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Medico-legal aspects� in �Treatment �of �Injured

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Medico-Legal/Police Cases

Sec- 44 IPC- The word “injury” denotes any harm whatsoever illegally caused to any person,
Sec. 174 of Cr.P.C.

All cases of suicide
All cases of death or injury by

Another person, Animal or Machinery

All cases of accident
All cases of death or injury in circumstances raising a reasonable suspicion that some other person has committed an offence

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Police Cases(Cont.)

Injured directly goes to the doctor

In emergency of hospital or private clinics
The doctor’s first duty is to save life- Treat him
Inform the police at the earliest opportunity

Maintain a police case register
Maintain an injury report register for writing reports
Pt. May be advised X-ray/ investigations or kept under observation if opinion can not be formed immediately

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Medico-Legal Cases

Injured goes to police station

After recording the statement of the injured
Police then send him to hospital
Treated, & injury report written
Injury report must be sent within 48 hours
Police may demand a preliminary report immediately

Writ Petition (Criminal) No. 270 of 1988 Supreme Court.:- The patient whether he be an innocent person or a criminal liable to punishment under the laws of the society, it is the obligation of those who are incharge of the health of the community to preserve life so that the innocent may be protected and the guilty may be punished. Every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. No law or State action can intervene to avoid/delay the discharge of the paramount obligation cast upon members of the medical profession. The obligation being total, absolute and paramount, laws of procedure whether in statute or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way. There is also no doubt that the effort to save the person should be the top priority not only of the medi- cal professional but even of the police or any other citizen who happens to be connected with the matter or who happens to notice such an incident or a situation. (3) The members of the legal profession, our law courts and everyone concerned will also keep in mind that a man in the medical profession should not be unnecessarily harassed for purposes of interrogation or for any other formality and should not be dragged during investigations at the police station and it should be avoided as far as possible. [1009C] (4) Law courts will not summon a medical professional to give evidence unless the evidence is necessary and even if he is summoned, attempt should be made to see that the men in this profession are not made to wait and waste time unnecessarily.

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Procedure

Detailed Examination: Proper Record
Regular follow up to be noted
Consent for medico-legal examination

Victim

Major/ Minor

Accused

With Consent
U/S 53 of Cr.P.C.

Article 21 of constitution“No person shall be deprived of his life or personal liberty except according to a procedure established by law.” ccording to Bhagwati, J., Article 21 “embodies a constitutional value of supreme importance in a democratic society.” Iyer, J., has characterized Article 21 as “the procedural magna carta protective of life and liberty.

This right has been held to be the heart of the Constitution, the most organic and progressive provision in our living constitution, the foundation of our laws.

‘Life’ in Article 21 of the Constitution is not merely the physical act of breathing. It does not connote mere animal existence or continued drudgery through life. It has a much wider meaning which includes right to live with human dignity, right to livelihood, right to health, right to pollution free air, etc. Right to life is fundamental to our very existence without which we cannot live as human being and includes all those aspects of life, which go to make a man’s life meaningful, complete, and worth living.

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Injury Report

Nature of Injury

Incised, lacerated, bruise abrasion etc
Describe findings on which your opinion is based

Size

Longest dimension given first
Maintain one system of measurement, inches or metric
Wound should actually be measured not guessed

On which part of body

Refer to some bony prominence, joint, anatomical line, or area
May give location from heel in measurement
Location should be three dimensional

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Whether Simple or Grievous

A simple hurt is that injury which is neither extensive nor serious and does not fall under grievous or dangerous hurt

“Bodily pain, disease, or infirmity” caused to someone is hurt Sec 319 IPC

Grievous hurt (Sec 320 IPC)
First- Emasculation
Secondly- Premanent privation of the sight of either eye
Thirdly- Permanent privation of hearing of either ear

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Grievous Hurt(Cont.)

Fourthly- Privation of any member or joint
Fifthly- Distruction or permanent impairing of the power of any member or joint
Sixthly- Permanent disfiguration of the head and face
Seventhly- Fracture or dislocation of a bone or tooth
Eighthly- Any hurt which endangers life or which causes the suffer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuits

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Injury Report(Cont.)

