MULTIPLE CHOICE QUESTIONS
Clause 3: Prenatal diagnostic techniques should be used in pregnant women, if any of the following conditions
Q. Is the hair identical with hair of the victim or the suspect?
• Blood groups (ABO) can be determined from a single hair bulb.
• If some root structure is present, standard DNA profiling can be used.
• Even if the shaft is there, mitochondrial DNA testing can be tried.
Q. Did the hair fall naturally or was it forcibly removed? (Fig. 5.10)
• The bulb of naturally fallen hair is distorted, atrophied and the hair sheath is absent.
• In forcibly plucked hair, the hair sheath is ruptured, bulb is swollen, larger and irregular.
• If the root is not present, an even break with regular edges indicates that it was cut off and an irregular break indicates the hair was broken off.
Q. What is the cause of injury? (Fig. 5.11)
• In uncut hair, the tip is pointed and non-medullated.
• Sharp weapon produces a clean uniform cut surface.
• Blunt force injury result in flattening and splitting of hair shaft.
• Singed hair due to burns or firearm injury are swollen, fragile, curled, twisted and have a peculiar odor.
Fig. 5.9: Cross section of hair
Differentiation 5.2: Ethnic differences in human hair
S.No. Feature Caucasians Mongolians Negroes
1. Color Light brown Black or dark brown Black or dark brown
2. Consistency Fine to medium Coarse Short, curly, finest
3. Shape Oval Round Flat
4. Shaft diameter Slight variation Constant diameter Wide variation
5. Pigmentation Uniform Coarse granules Irregular
6. Cuticle Thin Thick Medium
7. Medulla Fragmented or absent Unbroken Fragmented or absent
Fig. 5.11: Tip of hair
Fig. 5.10: (A) Root of a naturally fallen hair (B) Healthy hair bulb (plucked)
Postmortem root banding seen in people who are dead for some time, wherein an opaque band about 0.5 mm above the root bulb can be observed with transmitted light microscope.
Medico-legal Application 1. Identification
i. It is an important clue when similar hair may be detected on the alleged weapon and on the body of the assailant.
ii. Victim's hair remains identifiable long after the commission of crime and provides valuable physical evidence.
iii. In rape and sodomy cases, pubic hair of the accused may be detected on the victim and vice versa.
iv. In bestiality, animal hair may be found around the genitalia, body and clothing of the accused.
v. In road traffic accidents, hair of the victim may be found adhered to the offending car.
2. Nature of weapon: Whether sharp or blunt can be opined.
3. Nature of assault: Various trace evidence, like stains may be attached with hair, so it must be carefully looked for (Table 5.3).
4. It helps in differentiating burns from scalds. Hair is brittle, singed or charred with large round vacuoles at the point of burning which is absent in scalds.
5. Singeing of hair indicates burns or close range firearm injury.
6. Time since death can be calculated from growth of scalp hair and beard (growth rate: 2.5 mm/week or 0.4 mm/day).
7. Age and sex can be determined.
8. Poison can be determined from hair, e.g. arsenic, thallium and lead.
Superimposition
• Technique applied to determine whether the recovered skull is that of the person in the photograph.
• Technologically, skull-photo superimposition have passed through three phases—the photographic, video and computer-assisted superimposition techniques.
• While performing photographic superimposition, the comparison photograph is enlarged to the size of the unknown skull and then the skull is positioned in the same orientation as the facial photograph.
• Recently, computer-assisted superimposition has become a popular method which digitize the skull and facial photograph using a video computer with
appropriate software and then to compare the two images morphologically by image processing.
• The complete skull is required to obtain positive identification. Without the mandible, it cannot be positively be identified as the presumed person, even if a good match is seen in skull-superimposition image.
• The coincidence of dentition between the skull and facial photograph (if incisors and canines are seen) could lead to positive identification.
• When evaluating anatomical consistency between the parts, special attention should be paid to their outline, the facial tissue thickness at various anthropometric points, and the positional relationships between skull and face-eyebrow to supraorbital margin, eye to orbit, nose to nasal aperture, lips to teeth and ear to external auditory meatus.
• If they are well matched with each other, it can only be stated that the skull could be that of the photographed person.
• Test is of a more negative value, because it can be definitely be stated that the skull and photograph are not those of the same person.
