EXAMINATION OF A INJURED

PERSON

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 WHAT IS AN INJURY REPORT?
 Injury report is a kind of medicolegal report.
 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.
 INJURY CERTIFICATE
1.MLC No.: ___________

2.Name: ___________________________________________________

3. Age: _________ years

4 . Sex: ______
5. Address: _________

6 .Occupation: _____________________________________________

7. Brought by: ______________________________________________

8. Date, place and time of examination: ___________________________

9.Examined in presence of: ____________________________________

10.Consent: __________________________________________________

11. Signature:
Of Examinee In presence of

12.Identification marks: 1.__________________ 2. ___________________

13.Brief history of the case:

14.General Examination
• Built: Height Weight
15.Systemic Examination: ___________________

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Sl no. Type of Site of Size of Nature Type of Age of Remarks
injury Injury Injury of inflicting injury
1 Injury weapon
2 3 4 5 6 7 8

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 IDENTIFICATION MARKS
 Two identification marks must be taken.
 They are necessary to identify the person in court
One identification mark is more likely to lead to
mistaken identification, as it can be duplicated in
another person. Two identification marks are less
likely to lead to errors.
 They should be on exposed parts, and not on
hidden parts, so patient faces no embarrassment in
court where these marks may be tallied.
 IDENTIFICATION MARK

Black mole present over left cheek, 8 cm

front of left ear, 6 cm outer to left angle of
mouth, 0.3cm in diameter, hairy, slightly
raised above the surface.

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GENERAL CONDITION OF THE PATIENT
 Whether the patient is conscious or unconscious.
 If conscious, whether anxious, tense, afraid,
agitated.
 Bleeding from nostrils, ears, mouth, other natural
orifices (vagina in case of sexual assault, anus in
the case of buggery).
 Pulse rate, blood pressure, temperature, whether
in a state of shock, paralyzed or not.
 If the police wants a statement from the victim,
the doctor must first certify that the patient is
compos mentis.

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 1.Serial Number
1,2,3…

• First column is for serial number of

injuries.

• A look at this column informs about

total number of injuries over the body.
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 2. Type of injury
Stab injury
[Example]

This column is for recording the type of injury

whether it is an -
abrasion/contusion/laceration/ incised wound/
stab wound/chop wound / firearm wound/
fracture/ ………. etc.
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 TYPE OF EACH INJURY

 (1) All injuries, however insignificant they may

appear, should be recorded. Proper, adequate, and
complete documentation is very necessary for all
medicolegal work.
 Remember the maxim: Legally, only those injuries
are present that have been recorded. Whatever has
not been recorded was not present.
 Similarly, whatever procedures have been recorded
were performed; whatever was not recorded was
not performed.
 If necessary, photographic documentation should
be performed. Although this is a common practice
in the West, it has not yet caught on in India
  (2) Even old injuries should be recorded.
 (3) Type of each injury (e.g. whether it is an
abrasion, contusion, laceration, incised wound,
stab, burn, scald, fracture, dislocation of tooth
etc.) should be noted.
 (4) Systematic entries - In order not to miss any
injury, a systematic plan should be adopted. The
best is to go round the patient in this manner; start
with head and neck → right upper limb → right
lower limb → left lower limb → left upper limb →
front of the chest and abdomen → genitalia →
back of chest and abdomen.
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 5) Lens must be used in order to be able to
differentiate between incised and incised looking
lacerated wounds, or for noting other minute
details such as singeing of hairs around firearm
entry wounds.
 (6) Presence of any foreign material - (i) Note
presence on the body or within the wound e.g.
broken off point of a knife, bullets, coal, dirt, dust,
fibers, glass, grass, gravel, grease, hair, metal, mud,
oil, paint, pellets, powder, sand, shots, splinter of
wood, synthetic materials, wads etc.,
 These can often help identify the weapon, and
indicate the manner in which injury was inflicted
(e.g. Tip of a stabbing weapon may sometimes
break when it strikes a bone [sternum, rib, skull, or
when it gets lodged in a vertebra].
 MIXED INJURIES
 Contused abrasion

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3. Site of injury
Front of chest on left side,
1 cm below nipple, 7 cm left to midline.
[Example]

•This column is for recording the exact location of

injury.

