CLASSIFICATION OF INJURIES AND THEIR

MEDICO-LEGAL ASPECTS.

Submitted by
Alisha Ansari and Navodita Seth
B.Sc. (H) Biomedical Science– IV Semester

Under the Guidance of

Dr. Satendra Singh and Dr. Ritu Khosla
Department of Biomedical Science

ACHARYA NARENDRA DEV COLLEGE

(University of Delhi) Govindpuri, Kalkaji,

New Delhi-110019, India

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 ACKNOWLEDGEMENT

We bow in reverence to the Almighty God whose benign benediction gave us the
required zeal for undertaking the present report work.
We are grateful to our professors Dr. Satendra Singh and Dr. Ritu Khosla for
their constant guidance, motivation and support for the work entitled
“Classification of injuries and their medico-legal aspects” of the Biomedical
department at ANDC. The door to our professors was always open whenever we
ran into a trouble spot or had any query related to the topic.
Last but not the least we owe a deep sense of gratitude to all friends, colleagues
and family for their good wishes and perseverance.

Alisha Ansari
ZO-248
Navodita Seth
ZO-228
B.Sc. (Hons) Bio Medical Science
Acharya Narendra Dev College

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 CONTENT
1. Introduction
1.1 Definition of Injury
1.2 Mechanism of Injury
2. Classification of injuries
2.1 On the basis of Causitive Factor
2.1.1 Mechanical Injury
2.1.2 Thermal Injury
2.1.3 Chemical Injury
2.1.4 Miscellaneous Injury
2.2 On the basis of Severity
2.2.1 Simple Injury
2.2.2 Grievous Injury
3. Conclusion
4. References

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 INTRODUCTION

1.1 WHAT IS AN INJURY?

In forensic science, the injuries/wounds are produced by physical violence, which
interrupt the natural continuity of any of the tissues of the living body.
According to the Indian Panel Code (IPC), Section 44; an injury is defined as any
harm caused illegally to a person’s body, mind, reputation or property.

1.2 MECHANISM OF INJURY

The body absorbs the natural forces by the flexibility and elasticity of its soft
tissues and rigid skeletal framework. Injury is caused due to the result forces which
exceeds the limit of elasticity or resistance.
Mechanism of injury (MOI) is the force or forces that cause injury when applied to
the human body. The Mechanism of Injury (MOI) refers to the way damage occur
to skin, muscles, organs and bones which helps in determining the severity of the
injury.
Forces have characteristics such as speed, size and direction. There are four factors
to consider when assessing a mechanism of injury.
– Work area factors
– Force and speed.
– Force and size.
– Direction of force.
CLASSIFICATION OF INJURIES

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2.1 Classification based on Causative Factors-
2.1.1 MECHANICAL OR PHYSICAL INJURIES
The mechanical injury is characterized as "harm to any part of the body because of
utilization of mechanical force or physical violence", like Blunt force, Sharp force
and Firearms. This harm may cause loss of tissue
Types of Mechanical Injuries

BRUISES/
CONTUSIONS

A) BLUNT FORCE INJURIES -

1) ABRASIONS
Abrasions are injuries where there is
discontinuity in the skin due to loss of superficial
epithelial layer (Epidermis) which are caused by
hard, blunt and rough objects. These are produced
as a result of blow, fall on a rough surface, slide
or being dragged in a vehicular accident, finger-
nails, thorns or teeth bite. When abrasions are
healed there is no permanent scar.

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CHARACTERISTICS OF ABRASION
 They are superficial injuries.
 They bleed slightly, though sometimes there may be only lymph
exudation.
 Large abrasion may be painful and may bleed profusely.
 The site of abrasion is site of impact
TYPES OF ABRASIONS

MEDICO-LEGAL ASPECTS OF ABRASIONS

 They indicate site of impact and direction of force.

 They may be the only external science of serious internal injury.

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  Pattern abrasions are helpful in connecting the crime with the object which
produce them.
 The age of the injury can be known.

 In open wounds, dirt, dust, grease or grit are usually present which may
connect the injuries to the scene of crime.
 Manner of injury may be known from its distribution-
 In throttling, curved abrasion due to finger-nails are found on the
neck.
 In smothering, abrasions may be seen around the mouth and the
nose.
 In sexual assaults, abrasions may be found on the breasts, genitals,
inside of the thighs and around the anus.
 Abrasions on the face or body of the assailant indicate a struggle.

CONDITION OF ABRASION BY TIME-TAKEN

TIME CONDITION
Fresh Bright Red
12 to 24 hours Lymph and blood dries up producing a bright red scab
2 to 3 days Reddish brown scab
4 to 7 days Epithelium covers the defect under the scab
After 7 days Scab dries, shrinks and falls off

ANTE-MORT EM VS POST-MORTEM -
Points Ante-mortem abrasion Postmortem abrasion
1. Site Anywhere on the body Over exposed body
prominences
2. Oozing of Lymph Present Absent
3. Scab formation Present Absent
4. Color changes Present Absent, mostly yellowish
5. Parchmentisation Absent Present

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2) BRUISES/ CONTUSIONS
A contusion is an effusion of blood into the tissue, due to rupture of
subcutaneous vessels, usually capillaries. They are caused by application of
blunt force like fist, stick, in road traffic accident hit with a hard object like
stone, fall from height, hammer etc.

