- Persistent indulged sexual acts without penetration and consent
1) Sadism – lust murder (murder → stimuli to sex)
2) Masochism
3) Fetichism – Necrophilia (sex with dead), Necrophagia (eating dead), Transvestism (clothing as opposite sex),
voyeurism (satisfied after looking sexual object/acts), Exhibition (satisfied by exposure private part in
public), Frotteurism (satisfied by rubbing against people in crowd)

Toxicology
LO – Poison types, post-mortem features, role of doctors

Poison (Smell)
1) Rotten egg smell – Hydrogen sulphide
2) Fishy smell – ZnPO4, Opium
3) Onion smell – Phosphorus, Arsenic
4) Fruity – ethanol, nitrates
5) Kerosene – Organophosphate, Agriculture poison

Snake
Basic anatomy
1) Fangs is hallow for poisonous snake to allow venom to pass through
2) Parotid gland is modified to poison sac in poisonous snake
3) Viper (triangle with brown tan spot pattern), cobra (fanning of neck with distinctive pattern on back), krait
(banded scales), sea snake (banded flat tail)
Venom
1) Neurotoxin (cobra, krait) – absorbed through blood stream (splitting on cornea in cobra), ptosis
2) Hemotoxin (viper) – absorbed through lymphatic, bleeding → internal bleeding → hypovolemic
3) Myotoxin (sea snake) – gangrene change of muscle → rhabdomyosis + septicemia

Drug
Cannabis
- mainly use for rope industry
- various preparations modified contain tetrahydrocannabinol (THC) – active ingredient (Ganja,
Marjuana, Hashish, Bhemg)
- THC is powdered and mixed into cigarette (Ganja) → joint
- Can be ingested (marjun or bhemg)
- become drug (C. Indica (medical) – pain killer, resilient, Sativa – euphoria + illusion)
- Cannibal receptor → affects pain, cognition, memory and motor → Helps in survival (promote
sufficient breathe, eat, run, pain-free and vision)

Cocaine – CRAKE (since produce ‘crake’ sound when smoking), snow, white lady, coke
- Derived from coca leaves
- Inhaled, inject, ingest → ischemia of nose → nasal septum perforation
- Uses: anaesthetic in ear, nose, throat and analgesic in severe pain (terminal ill)
- Block DAT reuptake → ↓norepinephrine, dopamine, serotonin uptake → ↑ concentration
Opium
- Attained from poppy plant → codeine, heroine, morphine and methadone (dried seed for cooking)
- Subcutaneous injection → skin popping
- Activate Mu receptor → activate brain reward system (naloxone as antidote)
- Increase Dopamine, serotonin, noradrenaline

Metallic poisoning
1) Arsenic
- Acute (gastroenteritis like cholera) → Chronic (dark brown pigmentation, MODS, hemopoietic aplasia,
PNS pathology and Mee line)
2) Mercury
- Source: contaminated fish
- Acrodynia, pink skin (pink syndrome), Minamata disease
3) Lead
- Source: from all route (inhale and ingest for occupational)
- MOA: ↑ hemolysis, ↓heme synthesis and nerve conduction
- Sx – lead osteopathy→ shortening of limbs, basophilic stippling, lead lines
- Treated with chelating agent

4) Phosphorus
- Source: Fire crackers, fertilizers, chopsticks preparation
- Phossy jaw → phosphorus necrosis of jaw
5) Nitric acid
 - Xanthoproteic acid reaction → yellowish skin
6) Sulphuric acid
- Source: clean drain, remove kettle fur
- MOA: dehydration of tissue, coagulation, covert Hb to hematin → inflamed tongue and throat (burn
pain, swollen), Inflammed stomach with black mass
- Brown or dark
- Treatment: Demulcents, neutralize with alkali (Mg or lime water), analgesic
** Acid poisoning – X administered emesis inducing drug
7) Organophosphate
- Intermediate syndrome – Cranial nerve, PNS, diaphragm paralysis
- Delayed syndrome – muscle weakness, ↓ tone and sensation
- Chronic poisoning – muscle and tone weakness + psychiatric disorder
- Treatment – Atropine

Vitrolage (throw acid to face)

- Using HCl or H2SO4
- Permanent scarring or blind

Sx – ptosis present first

Role of doctor
1) Collect information and start management
2) If high concentration in urine→ report to police (suicidal, abuse) → MLC → collect gastric lavage wash
sample
3) Dead of toxic → collect samples from victim (urine, blood, gastric content by induced emesis) → autopsy

Medical Jurispredence
LO – courts list, procedure, physician role, function of Malaysia council, rights of medical practitioner

Courts list
Penghulu’s Court → Magistrates court → Session courts → High Courts → Appeal court → Federal court
- Higher court will have more power in term of punishment
- Subordinate court = courts < session courts

Summons – to person to be charged (> 3 times X present → warrant)

Subpoena – to person to testify evidence

Conduct money – In non-criminal cases, people who called up for subpoena needs to be paid
Oath – pledge to God or show promise to X falsify facts
Affirmation – declaration taking oath
Perjury – falsify facts

Doctor as witness – ordinary and expert

Doctor should punctual, well dress, laymen, honest

Court Procedure
Examination in Chief → cross examination (question about sampling errors) → re-examination (re-establish the
facts and question by defence lawyer)
Professional negligence
- breach in professional judgement clinically, res ipsa loquitur (things speaks for itself)
- Liability(responsible) formula – duty → breach of duty (cause harm & violate role of doctor) → direct
causation/damage → damages (claim from doctor, damage – act to harm patient)
Professional misconduct
- breach in ethical and professional conduct in term of behaviour (alcoholism, association, adultery,
advertisement)
Dying declaration: last words from dying person
Dying deposition: made before Magistrate with oath taken, more stronger
If the patient survives after Dying declaration / Dying deposition: The evidence will be taken as corroborative
evidence

Malaysian medical council

1) registry
2) medical education
3) foreign degree
4) disciplinary action

Physician duty
- On patient: preserve human life, loyal, X discrimination
- On doctor: Respect ethical relation, X entice and criticize
- Maintain secrecy (different in privileged communication – provide info to concerned authority about
interest of community and state)

Digital Autopsy
LO – background, basic procedure, advantages and limitations
Background
- Uses imaging techniques to reconstruct 3D and 2D images → multiplanar reconstruction (MPR)
- Tools used: CT, MRI, optic imaging/photogrammetry, robot (researching)
Basic Procedure
History → general examination (external inspection) → Imaging (CT, MRI) → transfer for DICOM (image colour
optimization) → 3D reconstruction → biopsy (minimal invasive autopsy) → internal examination (done of cause of
death not found)

Advantages
1) Less time taken
2) Prevent infection spread
3) Good full anatomical image → reduce procedure error and easier catch diagnosis
4) Reduce mutilation

Limitation
1) X good in external description (wound colour, real shape)
2) Expensive and not readily available