• Measurement should be taken from at least two

anatomical landmark.
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 On what part of the body inflicted

 (1) Exact location of the injury in relation to

important landmarks (e.g. midline, navel, nipple,
outer canthus of the eye, a joint, a bony structure
[e.g. knuckle]) should be noted. Distance from
landmarks should be noted.

 (2) Avoid technical terms as far as possible (e.g.

instead of writing "medial malleolus", write "inner
bony prominence of the ankle"). There is nothing
wrong in writing technical terms, and if the doctor
cannot think of a suitable common name, he can
use technical terms too.
  Writing in layman's language makes it more
comprehensible to judges and lawyers. A good
alternative is to use the technical term and then
common name within brackets, e.g. "Right
anterior superior iliac spine (bony prominence on
the right side of the waist)".
 (3) Concealed wounds - If the patient is
unconscious (i.e. can't point to areas of pain), a
careful search must be made for wounds in areas
such as ears, nostrils, vagina, rectum, etc.
 Surgical wounds-reffered cases.
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4. SIZE OF INJURY
4.5 cm × 2 cm × chest cavity deep; both margins clean
cut; both ends acute.
[example]

• This column is to write down the size of injury.

• Normally any injury has three dimensions, length,
width and depth but abrasion and contusion are to be
described in two dimensions.
• The size should be measured and no guess work
should ever be done.
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 Size, shape and direction of each injury

 (1) Size of each injury should be noted, after

measuring them with a ruler. No reliance should
be made on guesswork.:homicide-non accessible
 (2) Shape of injuries - whether linear, triangular,
circular, elliptical, oval, irregular or any peculiar
shape. :weapon
 (3) Direction of wounds - Whether horizontal,
vertical, oblique or in any particular direction.
Relationship with an organ is desirable (e.g.
directed toward the heart, or away from the heart).
Beveling of edges is particularly helpful in
determining this.
 (4) Labeled sketches of all injuries should be
made. This helps lay persons like judges and
lawyers to understand the injuries better.
Cut Laceration
5. NATURE OF INJURY
Grievous

• This column is to point out the nature of injury.

• Legally injuries are of two types.
• They are:Simple injury ,Grievous injury
• Any injury that poses an imminent danger to the
life of a person is termed as dangerous injury.
• It is the treating physician or the autopsy surgeon
that has to decide the nature of a particular injury
depending upon its type, site and involvement
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 Nature of each injury

 (1) Against each injury, its nature should be noted

(e.g. simple, grievous or dangerous)
 (2) If nature of injury is not immediately
apparent, patient must be kept under observation
and following entry made in the relevant column
"patient under observation." Similarly, if X-rays or
other investigations have been ordered and their
reports awaited, following entry should be made
"Awaiting X-ray report."
  Patient may have to be kept under observation in
obscure head or abdominal injuries. After
observation period is over, or when the lab reports
and X-reports have come, and the doctor is ready
to opine on nature of injuries, they could be given
on a separate piece of paper. This is called
"subsequent opinion." Many hospitals have
dedicated forms for giving such opinion. All
precautions must be made as in the original injury
report, e.g. making in duplicate, taking police
official's signatures, etc., Serial number should be
same as in the original MLC.
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6. Type of inflicting Weapon
Double edged sharp cutting weapon with a pointed
tip
[example]
• Depending upon the type of injury, the possible
weapon/s that can produce the injury is to be
mentioned in this column.
• One doesn’t have to name a particular weapon
like sword/ lathi /knife etc.
• The opinion that can be given is that the type of
inflicting weapon could be hard and blunt/sharp
cutting/heat/cold etc
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 By what weapon inflicted

 Examination of wounds and clothes can indicate

the nature of the weapon - whether sharp edged or
blunt; or if sharp-edged, whether single-edged or
double-edged.

 Blunt and sharp weapons - A weapon which

when used with some force can cause fractures, is
loosely referred to as a "heavy blunt weapon".
 In the case of cranial trauma, once the forensic
doctor was shown a cricket bat in court and asked
if it was a "heavy blunt weapon"? The answer was
"yes". The lawyer asked, "if I take off 100 g from it,
would it still remain a heavy weapon"? Answer -
Yes. Q - If I take off another 100 g would it still
remain a heavy weapon?
 Answer - You can remove as much as you want.
The answer does not lie in weight. Rather if that
weapon when used with force can cause a fracture
or not. Show me such a weapon, and I will opine if
it is a "heavy blunt weapon."