CHARACTERISTICS OF BRUISES/CONTUSIONS
 Usually there is no loss of continuity of skin but maybe associated
with rasions or laceration.
 When a large blood vessel is injured, haematoma is formed. The size
varies from small pin head to large collections of blood in the
tissue.
 Due to the application of force on the skin, the underlying
subcutaneous blood vessels rupture, this causes extravasation of
blood in subcutaneous tissues. This is called ecchymosis.
MEDICO-LEGAL ASPECTS OF BRUISES/CONTUSIONS
 The bruises may be accidental, suicidal, or a homicidal in nature. Self-
inflicted bruises are rare as they are painful.
 Actually it is simple injury, but contusion of the heart may cause death.
Multiple contusions may cause death from shock and internal hemorrhage. A
contusion may contain 20 to 30 ml blood or more.
 The shape and size of bruise generally correspond to the object. So, the
weapon or object can be identified.
 The age of injury can be determined.

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  In case of fall, sand, dust, mud etc. may be found on the body.
 The manner of injury may be known from its distribution.
 .Bruises may be artificially produced to make false charges against someone.
These false bruises are produced by irritants like juices from marking nut,
etc.
CONDITION OF BRUISES/CONTUSIONS BY TIME-TAKEN
Appearance of Bruises: A superficial bruise appears at one as a dark red
discoloration. A deep bruise may take several hours to one or two days to
appear. Therefore, a second examination should be carried out two days later.

TIME CONDITION
At first Red
Few days to 3rd day Blue
4th day Bluish black to brown
5th to 6th day Greenish
7th to 12th days Yellowish
2 weeks Normal

3) LACERATIONS
Laceration is a wound in which tissues are torn due to heavy, hard and blunt
force to the body. They are also called tears or ruptures. e.g. hit by stick or
blow or in road traffic accidents.

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CHARACTERISTICS OF LACERATIONS
 It involves injury to some deeper layers and parts of body.
 There may be fracture of bones.
 Shape and size of injury do not correspond to the weapon.
 The margins are irregular, torn, swollen and contused.
 Hemorrhage is less because in these vessels are crushed and torn across,
hence they bleed less.
 Hair and hair follicles can be crushed.
TYPES OF LACERATION
1.Split
2.Stretch Laceration
3. Avulsions
4.Tears
5.Cut laceration
MEDICO-LEGAL ASPECTS OF LACERATION
 Lacerations are usually seen in accidents and assaults.
 Suicidal lacerations are rare, as they are painful.
 The type of laceration may indicate the cause of injury or the shape of
weapon.
 Foreign matter may be found in the wound, indicate the crime
circumstances.
 These are usually grievous injury.

CONDITION OF LACERATION BY TIME-TAKEN

TIME CHANGES
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Initially Bleeding
After 12-24 hours Clotting
After 18-36 hours Pus formation
After 1-2 weeks Granulation tissue
After 4-8 weeks Healing of fractures

Case study
Blunt force trauma patterns in the human skull:- a case study from
northern California.

In May 2006, law enforcement responded to a call reporting the discovery of

human remains within a grove of trees behind a rural residence in northern
California. The decomposed body, clothed in jeans and a T-shirt, had been
partially exposed from a shallow grave by scavengers. Following the recovery by
law enforcement, the remains were transferred to a medical examiner’s office in a
nearby county for autopsy. The biological profile assessment suggested the
decedent was a 20 to 35 year old White male with a stature of 5 ft, 8±3.1 in.
(173±8 cm). Sex was estimated based primarily on morphological features of the
pelvis and skull. Adult skeletal age indicators suggested an age interval of
approximately 20–35 years. There is evidence of at least two blunt impacts on the
right temporal bone (Figure 1).

Linear fractures radiate away from the first impact area, with small fracture lines
propagating in an anterior, posterior, and inferior direction. These fracture lines
extend for approximately 6 cm (anterior–posterior) and only affect the external
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table. A second, much larger fracture bisects the first fracture series indicating that
it occurred after the first impact. This fracture line propagates postero-superiorly
for approximately 5 cm and terminates at the squamosal suture. A smaller fracture
deviates from this fracture line (inferior to the squamosal suture) and travels
postero-superiorly for approximately 7 cm along the right parietal toward the
sagittal suture. The large fracture line associated with the second impact area also
propagates inferiorly, traversing the cranial base (Figure 2).

This fracture travels along the margin of the external acoustic meatus, and
terminates at the squamosal suture of the left temporal (Figure 3 ).

The second impact completely displaced the cranial base from the rest of the vault,
with fracture lines passing through the sphenoid and basilar suture region
anteriorly and the foramen magnum posteriorly (i.e., a ring fracture). The cranial
base shows evidence of an externally beveled fracture margin and plastic
deformation. The separated cranial base portion could not be reconstructed due to
the extent of plastic deformation.
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This case study highlights the blunt force mechanical injury found in the skeleton
after the autopsy of the found skeleton.
B. SHARP FORCE INJURIES -

1) INCISED-
It is a wound produced by a sharp weapon such as knife, blade, scalpel etc.
and is a clean cut through the tissue, which is longer than its depth.

CHARACTERISTICS OF INCISED
 The edges are smooth, clean cut, everted and free from contusions.
 If an incised wound is caused by a heavy weapon, the edges of the wound
may show contusion.
 The starting of incised wound (head) is deeper and it gradually becomes
shallower and tails off towards the end. The tailing off of an incised wound
shows the direction by which the weapon was drawn off.
 If the blade of the weapon enters the body obliquely, the tissues will be
visible at one margin and the other margin will be undermined (Bevelling
cut).