Forensic Odontology
Definition: It deals with the application of dentistry to aid in the administration of justice.
The work of a forensic odontologist includes:
• Identification of unknown bodies through dental records.
• Identification of bite marks on the victims of attack.
• Comparison of bite marks with the teeth of a suspect and presentation of this evidence in court as an expert witness.
• Identification of bite marks in other substances such as wood, leather and foodstuffs.
• Age estimation of skeletal remains.
Identification of Human Remains
Unidentified bodies due to violent crimes, road traffic accidents, natural and manmade disaster and in particular, the mass casualties normally associated with aviation disasters, drowning, burns, murder, suicide or dead from natural causes rely on dental evidence to positively identify the body.10
The central dogma of dental identification is that postmortem dental remains can be compared with dental records, including written notes, study casts, radiographs, etc. to confirm identity.10 Clearly, individuals with numerous and complex dental treatments are often easier to identify than those individuals with little or no restorative treatment.
Table 5.3: Stains attached on the hair Type of stains Suggestive information
• Seminal Sexual offence
• Blood Injury
• Salivary Asphyxial deaths
• Mud Struggle/road traffic accident
• Carbon particles Burns/firearm injury
• Dyes Concealment of natural color
Identification II 79 Once the postmortem record is complete, a comparison
between this and dental records can be carried out. A range of conclusions can be reached when reporting a dental identification.
Even if only a few teeth are available, one can still offer an age estimation, smoking habit, state of oral hygiene and identification of individual features which may match with antemortem records. Where the subject has no teeth, useful information can still be obtained from the study of any dentures and by X-ray of mouth and skull.
In problem cases, a variety of techniques are used to assist in the identification issue. These include:
• Incremental line and other histology studies (Maples noted that 2nd molar was best for histological ageing techniques)
• Scanning electron microscopy with/without energy- dispersive X-ray analysis
• Metal ratio analysis in bone and teeth, especially magnesium/zinc ratio
• Serology studies for blood groups, serum proteins and polymorphic enzymes
• DNA analyses Bite Marks
Bites are commonly seen in cases of:
i. Sexual assault: Marks are usually seen on breasts, neck, shoulders, thighs, abdomen, pubis or vulva.
ii. Child abuse: Marks are seen anywhere on the body, such as arms, hands, shoulders, cheeks, buttocks and trunk.
iii. Bite marks on foodstuffs (apples, cheese, chocolate), leather (key rings and belts) and wood (pencils) in cases where a perpetrator might have taken a bite out of something in the victim's home and left it behind.
iv. Police officers may be bitten by the resisting offenders.
v. In sporting events, like football, rugby or wrestling.
vi. In assaults, where marks may be found anywhere on the body.
Nature of bite marks: Comprise of a crop of punctate hemorrhages varying from small petechiae to large ecchymoses merging into a confluent central bruise.
Human bite is semicircular or crescentic caused by the front teeth (incisors and canines) with a gap on either side due to separation of upper and lower jaw whereas deep parabolic arch or U-shaped is characteristic of an animal bite. There may be abrasions, bruises and lacerations or a combination of all these.
• Self-inflicted bite marks are present on accessible parts of the body, e.g. shoulders or arms, usually seen in psychiatric patients or teenage girls.
• Accidental marks resulting from falls on to the face and during fits, biting of tongue and lips may also be there.
• In sexual assault, sucking action during bites reduces the air pressure in the centre and produces multiple petechial hemorrhages due to rupture of small capillaries and venules.
Identification from bite marks is possible, if incisors and canines have some characteristic features.
Bite mark investigation
1.Photograph: Bite mark is photographed from different angles.
2.Swabbing of saliva: To identify or exclude assailant from 'secretor' status who exude blood group substances in the saliva.
3.Impression of bite mark: Plastic substance (rubber or silicone based) or plaster of Paris is laid over the bite mark that hardens and produces permanent negative cast of the lesion.
4. Skin carrying the bite is removed and preserved in formalin during autopsy.
Dental Profiling
When dental records are unavailable and other methods of identification are not possible, the forensic dentist often produces a 'picture' of the general features of the individual known as dental profiling. It will typically provide information of the deceased's age, ancestral background, sex and socio-economic status. In some instances, it is possible to provide additional information regarding occupation, dietary habits, habitual behaviors and occasionally, on dental or systemic diseases.