 IN ANOTHER CASE, a lawyer showed the

forensic doctor a single piece of paper and asked if
it's edge was sharp.
 Answer - Yes.
 Qu. So, this means it is as deadly as a blade or
dagger because they are also sharp?
 Ans - No.
 The answer does not lie in the sharpness of the
edge but whether it can produce an incised wound.
Since the edge of the paper cannot produce an
incised wound, we cannot classify it as a "sharp
weapon".
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7. AGE OF INJURY
Fresh
The column is to note down the age of the injury
mentioned. It can be approximately inferred as
follows;
Age of abrasion
• Fresh Red
• 12-24 hours Bright red
• 1-2 days Dark red
• 2-3 days Red brown
• 3-5 days Dark brown
• 5-7 days Fall off
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 AGE OF BRUISE

Fresh- Red
Few hours to 3 days - Blue
3 – 5 days- Brown
(due to hemosiderin)
5-7 days- Green
(due to haematoidin)
7-12 days- Yellow
(due to bilirubin)

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 AGE OF LACERATED, INCISED AND STAB
WOUNDS:
Unsutured

Inflamed skin edges- Up to 24 hours

Appearance of infection- More than 36 Hrs

Sutured

Inflamed edges-Up to 24 hours

Edges easily separated-1-3 days
Edges difficult to separate- 3-7 days
Red, soft, tender scar- 1-4 weeks
Pale, firm, nontender scar- More than 4 wks
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8. REMARKS
( TREATMENT REQUIRED, X-RAY, etc)

On exploration, the wound was found to be

entering the front of lower lobe of left lung through
an injury of size 3 x 0.5 cm, 3 cm deep into the
lung tissue

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 REMARKS

 This would include entries not covered elsewhere,

e.g. condition of clothes (whether they are blood
stained or stained by other body fluids like semen,
saliva etc., torn, buttons missing, burnt etc., or
not). Whether wet, dry or show corrosion (if hot
fluid was thrown on the body [as in scalds], they
would be wet. In case of vitriolage, they would
show corrosive marks). If blood stained, or if
showing associated defects due to firearms, they
must be sent to the forensic science lab for
examination of gunshot residues (to enable
estimation of distance of fire).
• This column is for any remarks to be made by the
examining doctor. If any investigation is to be
advised, it is mentioned here and the report kept
reserved till arrival of the investigation report.
• Injuries mentioned are consistent with RTA or
ASSAULT or THE HISTORY GIVEN.
• Injuries mentioned are not consistent with RTA or
ASSAULT or THE HISTORY GIVEN.

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  Treatment given:TT,dressing,iv fluids etc
 Investgations pending.
 Referred to which speciality?

 Like all other certificates, signature/left thumb

impression of the examinee should be taken at the left
hand corner with examining doctors’ signature at the
right hand corner with seal of name and designation.

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 CLINICAL CONSIDERATIONS

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PUNCTURED WOUND
PUNCTURED WOUND
Entry Vs Exit Wound
EXIT WOUNDS In SHOT GUN INJURIES
Only if there is contact
entry wound
• Fired tangentially to
surface
• Thin parts of the body
– limbs, Neck.
• Caused by rifled slugs
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Scrotal Contusion
DEFENCE WOUND
DEFENCE WOUND
 Stab Wound

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INCISED WOUND
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 ABRASION
• Injury to skin
• Simplest
• Types
*Scratch
*Graze
*Impact/
pressure/
imprint

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Impact/imprint abr

Replica of the
Object may be
Produced

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 Imprint Abrasion – Ligature Mark

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 Throttling – Nail Marks

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 CONTUSION/BRUISE
• Also in internal Organs
• Types:
*Ectopic
*Patterned
*Come out

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 CONTUSION / BRUISE

PATTERNED
BRUISE

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 LACERATED WOUND

Tear/split of skin.
Mucus m,muscle or
internal organs
Types
*Split
*Stretch
*Avulsion
*Cut laceration

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 INCISED INJURY
Clean cut
Through tissue
Length
Margins
Width
Depth

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 Stab Wound

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 Gunshot wound

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 Gunshot wound

6 August 2016
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