MEDICO-LEGAL ASPECTS OF INCISED

 It indicates the nature of weapon.
 It gives an idea about the site of impact and direction of the force.
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  The age of the injury can be determined.
 Position of wound may indicate mode of action i.e. suicidal, accidental
or homicidal.
 The homicidal incised wounds, defence incisions are present on
dorsum of hand, ulnar aspect of forearm or on the palm.
 Post Mortem incised wounds may be caused by the criminal to hide
crime or identity.

CONDITION OF BRUISES/CONTUSIONS BY TIME-TAKEN

TIME CHANGES
Fresh Haematoma formation.
12 hours The edges are red, swollen.
24 hours A scab of dried clot is seen on the
wound. Vascular buds begin to form.
36 hours The capillary network is complete.
2 to 3 days The wound is filled with fibroblasts and
capillary buds in from
the cut surface.
3 to 5 days Definite fibrils are seen, vessels show
thickening and obliteration.
1 to 2 weeks Scar is formed.

2) STAB
A stab wound is an injury, caused by a sharp pointed weapon, when the sharp
tip is thrust into the body.

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CHARACTERISTICS OF STAB
 In stab wound depth is more as compared to breadth.

 It is caused by sharp, pointed and cutting instruments such as knife,

dagger, nail, needle, spear, arrow, screw driver etc.
 Stab wounds are called penetrating wounds when they pass through
tissues, enter a body cavity like thorax or abdomen.
 A sharp, pointed, cylindrical or conical instrument may produce a
wound with circular margins.
 When puncture wound is hidden it is called concealed puncture
wound Example - puncture wound in fontanels, inner canthus of eye,
ears etc.
 Healing is usually by scarring.

MEDICO-LEGAL ASPECTS OF STAB

 Stab wounds are mostly suicidal or homicidal. Accidental wounds are rare.

 Position, number and direction of wounds may indicate mode of action that
is suicidal, accidental or homicidal.

 The shape of the wound may indicate the class and type of weapon.

 The depth of the wound will indicate the force of penetration

 Direction and dimension of the wound indicate the relative positions of the
assailant and the victim.

 The age of the injury can be determined.

Circumstances of Incised and Stab wound:

1. Accidental wounds
Usually caused by -
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 a) Fall upon a sharp edged object.
b) Impact by sharp objects e.g. glass pieces.
c) Unintentional cut or stab by sharp edged or pointed object e.g. knife, blade,
house hold appliance etc.
2. Suicidal wounds

In most of the cases, we may found -

a) Wounds are multiple, parallel, superficial in any one accessible area of the
body, such as neck, wrists and rarely on backs of legs or on chest.
b) Suicidal cut-throat wounds are usually seen above the thyroid cartilage, the
direction is from left to right. Multiple 20 to 30 wounds may be seen on the
other parts of the body. The cloths are not cut and circumstantial evidence may
be helpful.
c) Unintentional cuts are found on the fingers where the blade has been gripped.
d) More than one method may be used for suicide.
e) In right handed persons, the most severe wounds are often found on the left
side of the body.
3. Homicidal wounds
In it -
a) Multiple gaping wounds on any part of the body including back.
b) Defence wounds may be found.
c) Wounds, particularly on the breast and genitals indicate sexual offense.

Case study
Suicidal cut throat injury Case
A 32 year old male arrived at a coconut shop in a public place in the afternoon.
Coconut vendor being busy with other customers, taking advantage of the situation
the deceased grasped the knife, routinely used for cutting coconuts and cut his
throat with that knife in the presence of many people at the venue. He immediately
fainted down in the pool of blood and was brought to King Edward Memorial
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hospital, Mumbai in an injured condition where he was declared as brought
dead .The body of the deceased was sent to mortuary for postmortem examination
at postmortem center.
The autopsy findings show the presence of single cut throat injury over anterior
aspect of neck, slightly obliquely placed at the level of laryngeal prominence in mid
line, extending deep up to the vertebrae. It was not associated with tentative cuts or
tailing of wound which is suggestive of non suicidal cut throat injury over the neck.
Cut throat injury was present over anterior aspect of neck, slightly obliquely placed at
the level of laryngeal prominence in mid line, 7 cm below the chin and 7 cm above
the supra-sternal notch. It was situated 05 cm below the tip of the right mastoid and
4.5 cm below the tip of the left mastoid measuring 20 cm * 06 cm * bone deep.
Margins were clean cut showing irregular skin tags in between at places. Both angles
of injury were cleanly cut and acute. Underlying thyroid cartilage, supraglottic part of
larynx, laryngo-pharynx, soft tissue, blood vessels and musculature were cleanly cut
corresponding to surface injury along with cut fracture of body of fifth cervical
vertebra measuring 04 cm in length and maximum depth of 3 mm (Fig. 1a and b).

Internal jugular vein and external carotid artery on the left side were incised at the
level 1 cm above the origin of external carotid artery (Fig. 2)

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The right sided carotid artery and its main branches were spared. No tentative
incisions and tailing of wound were present over the neck. Crime scene investigation
reveals knife was found by the side of dead body in the pool of blood .
In context with the case, suicide cut throat injury extending to cervical vertebrae can
be attributed to the psychiatric disorder and occupation of the deceased in a slaughter
house. Circumstantial evidence, the absence of any defence wounds on the body, the
presence of psychiatric illness and previous suicidal attempt confirmed by the
presence of linear scars over anterior aspect of left forearm, were suggestive of the
fact that cut throat injury is suicidal in nature which was confirmed by the statements
given by the eye-witnesses at the crime scene.
C. FIRE ARM INJURIES-
Forensic Ballistics is the science dealing with the investigation of firearms, and the
problems arising from their use.
Ammunition - Projectiles, such as bullets and shot, together with their fuses and
primers, that can be fired from guns or otherwise propelled.
A firearm weapon is an instrument which discharges a missile by the expansive
force of the gases produced by burning of gun powder.
Firearm injury is an injury caused by a firearm weapon.