• Microscopic examination of teeth can confirm sex by the presence or absence of Y-chromatin and DNA analysis can also reveal sex.
• Because of the resistant nature of dental tissues to environmental assaults, such as incineration, immersion, trauma, mutilation and decomposition, teeth represent an excellent source of DNA material.
When conventional dental identification methods fail, this biological material can provide the necessary link to prove identity.
Charting of Teeth
On the charts following peculiarities are recorded:
i. Any extractions, recent or old
ii. Any fillings, number, position and composition iii. Artificial teeth, whether of gold, porcelain or stainless
steel
iv. Prosthetic work in mouth, such as bridge work or braces
v. Any crowned teeth vi. Any broken teeth
vii. Pathological conditions in teeth, jaws or gums viii. Congenital defects, such as enamel pearls,
Carabelli's cusps or ectopic teeth
ix. Malpositioned teeth that are rotated or tilted x. General state of hygiene, like caries, plaque, tobacco
staining and gingivitis
xi. Racial pointers, such as shovel shaped upper central incisors and multi-cusped molars.
Most widely used systems are:
i. Universal (Cunningham) system: Follows the plan advocated by American and International Society of Forensic Odontology. The permanent teeth are numbered from 1 to 32 and lettering the deciduous teeth A to T, starting at the posterior upper right and continuing in a clockwise direction.
Right 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 32 31 30 29 27 27 26 25 24 23 22 21 20 18 18 17 Left
ii. Palmer's notation: Palmer numbered the permanent teeth with Arabic numerals 1 to 8 from midline backwards.
Right 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
Left
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
iii. Haderup system: It is similar to Palmer notation, except it uses a plus sign (+) to designate upper teeth and a minus sign (-) for lower. For the deciduous teeth, a zero was additionally placed in front of the number. This notation was adopted by the Scandinavian countries.
Right 8 + 7 + 6 + 5 + 4 + 3 + 2 + 1 + + 1 + 2 + 3 + 4 + 5 + 6 + 7 + 8 8 - 7 - 6 - 5 - 4 - 3 - 2 - 1 - -1 -2 -3 -4 -5 -6 -7 -8 Left
iv. FDI (Federation Dentaire Internationale) - two-digit system: A two-digit notation capable of indicating tooth and quadrant was developed. Thus, lower right canine will be numbered 43. This was adopted as the International Standard.
A. Permanent teeth Upper
Right 1 8 1 7 1 6 1 5 1 4 1 3 1 2 1 1 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 4 8 4 7 4 6 4 5 4 4 4 3 4 2 4 1 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8Left
Lower
B. Deciduous teeth
Right 5 5 5 4 5 3 5 2 5 1 6 1 6 2 6 3 6 4 6 5 8 5 8 4 8 3 8 2 8 1 7 1 7 2 7 3 7 4 7 5 Left
v. Modified FDI system: In this method, the tooth and quadrant are designated by a separate number.
Right quadrant was designated by 2 and 3 and left was designated by 1 and 4 in permanent teeth.
vi. Diagrammatic or anatomical chart: In this, each tooth is represented by a pictorial symbol that gives the same number of tooth surfaces as those on that particular tooth in mouth. Incisors and canines are represented by four surfaces premolars and molars by five.11
Medico-legal Application
1. Identification: Dental identification is the most sophisticated method of comparative identification after dactylography. It is of not much use in developing countries, as dentists often do not keep records.
2. Age estimation of an individual.
3. Grievous hurt: Fracture/dislocation of tooth amounts to grievous hurt according to Sec. 320 IPC.
4. Cause of death: The teeth resist putrefaction and deposition of metals can be detected after considerable time after death, e.g. poisoning.
5. Dentures (partial or complete) are useful in identification, if they have the patient's name or code number in them.
6. Criminals can be identified through bite marks left either in human tissues or foodstuffs.
Miscellaneous Methods of Identification
Clothes and Personal Effects
They are helpful in establishing identity in case of mass disasters. It is necessary to preserve the clothes along with any articles, such as driving license, watch, spectacles, ornaments and wallet found on a dead body for the purpose of future identification. The clothes are examined for mark of the tailor, foreign material or any tear.
