Injury - Any harm whatever illegally caused to any person, in body, mind, reputation or

property (S.44, IPC).

Wound - A break in the natural continuity of any of the tissues of the living body.

An injury is any damage to any part of the body due to application of mechanical force. Wound
is defined the forcible solution of the continuity of any tissue of body by mechanical force.
Trauma is an insult to the state of well-being and the insult may be physical or mental.

Classification of injuries

A) ACCORDING TO CAUSATIVE FORCES

(1) Mechanical injuries:

(a) Due to blunt force –

(i)Abrasions (ii) Contusions (iii) Lacerations (iv) Fractures and dislocations

(b) Due to sharp force –

(i) Incised wounds (ii) Chop wounds (iii) Stab wounds

(c) Firearms - (i) Firearm wounds

(2) Thermal injuries:

(a) Due to cold - (I) Frostbite (II)Trench foot (III) Pernio (Chilblains)

(b) Due to heat - (i) Burns (ii) Scalds

(3) Chemical injuries - (a) Due to corrosive acids (b) Due to corrosive alkalis (c) Due to
corrosive salts

(4) Physical agents - (a) Electricity: - (i) High tension (ii) Low tension

(b) Lightning (c) X-rays (d) Radioactive substances

B. LEGAL CLASSIFICATION

Courts would generally follow this classification.

1. Hurt - Hurt would fall u/s 319, IPC 9 (S 114 BNS). Law does not mention the word “simple
injury’’ anywhere, and thus this term should best be avoided. By common usage, “simple
injury” is used as a synonym of hurt.

2. Grievous Hurt - Grievous hurt would fall u/s 320, IPC. All injuries which are not simple
are grievous and vice-versa.

C. MEDICOLGEAL CLASSIFICATION

1. Suicidal Injury

2. Homicidal Injury

3. Accidental Injury

4. Defense Injury

D. INJURIES IN RELATION TO DEATH

1. Antemortem Injury

2. Postmortem Injury

LAW GOVERNING INJURIES

u/s 114 BNS – Hurt: - Whoever causes bodily pain, disease or infirmity to any person is said
to cause hurt.

u/s 115 BNS - Voluntarily causing hurt

u/s 116 BNS – Grievous Hurt The following kinds of hurt only are designated as “grievous,”
namely: —

(a) Emasculation;
(b) Permanent privation of the sight of either eye;

(c) Permanent privation of the hearing of either ear;

(d) Privation of any member or joint;

(e) Destruction or permanent impairing of the powers of any member or joint;

(f) Permanent disfiguration of the head or face;

(g) Fracture or dislocation of a bone or tooth;

(h) Any hurt which endangers life or which causes the sufferer to be during the space of fifteen
days in severe bodily pain, or unable to follow his ordinary pursuits.

u/s 117 BNS – Voluntarily causing grievous hurt.

u/s 118 BNS – Voluntarily causing hurt or grievous hurt by dangerous weapons or means.

u/s 119 BNS – Voluntarily causing hurt or grievous hurt to extort property, or to constrain to
an illegal act.

u/s 120 BNS – Voluntarily causing hurt or grievous hurt to extort confession, or to compel
restoration of property.

u/s 121 BNS – Voluntarily causing hurt or grievous hurt to deter public servant from his duty

u/s 122 BNS – Voluntarily causing hurt or grievous hurt on provocation.

u/s 123 BNS – Causing hurt by means of poison, etc., with intent to commit an offence.

u/s 124 BNS - Voluntarily causing grievous hurt by use of acid, etc

u/s 125 BNS – Act endangering life or personal safety of others.

ABRASION

An abrasion is an injury involving destruction of epidermal layers of the skin and dermal
papillae.

Producing abrasions can be of two types (a) tangential (sliding force or friction) (b)
perpendicular (Compression)

A. Types of Abrasions

1. Scratch abrasions (Linear Abrasion)

Scratch abrasion are abrasions with appreciable length, but no significant width. They are
typically produced by sharp, pointed objects such as fingernails, pins or thorns. (a) When
produced by tip of knife or razor, they are called point scratches. (b) Nails produce typically
curved scratch abrasions, known as semilunar abrasions.

Direction - Surface layers of the skin are “heaped up” in the direction of the movement.

2. Graze abrasions – syn: sliding abrasion, gliding abrasion, brush abrasion, scrape
abrasion.

These abrasions are produced by sliding movement of broad or wider surface against skin.
Comprise of uneven, longitudinal parallel lines (grooves or furrows) with the epithelium
heaped up at the ends of these lines. This heaping up indicates the direction in which force was
applied. When the friction force is great, grazed area appears like burn injury. Such graze
abrasions are called as brush burn.