Kind of Weapon

Inferred from wounds
Sharp, blunt, firearm etc

Remarks

In this column age of injury is mentioned
Exact time of infliction can’t be determined so add “About”
Whether all injuries were inflicted on the same time

Injury Report prepared in four copies, in prescribed porforma sent by police

Original to Police station, one copy to S.P. via the C.S., One for record, & one personal copy

Record copy is usually on the page of the injury register

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Causes of Death of Injured

Immediate causes

Haemorrhage

External or internal
Loss of 1/3 of total blood volume will cause death
Children, women and old may die with smaller loss
Bleeding disorder cases die from small wounds

Shock

Blood loss, Neurogenic, cardiac & cold
Toxins & Poisons
Fright & fear

Injury to vital organs

Injury to heart/ lungs/ or brain

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Causes of death (Cont.)

Remote or indirect causes

Inflammation of internal organs- peritonitis
Septic Infections- septicaemia, pyaemia
Gangrene
Embolism & thrombosis
Infective diseases- tetanus
Fat embolism- Injury to fatty tissue & bones
Air embolism

Criminal abortion,Injury to neck veins, lung injuries

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Indirect Causes of Death

Supervention of disease after trauma

Strangulated hernia causing death
Paraplegia finally death due to UTI, bedsore

Neglect of the injured person

Causa causati

Surgical operation resulting in death

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Which of Several Injuries Caused Death

Injury to vital organ,

Large blood vessels
Resulting in to secondary causes of death

No defence that the accuse did not inflict the fatal blow if-

There was common intention to cause death
Causing such hurt as would cause death

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Volitional Acts After Fatal Injury

Whether injured capable of

Speaking, Walking, Climbing,
Any other volition act or acts

A guarded opinion should be given

As persons are known to have done all this after having received a fatal blow

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Difference Between Antemortem & �Post mortem Wounds

May be difficult to differentiate if inflicted within 1 to 2 hrs of death (Before cellular death)
Inflicting of wounds on dead body to support false charge is very common

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Haemorrhage

Either external or internal or in tissue
Presence of blood clot
Wound and neighbouring tissue stained with blood
Antemortem stain of blood cannot be removed
Spouting of arterial blood on body, clothing, and vicinity

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Ante-mortem Vs Post-mortem

Retraction of the edges of the wounds

Antemortem wounds gape due to retraction of cut muscle fibres

Signs of inflammation and repair

Swelling of edges with leucocytic infiltration in a few hours
Pus forms in not less than 36 hours
Firm clot does not form in wounds inflicted 10 mts after death
Margination and limited emigration of leucocytes may occur in injuries inflicted after somatic death
Marked cellular exudation and reactive changes in the tissue cells are seen in antemortem wounds only

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Antemortem Wounds Without Tissue Reaction

Insufficient time before death for tissue reaction
Reaction may have ended in resolution
Degree of cellular injury may have been insufficient to elicit an appreciable leucocytic exudation
In severe injury failure of circulation(Shock) may have interfered with tissue reaction.

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Intensity of Tissue Reaction

It depends on

Severity of injury
Nature of tissue injured
Vascularity of the injured tissue
Presence of infection or foreign body

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Reaction to an aseptic injury

Dilation of capillaries and margination of leucocytes

Within a few minutes

Emigration of leucocytes – Within 1 hr

Monocytes seldom seen – Before 12 hrs

Reactive changes in tissue histiocytes

And swelling of vascular endothelium may be observed within an hour of injury

Fibroblasts

At the site of injury show reactive changes within a few hrs
Begin to undergo mitotic division- after about 15 hrs

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Difference between Suicidal, homicidal, & accidental injury

Position of wound	Accessible parts only	No fixed site	Exposed & body prominences
Nature of wound	Usually incised & stab, occasionally firearm	Usually chop, lacerations& stabs & firearm	Abrasions, bruises, & lacerations

Suicidal

Homicidal

Accidental

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Suicidal Homicidal Accidental

No. of wounds	One deep wound several tentative	Multiple deep wounds + superficial	Usually single but may be multiple
Direction	Whether Lt handed or Rt.	Any direction depending on position	Any direction
Extent of wound	Mostly superfical one/two deep	Severe and extensive	Variable severity

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Suicidal Homicidal Accidental

Grouping	Arranged	Irregular	Vulnerable parts
Clothing	Not damaged	Damaged	Damaged, mud ,dirt, grease
Defence wound	Absent	May be Present	Absent
Secondary injuries	Absent	Connected with fight	Connected with accident

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Suicidal Homicidal Accidental

Weapon	Found clasped in hand or near the body	Usually not found	Present or known
Scene of crime	In order, room may be locked	Disturbed, sign of struggle, blood stain	Varies with nature of accident
Motive	Present, failure in Exam. Love, depression	Revenge, robbery, sexual offences	Absent

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WHO DIED FIRST WHEN MORE THAN ONE PERSON DIED TOGETHER

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