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Types of fire-arm weapons
1. Smooth Bored or Shotgun Weapons
These are heavy weapons carried over the shoulder and they have a barrel which is
smooth bored inside. The shotgun may have one barrel or double barrel. These
guns are usually used by police to control mob, or they are used in killing birds or
small animals. Example - Shot gun, Muskets, air guns, air pistols etc.
2. Rifled bore weapons
Rifling is a process in which spiral grooves are cut upon the inner surface of the
bore to impart rotator motion to a ballet. It stabilizes the bullet and gives greater
accuracy and long for the bullet to hit the target. Examples - Rifles, hand guns,
revolvers, pistols.
Factors affecting fire arm injury

1) Type of fire arm weapon.

2) Type of cartridge.

3) Type of projectile.

4) Muzzle velocity.

5) Range of firing.

6) Angle of firing.

7) Time since firing.

8) Ricocheting of bullet.

9) Part of body struck

Injuries due to associates of missile
ASSOCIATES INJURY CAUSED
Flame Burns, singeing
Heat Scorching
Smoke and gases Blackening, smoke deposition
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Gun powder Tattooing
Wads Abrasion, contusion

Postmortem Examination of fire arm injuries

The following steps should be taken while conducting PM of fire-arm injuries:
1. Record preliminary data.
2. The photograph of front and back view is taken without removing clothes.
3. Examination of clothes should be done carefully by removing without cutting.
4. All wounds (with scale) on the body should be photographed again after
removing the clothes.
MEDICO-LEGAL ASPECTS OF FIRE ARM INJURIES
 Suicide by fire arm is seen mostly in males. The weapon is usually found at
hand due to cadaveric spasm.
 In case of homicidal fire arm injury - the weapon will not be found at the
scene. There may be evidence of struggle. Variety of wounds can occur
depending upon the circumstances. The wound is usually close range or long
range type.
 Accidental fire arm injuries are rare.
 When wound of entry present and wound of exit absent\
i.) Bullet may be lodged in body tissue, bone or clot.
ii.) Bullet may be thrown out through natural orifice i.e. through vomit,
cough or faeces.
iii) Bullet may come out through the wound of entry itself.
 When - During single firing, single wound of entry but multiple wounds of
exit
i.) Internal bullet fragmentation.

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 ii.) Bone fragmentation.
iii.) Contact or close range firing in shot gun
 When - During single firing, multiple wounds of entry and exit
i) External bullet fragmentation
ii) Long range firing
iii) Depending upon the posture of the body same bullet may enter through
arm, trunk etc.
CASE STUDY
Multiple suicidal firearm injuries
A citizen reported to the police that he found his brother dead in his private flat.
The death scene examination was performed by the investigation team, consisting
of competent relevant authorities and accompanied by the forensic medical
examiner
The deceased was found lying on his right side. The pistol was in his right hand
and the thumb was in the trigger guard, while the other fingers were firmly holding
the grip in “cadaveric spasm” (Fig. 1). The postmortem lividity was purplish in
color, fixed, and posterior, consistent with the position of the body. Decomposition
was not yet evident externally.

Fig. 1 – The scene of death showing the victim holding the gun firmly.

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A necessary forensic medical examination and autopsy of the dead body was
performed based on an official request from the investigating attorney general in
Dammam.
On external examination, multiple relevant antemortem firearm injuries were
noticed as follows:
(1) A rounded entry wound, 0.5 in diameter, encircled with evidence of near firing
(burning and blackening), in the anterior left part of the chest (Fig. 2).
(2) An exit wound in the left side of the back (Fig. 3),
(5) An entry wound, located on the abdominal mid-line, about 0.5 cm in diameter,
encircled with evidence of near firing (Fig. 2).
(6) An exit wound located on the left posterior axillary line just about 12 cm below
the shoulder (Fig. 3).
(7) An entry wound in the right lower part of the back (Fig. 3), about 0.5 cm in
diameter, encircled with evidence of near firing. No other injuries were noticed on
the dead body.

Fig. 2 Circular firearm entry wound above the umbilicus (black arrow) and the
other entry wound at the left lower part of the chest (white arrow). Both are
surrounded by burning and blackening of the skin (sign of near firing).

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Figure 3. Two firearm exit wounds in the back on the left side (black arrows). The
unusual entry wound at the right of the back (white arrow).
Autopsy of the chest and abdomen revealed the path of the bullet in the anterior
left part of the chest: penetrating through the eighth left intercostal space into the
chest cavity causing a tear of the left part of the diaphragm, rupturing the spleen
and passing through the tenth intercostal space about 10 cm to the left of the spine
via the exit wound hole previously described.
Following the path of the bullet, whose entry wound was located at the abdominal
mid-line, we found that it caused a tear in the small intestine and passed through
the ninth intercostal space 10 cm away from the spine and exited at the left
posterior axillary line as previously described. The path of the entry wound at the
right lower part of the back showed that the bullet had lacerated the right kidney
and caused a fracture of the transverse process of the L1 vertebra, in addition to a
tear in the small intestine and the left side of the diaphragm and fractures of the
sixth and seventh ribs, which caused severe hemorrhage in the subcutaneous tissue
in the left part of the chest. The bullet retained in the subcutaneous tissue of the left
shoulder and was then extracted and preserved through a chain of custody for
further examination by the forensic lab.
The forensic investigation lab confirmed that the bullet was fired from the gun
found in the hand of the deceased. The firearm experts confirmed the assumption
of near firing by revealing the same type of gunpowder from the deceased’s hand,
which was holding the gun at the time of death, and they also confirmed the
forensic autopsy findings concerning the suspected entry and exit holes in the
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clothes. In addition, they commented on the scene of death, particularly on the
door and windows, which had been secured from the inside, and on the
inaccessible fourth-floor residence of the deceased.
The case was declared a suicide by the final report of the attorney general’s office
owing to the stated findings and their correlation in the investigation to all the
suspects (including the brother) and all the data related to the deceased, especially
his confirmed history of severe financial problems.
D. FRACTURES/DISLOCATION-
Fracture of a bone is defined as disintegration or breakage of bone due to blunt
force or sharp force either directly or indirectly.
Types of Fracture
1) Direct Fracture

