Duties of medical practitioner while Treating Poisoning Cases

First and most important duty is to resuscitate the patient.

In suicidal or accidental poisoning, doctor (in private set up) is not bound to inform police.

In case of death, do not issue death certificate. Police have to be informed.

Doctors in Govt. Hospitals are to report every cases of poisoning to police

All cases of definite/suspected homicidal poisoning must be informed to police. sec. 39 (CrPC)

Collect and preserve all materials like vomitus, faeces, stomach washing contaminated food etc and send to State Forensic Science Laboratory for analysis. (Deliberate omission will lead to sanction under 201 IPC)

In conscious patient, who is dying, arrange for dying declaration.

Notify all cases of poisoning from public eatery to public health authority

Maintain written records in all cases of poisoning.

Book review

Text Book of Forensic Medicine and Toxicology by V.V. Pillay is a very concise book of Forensic Medicine for the undergraduate students. The 15th Edition is much more elaborate one than the previous issues, many advancement in the field of Forensic Medicine and Forensic Science has been included like the fMRI, Brain Fingerprinting and many more. In the field of Toxicology, as we all know he is one of the pioneers in India and as such, the toxicology section of the text book is very impressive; all the topics are described in concise without any unnecessary elaborations but, has narrated a few case references at the appropriate place which will be beneficial for the undergraduate students. The photographs included in the book are also of good quality and are very appropriate in relation to the text. In my opinion it is a complete book for the undergraduate students.

Case report:

A case of burn was brought to the Deptt. of Forensic Medicine, Assam Medical College, Dibrugarh, Assam, for ML autopsy. The victim suffered approximately 98% burn. No injury detected except the burn injury on external examination. I used the “Fourth Autopsy Incision” which I developed in the year 2006, and found few contusions in the back of the chest which would have remained unnoticed in ‘I’ shaped, ‘Y’ shaped or modified ‘Y’ shaped incisions. Advantages of the “Fourth Autopsy Incision”:

• whole of the circumference of the neck, thorax and abdomen is visualised, so, better detection of the wounds.
• no or minimal seepage from the cavities.
• stitches can be kept hidden in the front of the neck, so, better acceptance for the relatives of the deceased.
• no separate incision is required for opening the spinal canal from the back.

Indications: in cases of death related to

• torture,
• custodial death
• burn
• road traffic accidents and any other cases, where there is history of injury just before death of the person.
  

Case of death with 98% burn

Same case with contusion in the deepper tissues

N.B. The incision is described in “Text Book of Forensic Medicine and Toxicology” by Dr. V.V. Pillay pp. 152-155.
Article on the incision technique is being published in the American journal of Forensic Medicine and Pathology in Volume 30, Number 4, December 2009.

CASE REPORT:

A bundle of bone was sent by the police for autopsy. Police suspected that the bones belong to a boy aged around 17 years who was kidnapped for ransom around two years back.

On examination of the bones found as follows:
List of the bones found

• Skull bones
• Right maxilary bone
• Mandible
• Both femures
• Both hip bones
• Both the scapulae
• Sacrum
• Two clevicles
• 11 Vertibrae
• 17 Ribs.

Photographs of the findings:

On the basis of the findings, the following opinion was formed:

• The skeletal remains were of human origine and from one and same individual.
  Sex was male
  Age of the person was above 16 years and bellow 18 years at the time of death.
  Height of the person was approximately 160.4 ± 3.9 CM.
• Time since death was approximately 18 to 24 months.
• Death of the person was due to the incised wound over the skull caused by sharp cutting heavy weapon and was homicidal innature.

VIRTOPSY: One step forward in the field of Forensic Medicine

Virtual autopsy or more popularly known virtopsy is a scalpel free procedure of autopsy carried out using modern imaging techniques. Here, there is no need of any dissection of the body for opening the body cavities or dissection of the different organs of the body. Using the different imaging techniques, which provide a complete three dimensional view of the inside as well as outside of the body, all the vital information like position and dimensions of the wounds, or other pathological conditions in the body can be known and documented without use of any scalpel. The technique could offer an alternative to the standard invasive procedure that upsets many families and is prohibited by some religions, the developers say.

Imaging techniques used:

• Multi-slice computed tomography (MSCT) and
• Magnetic resonance imaging (MRI) – which visualise the interior of the body for collection of all the data in details in regards of condition of different organs. One can examine the part of the body in slice by slice in different planes according to the requirement of the situation.
• 3-D surface scan used in the automobile designing is used to map the exterior of the body. It gives and documents the three dimensional image of the body surface area in details.
• Magnetic resonance imaging spectroscopy for estimation of time since death by measuring metabolites in the brain emerging during post-mortem decomposition.

Advantages:

• Most effective in study of the wounds including the matching of the probable weapon. The wound can be studied without disturbing the body architecture.
• No scalpel method, so no hazard of infections from the blood or other tissue fluids.
• No mutilation of the body, so, can be examined again without any autopsy artifacts.
• The data is stored in digital format, so can be transmitted to any part of the world easily.
• Less time consuming and body can be released immediately after the scanning.
• Better acceptance for the relatives of the diseased and also by the religious customs as incisions are used.
  

Disadvantages:

• Insufficient data base of comparative study of virtopsy and conventional autopsy.
• It is not possible to distinguish all the pathological conditions with this technique.
• Collection of sample for histopathological and the toxicological samples from internal organs is not possible.
• Can not speak about the infection status.
• Difficult to differentiate antemortem or the postmortem wounds.
• Difficult to appreciate the postmortem artifacts.
• Difficult to appreciate the colour changes.
• Small tissue injury may be missed.
• In our scenario, it is not possible to provide these types of investigations to all the living persons, so how far it will be practical to start with the same for the dead is questionable as in our setup, deads come last in the priority list.

FOR VIDEO OF VIRTOPSY PLEASE CLICK THE LINK BELLOW http://www.virtopsy.com/index.php?id=45

Modern Mortuary Plans

PLAN FOR A MEDICAL COLLEGE MORTUARY


PLAN FOR A DISTRICT HOSPITAL MORTUARY

THE FOURTH INCISION - A COSMETIC AUTOPSY INCISION TECHNIQUE

Abstract

Autopsy procedure includes thorough external examination as well as internal examination including opening of all the body cavities for proper visualization of all the visceral organs. As such there remains incision marks with stitches which harts the sentiment of the already traumatized relatives of the deceased. Moreover, it looks odd especially in cases of otherwise healthy dead bodies.
So, autopsy incisions should be such that, we can get maximum possible visualization of the body particularly the thorax and abdomen and at the same time the incision as well as the stitch marks are also hidden.
This new incision technique is designed with few modifications in the autopsy incisions for opening the thorax and abdomen and also proper visualization of the neck structures during autopsy where the incisions and the stitches are kept hidden. In all the other incisions, the back of the neck, thorax and abdomen is not at all visualised. So, this incision is designed in such a way that, the whole circumference of the body can be visualised.

Advantages of this incision technique are-

• whole of the circumference of the neck, thorax and abdomen is visualised, so, better detection of the wounds particularly in cases of death related to torture, road traffic accidents and any other cases, where there is history of injury just before death of the person.
• no or minimal seepage from the cavities.
• stitches can be kept hidden in the front of the neck, so, better acceptance for the relatives of the deceased.
• no separate incision is required for opening the spinal canal from the back.
• the only disadvantage that I encountered is that, it is more time consuming in comparison to the “I shaped incision”. It takes 25min more time in comparison to the I shaped incision.

Few photographs of the incision: ( for medical professionls only )

( please do not copy )

For details of this incision technique, please contact at drajpatowary@gmail.com .