3. Pressure abrasions – Pressure abrasions [syn, crushing or friction abrasions]

are abrasions produced by crushing of epithelium, when a relatively small force is applied
perpendicularly to the skin for large time periods. The pressure abrasion, due to crushing, on
getting dried up resembles parchment like and appears brown to black.

Eg: Ligature marks - of hanging and strangulation, Shoe bite, Teeth bite marks.

4. Impact abrasions – Impact abrasions [syn, patterned, contact or imprint abrasions]

are abrasions produced by crushing of epithelium, when a relatively large force is applied
perpendicularly to the skin for minuscule time periods.

Eg: Shoe sole marks – in kicking, Tire marks of a car, bus or truck on pedestrian - in run over
accidents.

Medicolegal importance:

(1) Direction of force – can be estimated from tissue tags

(2) Force of impact – can be judged

(3) Foreign matter sticking over abrasions – may give an idea of scene of crime [eg grass,
gravel, sand etc]

(4) Manner of production – (i) Generally accidental or homicidal in nature (ii) May be self-
inflicted for leveling false charges against enemies

(6) Nature – (i) Usually simple, because they heal without scarring (ii) Do not pose danger to
life, until and unless multiple and massive, or involve underlying vital organs

(7) Time of assault – can be calculated

(8) Type of offence – is indicated by site of abrasions

(i) around anus - homosexuality (ii) around breast, cheeks, neck, inner side of thighs – indicate
sexual assault (iii) over face – indicate struggle (iv) over mouth and nose – in smothering (v)
over neck – indicate throttling, especially crescentic abrasions

(9) Weapon – can be identified from patterned abrasions. Sometimes peculiarity of the
offender’s nails can be estimated [eg long, crooked, broken, irregular etc).

CONTUSION (BRUISE)

A contusion is an extravasation or collection of blood due to rupture of blood vessels caused

by application of mechanical force of blunt nature without loss of continuity of tissue.

Mechanism:

Contusion is caused by blunt force impact causing crushing or tearing of subcutaneous tissue
or dermis without breaking the overlying skin or mucous membrane. Due to rupture of blood
vessels, there is extravasation of blood out of vessels and collected underneath the tissue.
Collection of blood is accompanied by swelling and pain.
Types

• Intradermal bruise

• Subcutaneous bruise

• Deep bruise

Intradermal Bruise

• In this type, the bruise is situated in the sub-epidermal layer of skin.

• Patterned bruises are often associated with intradermal bruise. Due to superficial
position of these bruises and translucency of the skin that overlies these bruises, the
patterned contusion becomes more prominent.
• Examples – motor tyre marks, impacts from whip, impact from rubber soles of shoes

Subcutaneous Bruise

• These bruises are the commoner types and are located in the subcutaneous tissue often
in the fat layer above the deep fascia and therefore are fairly visible through the skin.
Such bruise is called as superficial bruise

Deep Bruise

• If such bruises are located below the deep fascia, such bruises are called as deep
contusions and these bruises take time to appear over surface.
Table 9.3: Age of Contusion

Table 9.3: Difference between AM and PM Contusion

Medicolegal Importance

1. Offending weapon can be known.

2. The age of injury can be determined.

3. Character and manner of injury can be known.

4. Application of degree of violence can be estimated.

5. A bruise is usually simple injury but if present on vital parts or organs may amount to
grievous hurt or may cause death.

LACERATION

Definition: Laceration wound is form of mechanical injury caused by hard and blunt force
impact characterized by splitting or tearing of tissues.

Mechanism:
When the skin or other structures are subjected to blunt forces, the tissue gets crushed or
stretched beyond the limits of their elasticity leading to tearing of the skin or other tissue thus
producing laceration. Laceration differs from the incised wounds because in laceration, the
continuity of the tissues is disrupted by tearing rather than clean slicing.

Types:

Following are the types of lacerated wounds

1. Split laceration

2. Stretch laceration

4. Avulsion laceration

5. Crush laceration

Medicolegal Importance

1. Cause of injury can be known

2. Type of lacerated wound may be known

3. Nature of injury can be ascertained – whether simple or grievous

4. Foreign bodies present in wound may help in identification of the offending weapon/place
of incident etc.

5. Age of injury can be estimated

6. It can be known whether the injury is accidental or suicidal or homicidal

7. Direction of application of force can be known.

INCISED WOUND

Definition: An incised wound is form of mechanical injury characterized by orderly solution

of skin and tissues by a sharp cutting force.