 Focal fractures
Small force applied to a small area. Injury to overlying soft tissue is
minimal. For example- forearm and leg, where two bones lie adjacent to
each other. While defending blows during an attack. ‘TAPPING
FRACTURE’.
 Crush Fractures
It results from application of a large force over a large area and is typically
fragmented. Injury to the surrounding soft tissues is usually extensive. If 2
bones lie adjacent to each other, both are involved. For example- fracture
of tibia and fibula in RTA
2) Indirect Fracture
 Traction Fractures
It results when a bone is pulled apart by traction. For example- transverse
patellar fracture due to violent contraction of quadriceps.
 Angular Fractures
It occurs due to bending of bone. The concave surface of the bend is
compressed, while the convex surface is put under traction resulting in
breakage.
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MEDICO-LEGAL ASPECTS OF FRACTURES
 Fracture of a bone constitutes grievous injury according to the law.
 The type of fracture can give the clue of causative force, whether direct,
indirect, rotational or angular, etc.
 The site of fracture may help to indicate the cause of death.
 For example- fracture oh hyoid bone suggestive of throttling.
2.1.2 THERMAL INJURIES
Thermal injuries are defined as the tissue injury resulted from the effects of
systemic (general) or/and localized exposure to HEAT or COLD to the
external or internal body surfaces.
Types of Thermal Injuries

A. DUE TO HEAT-
i) BURNS
The injuries are caused by the application of dry heat from flame, radiant heat
or some heated solid substance like metal or glass.
CHARACTERISTICS OF DRY HEAT
 Dry lesions.

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  Does not bleed.
 Hard to touch.
 Very painful.
 Erythema.
 Coagulated and roasted patches area.
 Singing of hair.
 Burnt cloths
 Carbon material in air passages.
 Vesicles not appear/small.
 Dry cooked appearance of muscles
 Dry and coagulated blood and pink tissues.
TYPES OF BURNS
Depending on the depth of burn-

The total body surface area (TBSA) of burns can be calculated according to
the rule of nine. It must be remembered that the head of an infant is
proportionally bigger than that of adults. The TBSA is of relevance for the
prognosis as is the distribution of burned areas over the body, which may be
of importance in reconstructing the case (e.g. to ascertain what position the
body was in at the beginning of a fire)
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The degree of burn (depth of burn) and the victim’s age are also
important.Rule of nine for the estimation of the burned body surface: arm 9%,
head 9%, neck 1%, leg 18%, anterior trunk 18% and exterior trunk 18%.
These rates vary depending on the age of the child or young adult, as shown.
AGE OF BURN

TIME CHANGES
Immediately Redness
2 to 3 hours Vesication
36 to 72 hours Purulent inflammation
1 to 2 weeks Sloughing
After 2 weeks Granulation tissue formation
End result Scar formulation

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ANTEMORTEM BURNS VS POSTMORTEM BURNS
TRAITS ANTEMORTEM POSTMORTEM
BURNS BURNS
Line of redness Present Absent
Blisters Serous fluid with proteins Air and thin clear fluid
and chlorides
Base Red and inflamed Yellow, dry and hard
Vital reaction Present Absent
Infection Present Absent
Repairative process Present Absent
Enzymes in peripheral Present Absent
zone
Carboxy Hb Present Absent

MEDICO-LEGAL ASPECTS OF BURNS

 Accidental mostly and Suicidal occasionally and maybe homicidal as well.

 Concealment of crime and death.

 Identification of deceased.

 Self-inflicted burns for false accusation.

ii) SCALDS
The injuries are caused by the application of moist heat from liquids/pressure
steam at high temperature.
CHARACTERISTICS OF MOIST HEAT
 Erythema or reddening due to vasoparalysis.

 Extensive vesication of large sizes due to increased capillary permeability.

 Necrosis of dermis.
 No singing/burning of hair/clothes.
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  Clothes wet.

 No deposit of carbonaceous material.

 Limited to skin/mouth or throat.

 Skin and mucosa blisters.

TYPES OF SCALDS
1. Immersion - accidental or deliberate immersion in hot water.
2. Splash - bursting of hot water bottles, boilers, pulling over saucepans or
kettles by children.
3. Steam - exposure to superheated steam.

TIME TO BURN BY WATER TEMPERATURE

TIME TEMPERATURE
1 seconds 65 C
2 seconds 60 C
12 seconds 55 C
2 minutes 50 C

The time to burn in children would be shorter given that a child’s skin is
thinner than that of an adult.
MEDICO-LEGAL ASPECTS OF SCALDS
 Usually accidental due to splashing.