Occupational Marks
These are helpful in identifying unknown dead bodies, as certain occupation leave marks by which persons engaged in them may be identified, e.g. in clerks, a callosity on the proximal part of right middle finger may be seen where the pen usually rests or dyers/
photographers may have there fingers stained with dyes or chemicals.
Handwriting
Opinion regarding the handwriting is usually given by the expert in this field and doctors are seldom
Identification II 81 asked to testify. But, sometime the doctor may have to
examine a person to whether he is able to write when a plea of paralysis or mental incapacity is put forward.
Speech, Voice, Ticks, Manner and Habit
Sometime, it is possible to identify a living person from certain peculiarities, like stammering, nasal twang and jerky movement of muscle of the face or shoulder.
Other methods of identification
1. Palatoscopy/palato-print/rugoscopy: It is the study of palatal rugae in order to establish identity. Rugae ('plica palatine') are anatomical fold or wrinkles formed by 12-14th week of IU life, the irregular fibrous connective tissue located on the anterior third of the palate, behind the incisive papilla.12 Palatine rugae are unique and can be used for identification in circumstances when it is difficult to identify a dead person through dental records or fingerprints (even in advanced decomposition). This method of identification is useful, if antemortem record of palatal rugae is available.
This method is useful since:
• Rugae pattern remain stable throughout life and does not change during growth.
• It is protected from trauma due to its situation and from heat by buccal pad of fat and tongue.
• Even in twins, the pattern of rugae may be similar but not identical.
2. Fronal sinus print: It is unique to a particular individual and these are permanent and fixed (after 15 years of age) and rarely alter following infection or injury. For comparison, antemortem X-ray of skull taken on occipito- mental plane is compared with postmortem X-rays.
3. Vascular grooves and sutural pattern: The sutural pattern on the skull bone particularly of sagittal and lambdoid sutures are complex and are individualistic. Similarly, the vascular grooves over skull bone, particularly of middle meningeal vessels are individualistic. Rather, vascular grooves over skull are more helpful for identification as compared to suture lines, because these are well demonstrable in X-rays.
4. Ear print: It is the study of shapes of the ear lobules and tips of ears as well as the hardness or softness of the helix and lobules, and hairiness of the helix and tragus. These characters of the ears are considered to be individualistic.
5. Nose print: The lines on the nose and shape of the tip of nose are considered to be individualistic. Chance impressions may be found over door, wall and mirror at the scene of crime or even on the body of the victim or accused.
6. Nail print: It is the study of the depressions and elevations (striations), numbers, distribution and dimensions of the ridges on the surface of the nails which are considered to be individualistic. They remain unchanged throughout life and with advancement of age the striations become more prominent. The longitudinal striations are present over both convex and concave surfaces of finger and toe nails.
7. EV method of identification: The electrocardiogram (ECG or EKG) and vector cardiogram (VCG) trace expresses cardiac features that are unique to an individual.
As a biometric, heartbeat data are difficult to disguise, reducing the likelihood of successfully applying falsified credentials into an authentication system.
8. 'Barium meal' X-ray of stomach: It is also considered to be individualistic and may be helpful in identification, if previous record is available.