Mechanism of Incised Wound

• Caused by sharp cutting weapons (razor, knife, scalpel, sword, axe).

• Force acts over a narrow area (cutting edge of blade).

Mechanism

1. Striking with sharp edge

2. Drawing/swiping action over skin
3. Sawing action → multiple cuts at start, merging into one wound at end

Features of Incised Wound

• Broader than weapon edge due to tissue retraction

 • Length > depth and breadth
• Margins: clean-cut, well-defined; usually everted
• Tissues cut cleanly in same plane
• Length of wound ≠ length of weapon

Special Points

• Tailing at end → shows direction of weapon movement

• Profuse bleeding due to clean-cut vessels
• Oblique cut → beveling of one edge and undermining of other (indicates direction)

Medicolegal Importance

1. Cause of injury can be known

2. Nature of injury can be ascertained – whether simple or grievous

3. Age of injury can be estimated

4. It can be known whether the injury is accidental or suicidal or homicidal.

5. Direction of application of force can be known.

CHOP WOUND

Definition: Chop wounds are type of incised wounds made by hacking or chopping motion
with a fairly sharp and relatively heavy weapon.

Features of Chop Wound

• Caused by heavy sharp weapons (axe, chopper, sword)

• Margins not clean-cut → show abrasion/bruising
• Weapon weight plays major role in deep penetration
• Wound is wider and deeper than incised wound
• Oblique impact → beveling of margins
Special Features

Two ends:

• Heel end (near assailant) → deeper

• Toe end (farther) → less deep → Helps in determining position of assailant and
victim.

Medicolegal Importance:

1. Chop wounds are usually homicidal in nature however, accidental injuries may be
sustained by a person working in factories etc.
2. From the heel or toe end, the relative position of the assailant and the victim can be
known.
3. The type of weapon used can be known.
4. Age of injury can be known.

STAB WOUND

Definition: Stab wound is a piercing wound produced by application of mechanical force

along the long axis of a narrow or pointed object.

Classification:

1. Penetrating
 2. Perforating

Penetrating Wounds

• These are the stab wounds that terminate in the tissue/ organ/cavity.

• In these wounds, only one surface wound is present on body due to entry of blade and no exit
wound as the stab terminates in the tissues/organ/cavity.

Perforating Wounds

• Through-and-through stab wounds

• Have two wounds:
Entry wound
Exit wound

Features

• Entry wound: larger, margins inverted

• Exit wound: smaller, margins everted
• Foreign material (cloth, hair) may be present in tract/entry
• Line joining entry & exit → indicates direction of injury

Medicolegal Importance:

1. Type of weapon used can be known.

2. Dimensions of weapon can be known.

3. Movement of knife in the wound can be known.

4. Depth of thrust can be known.

5. Direction of thrust can be known.

6. Amount of force used can be known.

7. Age of wounds can be known.

8. Manner of infliction – suicidal/homicidal/accidental can be known.

THERMAL INJURIES

Introduction

Thermal injuries are caused either due to exposure to cold or exposure to heat. The effect of
heat or cold over body may be in generalized form or may have localized effect to a particular
body part.

Due to Exposure to Cold

1. General effects: Hypothermia

2. Local effects: Such as– Frost bite– Trench foot– Pernio (chilblains).

Due to Exposure to Heat

1. General effects– Hyperthermia

2. Local effects: Such as– Burns– Scalds.

Hypothermia:

Definition: Hypothermia is state where an individual’s core body temperature is below 35°C
(95°F)

Classification:

[Link] Hypothermia: core body temperature 35 to 32°C

[Link] Hypothermia: core body temperature < 32 to 28°C

[Link] Hypothermia: core body temperature < 28°C

Causes of Hypothermia

1. Severe cold exposure + exhaustion (environmental hypothermia)

2. Immersion in cold water
3. Excess heat loss
4. Reduced heat production (malnutrition, hypothyroidism, liver failure)
5. Drugs (barbiturates, alcohol, opiates)

Causes of Death

1. Ventricular fibrillation

3. Acid-base imbalance

4. Bronchospasm

5. Pulmonary edema.

Frostbite

• Frostbite occurs from exposure to severe environmental cold exposure or dry cold or from
direct contact with cold object (below 0°C).