 Can be Intentional.

 Child abuse by hot water.

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CASE STUDY
The Burned Dead Corpse
The almost fully charred corpse of a man was found in a totally burnt-out car that
was detected in a forest. The man could be identified as the owner of the car by
characteristic osteosynthetic material. The autopsy revealed a blasted skull
(induced by heat) and loss of the soft tissues of the cervix, thorax and extremities
through shrinkage. The remaining parts of the trachea and bronchi were filled with
a brownish crumbly substance that was histologically defined as blood coagulated
due to heat impact. The blood alcohol concentration was 81 mg/ 100 mL and the
test for CO-Hb was negative. Police investigations were accordingly intensified
and a fire accelerant was detected in the car. Additionally, there were blood stains
on the forest soil close to the car as well as in the apartment of the dead male. The
blood stains that were found in the apartment indicated that a fight had taken place.
The following circumstantial evidence lawsuit found the deceased’s wife and her
lover guilty of having killed him by force against the neck and subsequently
having simulated his suicide in order to start life as a couple .
B. DUE TO COLD-
i) Frost bite
Results from exposure to great extreme of severe cold (-2.5 C). It is a dry cold
injury.

CHARACTERISTICS OF FROST BITE

 The exposed parts such as ears, nose, fingers and toes may show localized
effects.
 Lesions(blisters) may superficial involving skin and subcutaneous tissue.
 Necrosis of tissues.
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  Temperature usually below 0 C.
 It is only produced in living state, can’t be caused postmortem.
CLINICAL PRESENTATION-
 Mild - numbness, prickling and itching due to involvement of skin and
subcutaneous tissues.
 Deep - infraction of the peripheral digits with oedema, redness and later
necrosis and gangrene formation beyond the line of inflammatory demarcation.
Paresthesia and stiffness of deeper structures.
TREATMENT
 Rewarming.
 Protection of the affected part (don’t rub).
 Tetanus prophylaxis and antibiotics.
ii) Trench foot/ Immersion foot
Results from prolonged exposure to severe cold (5-8 C). It is a moist cold injury.
CHARACTERISTICS OF TRENCH FOOT
 Extremities are affected in these condition.
 It is seen in soldiers during winter warfare, trenches and persons exposed to
prolonged immersion or exposure at sea.
 Temperature usually above 0 C (moist cold).
CLINICAL PRESENTATION-
 Pre-hyperemic- cold and anesthetic.
 Hyperemic- burning and shooting pain.
 Post-hypodermic- decrease pulsation with paleness or cyanosis.
TREATMENT
 Air drying at room temperature.

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  Protect from trauma and secondary infection.
 Avoid heating, moistening, massaging and immersing in water.
MEDICO-LEGAL ASPECTS OF COLD INJURIES
 Suicide by exposing to cold is unlikely.
 Most of the deaths by exposing to cold are-
a) Accidental- As observed in alcoholics, who fall asleep even in snow, or
person lost in snow drifts, etc.
b) Homicidal- As observed in getting rid of unwanted newborn babies or
elderly people, etc. by leaving them exposed to cold weather.
CASE STUDY
Frostbite Case Report
An 18 years old man in good general health suffered frostbite from 09.00 to 21.00
while working in a snowy beet field in December. He was directly in snow for 5–6
hours of that 12 hour. His shoes were too hard for his feet especially left foot. He
complained when he arrived home intensive pain, discoloration, lack of sensitivity
and limited movement on his toes. He walks for a while and thaw feet near an
owen. A day after frostbite he admitted regional hospital. Vein line, tetanozis
prophylaxis and crystalloid solution started to him and observed for 6 hours. After
the observation he transferred to the Dicle University Emergency Department. On
patient examination arterial pressure 120/80 mmHg, ECG sinus rhythm at rate 70
bpm, inspiration rate 16/ min, body temperature 38°C. Odema on his left toes and
4x3 cm blister on left foot first finger dorso lateral surface. Left 3rd 4th and 5th toes
were with erythema, left plantar surface distal 1/3 were odema and erythematic
(fig.1).

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He had pain and limited moving on left toes. Left foot arterial dorsalis pedis pulse
was clear but quality less than right foot. Lack of sense on left finger tips and distal
1/3 of plantar surface, 3x3 cm blister on right foot posterior surface, erythema on
right 1st finger tip (fig. 2).

There was no abnormality on right toes for sense, movement and arterial dorsalis
pedis pulse clear. Other systemic examination was clear and no pathological sign
in feet x-ray. At first the doctors cleaned feet. But no blister debridement.
Elevation, antibiotherapy, analgesia (morphine sul-phate 5 mg 1x1), enoksaparine
0, 4 cc 1x1, pentoxifylline 600 mg/day and acetylsalicylic acid (ASA) 300 mg 1x1
were ordered in treatment.
Second day blister and necrotic tissue debridement was performed without any
anesthesia while the patient did not feel any pain (fig. 3).

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Silver sulfadiazine and %0, 2 nitrofurantoin were used for wound. Third day both
dorsalis pedis pulse were clear, capillary circulation was normal, lack of sense
completely improve so pentoxifylline therapy stopped. Tenth day patient’s effected
areas lesions improve and all laboratory parameters were in normal range so
patient discharged. After one month at control consultation lesions completely had
improved (fig. 4)

2.1.3 CHEMICAL
A wide variety of chemicals may cause cutaneous and ocular burns and systemic
effects either by absorption or inhalation, requiring in most of the cases medical
and/or surgical treatment. Given the nature of the agents involved and the type of
injuries (depth, lung injury, eye involvement, etc.) they produce a relevant loss of
working time.
The severity of a chemical burn injury is determined by:
(a) concentration.
(b) quantity of burning agent
(c) duration of skin contact
(d) penetration
(e) mechanism of action.