MULTIPLE CHOICE QUESTIONS
1. A convict whose family or relations was not known and no biological sample was available with jail authorities, escaped from the jail. A dead body resembling the convict was found in nearby forest, but due to mutilation of face, identity could not be established. The positive identity that he is the same convict who escaped from jail can be established by:
AI 04 A. Blood grouping B. DNA profile
C. Anthropometry D. HLA typing
2. The system of identifying and utilizing fingerprints is
called: Delhi 05
A. Galton system B. Anthropology
C. Thanatology D. Bertillon system
3. Study of fingerprints is known as: PGI 05 A. DNA fingerprinting
B. Dactylography C. Poroscopy D. Cheiloscopy
4. The most reliable method of identification of an
individual is: AI 05; PGI 05
A. Dactylography B. Scars C. Anthropometry D. Handwriting
5. The fingerprint pattern may be impaired permanently
in case of: AIIMS 06; AI 09
A. Eczema B. Scalds
C. Scabies D. Leprosy
1. C 2. A 3. B 4. A 5. D
6. Most common pattern of fingerprint is:
AI 05; Delhi 05, 07; Gujarat 07; UP 08; Manipal 10
A. Arches B. Loops
C. Whorls D. Composite
7. Fingerprint Bureau was first established in:
AI 06, AIIMS 08 A. England
B. China C. India D. Singapore
8. Cheiloscopy is the study of prints of:
AIIMS 04
A. Foot B. Fingers
C. Palate D. Lips
9. In humans, cortex of hair is usually: Delhi 11 A. Double that of medulla
B. Same as medulla
6. B 7. C 8. D 9. C 10. B 11. B 12. A
C. 4-10 times broader than the medulla D. Thin in comparison to medulla
10. In a charred body, which of the following means is useful in its identification: Karnataka 03 A. Stature
B. Comparison of dental records C. Scar marks
D. Skeletal features
11. Dental numbering is done by all, except: AI 11 A. FDI two digit system
B. Anatomic and diagrammatic charting C. Palmer notation
D. Universal system
12. Palato-print is commonly taken from which part of
palate: AIIMS 11
A. Anterior part B. Lateral wall C. Medial wall D. Posterior part
Medico-legal Autopsy 8 3
Definitions
• Forensic pathology deals with the investigation of sudden, unexpected and/or violent deaths that includes determining the cause of death and the circumstances of how the death occurred.
• Autopsy* refers to the systematic examination of a dead person for medical, legal and/or scientific purposes.
It is of three types:
i. Academic: Dissection carried by students of anatomy.
ii. Pathological, hospital or clinical: Done by patho- logists to diagnose the cause of death or to confirm a diagnosis. Physicians cannot order these autopsies without the consent signed by the next of kin.
iii. Medico-legal: Type of scientific examination of a dead body carried out under the laws of the State for the protection of rights of citizens. The basic purpose of this autopsy is to establish the cause and manner of death.
• It is said 'the only thing worse than no autopsy is a partial autopsy'. In every case, the autopsy must be complete, i.e. all the body cavities should be opened, and every organ must be examined. Partial autopsies have no place in forensic pathologic practice.
• The autopsy should be carried out by the registered medical practitioner, preferably with training in forensic medicine. The doctor should remove the organs himself.
The attendant should prepare the body and help the doctor where required, such as sawing the skull cap, reconstructing the body, etc. As the autopsy is proceeded with, details of the examination should be taken down verbatim by an assistant.
• The person responsible for handling, moving and cleaning the body is often called a diener (German, servant).
• Virtopsy (combination of 'virtual' and 'autopsy') is a bloodless and minimally invasive procedure to examine a body for cause of death. It utilizes imaging techniques (CT and MRI), photogrammetry and 3-D optical measuring techniques to get a reliable, accurate geometric presentation of all findings (the body surface as well as the interior).
• Psychological autopsy is an investigative procedure of reconstructing a person's state of mind prior to death.
This is based upon information gathered from personal documents, police and medical records and interviews with survivors of the deceased-families, friends and others who had contact with the person. The typical case is one which there is some doubt as to whether death was accidental, self-inflicted or malicious, and whether the deceased played an active role in his or her own demise.
Such matters can be especially important in life insurance claims that are void if death was suicidal.
Purpose/Objectives of Autopsy
Who, when, where, why, how and what are the questions that the autopsy assists in answering. The objectives of medico-legal autopsy are:
i. To determine the identity of the deceased in case of decomposed, burnt, mutilated or an unidentified body.
ii. To determine the cause of death, whether natural or unnatural and to interpret the significance and effect of the disease present in case of natural death.
iii. To find out the manner of death, whether accidental, suicidal or homicidal; and if homicide, whether any trace of evidence has been left by the accused on the victim.
iv. To know the position of victim, sequence of injuries and to identify the poison or weapon responsible for death in homicide investigation.
v. In case of fatal wounding, to determine the volitional activity possible after such trauma and survival time.
vi. To determine approximate time of death, age of injuries and place of death.
vii. In case of newborns, to determine the question of live birth and viability of the baby.
* Autopsy (Greek autos—self, opis—view)—to see for oneself; also called necropsy (Greek necros—dead, opis—view) or postmortem examination (post—after, mortem—death).