• It is commonly seen in mountaineering and polar expeditions.

• Tissue injury results from freezing and vasoconstriction.

• It usually affects the distal aspects of extremities or exposed parts of face such as ears, nose,
chin and cheeks.

Immersion Foot

• Also called as trench foot

• It occurs when foot or hand is exposed to a low temperature of 5 to 6°C if the limbs are wet.

• Wetness is an important contributory factor because when limbs are wet, cold is more
penetrating. Necrosis of fingers, toes or hand and feet may occur. Obliterating angiitis causes
severe gangrene and loss of tissue.

Pernio (Chilblains)

It is a vasculitic disorder associated with exposure to cold. When exposed to cold, patient
develops raised erythematous lesion on lower part of legs and feet. These lesions are associated
with Pruritis and burning sensation.
Exposure to heat:

Hyperthermia

Definition: The normal temperature in human is said to be 37°C (98.6°F). Hyperthermia is an

elevation of body temperature above the hypothalamic set point.

Causes

Causes are as follows

1. Heat stroke

2. Drug induced – such as amphetamines, monoamine oxidase inhibitors, tricyclic

antidepressants

3. Malignant hyperthermia – due to inhalational anesthetic agents, succinyl choline

BURNS

Burns are not uncommon injuries and vary from minor and insignificant injuries to severe
forms. A burn injury is defined as “tissue injury due to application of heat in any form to the
external or internal body surface”.

1. Dry heat – burns

2. Moist heat – scalds

Classification of Burns:

Burns have been classified by the American Burn Association and the American College of
Surgeon’s committee on trauma.

1. Minor – superficial burns of less than 15 percent total body surface area (TBSA).
2. Moderate – are defined as – Superficial burns of 15 to 25 percent TBSA in adults or –
10 To 20 percent TBSA in children or – Full thickness burns of less than 10 percent
TBSA and burns not involving eyes, ears, face, hands, feet or perineum.
3. Major burns – above plus most full thickness burns in infants and elderly patient.

Dupytren’s Classification:

Dupytren’s had classified burns into six degrees as:

Wilsons Classification:

To overcome the tedious Dupytren’s classification, a more practical classification was proposed
by Wilson. Wilson had divided the burns into three degree.

Modern Classification:

This is easier and gross classification, dividing the burns into two degrees namely superficial
and deep burns

• Superficial burns – it is dermo-epidermal burn injuries and here burns do not extend the full
thickness of skin.

• Deep burns – here the burn lesion involves deeper structures beneath the skin. Any burns
involving more than true skin are grouped in this category.
Estimation of Extent of Burn (Surface Area)

The estimation of extent of burns is done to note the involvement of total body surface area
(TBSA). For estimating the surface area or assessing the percentage of burns following
methods are used.

Wallace rule of nine – the estimation of burn surface area in adult is usually carried out by
“Wallace Rule of Nine”.
Medicolegal Importance:

1. Identity of deceased – if burns involve face with char ring, may create problem in identity
of victim

2. Whether the burns are antemortem or postmortem?

3. What is the time of sustaining burn injuries?

4. What is cause of death?

5. Whether the antemortem burns were sufficient to cause death?

6. Whether the burns are suicidal, homicidal or accidental?

7. Bride burns and dowry death.

SCALDS

Scald injuries are the tissue damage caused from application of moist heat. Usually, water is
common causative agent however, other culprits being oil, molten rubber, liquid chemicals, tar,
molten metals etc. Application of liquid to the body at or near its boiling point or in its gaseous
form (steam) will cause the scalds. Application of water of 50°C at vulnerable part will cause
scald.

Classification Scalds are classified into three degrees as:

• First degree – characterized by erythema formation of affected part

• Second degree – characterized by blister formation with increased vascular permeability

• Third degree – characterized by drying and desiccation of underlying tissue with necrosis.
Features of Scalds

• No charring, carbonization, or singeing of hair

• Well-defined margins corresponding to fluid contact
• Trickle pattern seen due to flowing liquid (gravity effect)
• Severity decreases downward as fluid cools
• Immersion → clear horizontal level line
• Steam inhalation → burns in airway (mouth, nose, larynx)
• Clothes may protect or worsen injury (retain heat)

Medicolegal Importance:

• Scalds are usually accidental injury often involved infants, toddlers or children.
• Scalding may be intentional when someone with malicious intention throws hot water
or liquid over someone else’s body to cause injury/hurt and/or disfigurement.
• It may be one pattern of battered baby syndrome.