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CHARACTERISTICS OF CHEMICAL BURNS

INJURIES CHEMICALS
Cause Corrosive chemicals
Site At and below
Splashing Present
Skin May be destroyed
Vesicles Very rare
Red lines Absent
Color Distinctive
Charring Present
Singeing Absent
Ulceration Present
Scar Thick and contracted
Clothes May be burnt, show characteristic stain

TYPES OF CHEMICAL AGENTS

 Corrosive acids
 Corrosive alkali
 CORROSIVE ACIDS
Acids are proton donors. They release hydrogen ions and reduce pH from 7 down
to values as low as 0. Acids with a pH less than 2 can produce coagulation necrosis
on contact with the skin. A better predictor than pH alone is the amount of alkali
needed to raise the pH of an acid to neutrality. This may reflect the strength of the
acid involved.

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 CORROSIVE ALKALIS
Bases are proton acceptors. They will strip hydrogen ions from protonated amine
groups and carboxylic groups. Alkalis with a pH greater than 11.5 produce severe
tissue injury through liquefaction necrosis. Liquefaction loosens tissue planes and
allows deeper penetration of the agent. For this reason, alkali burns tend to be more
severe than acid burns.
MEDICO-LEGAL ASPECTS OF CHEMICAL INJURIES
 Usually accidental, most fatal are homicidal or suicidal.

 Chemical attacks cause physical and mental conditions, in which acid attacks
are more common.
 Patient demographics and Burn demographics.
 Extent of injury, management strategies and length of inpatient stay
 Psychological support provided
 Circumstances of assault
CASE STUDY
A case of chemical assault in Hong Kong
This report describes a case of an acid assault burn suffered by a 16-year-old girl.
The assailant was her 17 year old ex-boyfriend. The incident took place outside the
backdoor of her family residence. The acid was thrown at her face, but she raised
her arms and turned away to limit the facial damage. She sustained an 8% TBSA
burn of which 6% was deep dermal to full thickness. The burn involved the face,
posterior scalp and multiple patches over her back and upper limbs (Fig).

36
 Figure - Confluent burn of the face, scalp, limbs and back: Day 0 in accident
emergency (top row); Day 12 urgent shaving (middle row); Day 20 post injury
(bottom row).
She was initially taken to the nearest hospital, which commenced primary
resuscitation with immediate lavage. The extent of her injuries, which included
airway compromise and chemical assault, fitted the criteria for transfer to a Burns
Centre for definitive care . She was subsequently transferred to PWH. She was
primarily seen in the Emergency department and the severity of injuries was
assessed; immediate lavage was continued. Urgent eye consult was requested to
document corneal damage and institute appropriate therapy. Her burn injuries
matched the criteria for urgent examination under anesthesia (EUA), which
included confluent areas of discolored skin greater than 20cm2 on the face and 100
cm2 on the trunk or limbs . She was taken immediately from the emergency room
to the operating theater for an EUA. Tangential test shaves were performed in all
burn areas confirming that the burns were deep, and thin layers of tissue were
removed until there was active bleeding (lacuna-like or punctuate bleeding). Over
the next forty-eight hours she had saline soaks applied that were changed every
two hours. This was followed by application of porcine skin to the wound bed to
assess the suitability for grafting. At day three to five she was taken back to theater
for some supplementary shaving and definitive grafting. One year after the
incident, her wounds had healed well with minimal hypertrophic scarring on the
trunk and limbs. The burns on the face that had been shaved also healed with
minimal hypertrophic scarring, but two linear tracks of hypertrophic scar
developed in two areas of burn that were thought to be too narrow for initial
tangential shave. These hypertrophic areas were attributed to where the acid had
run off, and they were subsequently treated with minor revision surgery. Overall,
she made a remarkable recovery psychologically and physically.
2.1.4 MISCELLANEOUS INJURIES
There are various different types of injuries which comprises in miscellaneous
injuries which can be caused by various factors and reasons.

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TYPES OF MISCELLANEOUS INJURIES

SELF-INFLICTED INJURIES
The injuries are caused by own self intentionally by direct injuring body tissues.
The self-inflicted traumatic injuries tended to be either relatively minor or
potentially very serious. Lacerations to the upper limb were seen most frequently.

DEFENCE INJURIES
Defence injuries are the results of immediate and instinctive reaction of the victims
in order to protect themselves during an assault. Presence of such injuries indicates

38
that the victim was conscious and could comprehend the attack and provide
resistance. They also help in identifying the weapon.

OFFENSIVE INJURIES
These injuries are caused to annoy or aggressively attack someone with particular
motive. Mainly seen in sports like football injuries caused to eliminate
competitions.
UNINTENTIONAL INJURIES
Unintentional injury can be defined as “any injury that is not caused on purpose or
with intention to harm”. It is a broad category that includes injuries from causes
such as motor vehicle collisions, falls, poisoning, drowning, suffocation and work-
related or sports-related injuries.
FATAL AND NON-FATAL INJURIES
Fatal injury means a personal injury resulting in death of the injured person. For
example- Head and Brain Injuries, Skull fractures and brain injuries can be
immediately fatal, or result in delayed fatalities, Chest Injuries-In head-on
collisions, the chest may be crushed and result in internal bleeding or damage to
internal organs so severe that the injury is fatal.
Nonfatal injury is bodily harm resulting from severe exposure to an external force
or substance (mechanical, thermal, electrical, chemical, or radiant) or a
submersion. This bodily harm can be unintentional or violence-related.
CASE STUDY
Case 1.

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A state trooper observed a man on an expressway driving a motor scooter with no
license plate. The trooper initiated a traffic stop, and, at first, the suspect complied
and pulled to a stop. When the trooper got out of his cruiser to speak with the
suspect, he drove away, and a low-speed pursuit ensued. The suspect eventually
tried to pull into the parking lot of an apartment complex, but he crashed when he
struck a cable that was blocking the entrance. The scooter began leaking petrol that
coated the suspect's clothes. The suspect ignored the trooper's commands to stay on
the ground, and a struggle ensued between the suspect and the trooper. The trooper
unsuccessfully tried electronic control several times, and these applications did not
ignite any fumes. Another trooper arrived and applied his CEW igniting gasoline
fumes and the subject's clothing. The suspect fell to the ground, and officers used
fire extinguishers to put out the flames. Once the troopers extinguished the flames,
the suspect rose and again threatened the troopers. They used the CEW once more
to secure the suspect. The suspect survived, but he suffered burns over about 1/3 of
his body.
Case 2.
A federal agent attempted to stop a vehicle driving on the wrong side of an
interstate highway. The suspect, a 24-year-old male, initially refused to stop, but he
stopped after running over a tire deflation strip. Agents approached the vehicle, but
the suspect refused to get out or unlock the doors. When an agent saw the suspect
reach toward the center console, he broke out the passenger door window and
discharged his CEW into the vehicle When he did, the vehicle violently erupted in
flames. The suspect was engulfed in flames and died in the vehicle. The agent
suffered burns and lacerations of the face, but he survived and recovered from his
injuries. Subsequent investigation suggested that the suspect had a quantity of
exposed petrol in his vehicle d from earlier petty arson activity d that had
vaporized and exploded with the spark from the CEW. Dash camera video clearly
shows that the explosion was initiated by the CEW
2.2 Classification based on Severity-
2.2.1 SIMPLE INJURY
A simple injury is one which is neither extensive nor serious which would heal
rapidly without leaving any permanent deformity and disfiguration.

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2.2.2 GRIEVOUS INJURY
Any hurt which endangers life or which causes the sufferer to be during the space
of 20 days in severe bodily pain or unable to follow his ordinary pursuits. Any
dangerous hurt is grievous.
The Section 320 in IPC defines grievous hurt. The punishment is enhanced
when the hurt is grievous.
The following kinds of hurt only are designated as "Grievous".
First- Emasculation
Second- Permanent privation of the sight of either eye
Third- Permanent privation of the hearing of either ear
Fourth- Privation of any member or joint
Fifth- Destruction or permanent impairing of the powers of any member or joint,
Sixth- Permanent disfiguration of the head or face
Seventh- Fracture or dislocation of a bone or tooth,
Eighth- Any hurt which endangers life or which causes the sufferer to be during
the space of twenty days in severe bodily pain, or unable to follow his ordinary
pursuits.
3. CONCLUSION -
Legal term hurt means bodily pain, injury or wound and disease or infirmity
caused to any person. Abrasion, bruise, laceration, fracture, dislocation, incised
wound, stab wound, puncture, penetrating wound, firearm wound, bomb blast
wound, burn, scald are common types of injury or hurt. Different types of
weapons or means used to cause hurts are blunt, sharp and pointed
weapons, firearms, bombs, heat, electricity and corrosives. For legal purposes,
hurts are grouped as grievous hurt and simple hurt. There are eight categories of
grievous hurt. In reporting hurt cases, the clinical state of the victim with full
description of the wounds are noted and an opinion regarding their legal state i.e.
whether grievous or simple, age of the injury, type of the weapon or means
causing the injury, whether inflicted by others or self inflicted etc. is given. These
help the court to give its judgment. There are enacted laws describing section,
numbers, types of crime and their punishments.

4. REFERENCES -
1. Handbook of Forensic Medicine
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 Edited by Burkhard Madea Institute of Forensic Medicine University of
Bonn Bonn, Germany, Publisher-Wiley Blackwell
2. Textbook of forensic medicine and toxicology second edition Nageshkumar
G ao published by jitendar p vij jaypee brothers medical publishers (p) ltd
3. A case of chemical assault in Hong Kong (case report).
Published online - 2015 Apr 4. doi:-10.1016/j.ijscr.2015.03.059 PMCID:-
PMC4430095 PMID: 25898282
4. Multiple suicidal firearm injuries: A case study.
Available online 25 September 2011.
https://doi.org/10.1016/j.ejfs.2011.07.003
5. Frostbite a case report
Published: 2007.05.08 Author’s address: Murat Orak, Dicle Üniversitesi,
Tıp Fakültesi, İlk ve Acil Yardim ABD. 21280, Diyarbakır, Turkey.
6. Fatal and non-fatal burn injuries with electrical weapons and explosive
fumes. Available online 20 June 2017
http://dx.doi.org/10.1016/j.jflm.2017.06.001
1752-928X/© 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine
7. An atypical case of suicidal cut throat injury
http://dx.doi.org/10.1016/j.ejfs.2016.04.003
8. 2090-536X Ó 2016 Published by Elsevier B.V. on behalf of The
International Association of Law and Forensic Sciences (IALFS)
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Burns_juil2009_Chemical%20burns_pathophysiology.pdf
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269557204_Medicolegal_Aspects_of_Hurt_Injury_and_Wound
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