Patterns of cause of death in unknown dead bodies a three year study in a tertiary care hospital.

Opinion about the cause of death in unknown dead bodies is a test of ability of the Forensic expert and on many occasions yields little or no results. The reasons may be inadequate/no history, disinterested Investigating officers unwilling to properly work out the case, partial/complete decomposition/destruction/mutilation of the body, etc. In such cases, identification of the body as such poses problems; rest aside the opinion regarding the cause/manner of death. The present 3 year study was undertaken to find the cause of death and the pattern of causes of death in unknown dead bodies, as well as the efforts made to establish the identity in these cases. Unidentified bodies comprised 4% of the total 1577 cases brought for postmortem examination to the department. Maximum number of cases belonged to the age group 41 -50 years, 35%. Majority of the opinions regarding the cause of death were given as cranio-cerebral damage, 30%, followed by “no definite opinion”, 28%. Viscera for chemical analysis were sent in 24%, histopathology in 8% and for both chemical analysis and histopathology, in 27% cases.

Recent advances in the management of poisoning cases.

Deaths due to poisoning are on the rise over the years, despite advanced knowledge regarding their pharmacokinetics and pathology, and newer and better techniques being developed for the management of poisoning cases. The management of a poisoned patient has changed over the years. Though the general principles of treatment of a poisoned patient remain the same, traditional methods like gastric lavage, for example, have taken a back seat. There has been gaining popularity of newer methods like use of activated charcoal and a variety of newer antidotes. Attention has also shifted to toxidromes, the collection of symptoms and signs that consistently occur after ingestion of a particular toxin or drug. Grouping the various signs and symptoms exhibited by a poisoned patient into different toxidromes helps the physician in rapid identification of the toxidrome and saves time in evaluating and managing a poisoned patient. However, the mainstay of the treatment, according to the experts is stabilization of the patient.

Death due to ruptured ectopic pregnancy natural death or negligence.

A young adult female of low socio-economic status, and a labourer by profession, was brought dead to the Government Medical College & hospital, Chandigarh. History provided by her husband revealed that she had pain abdomen for the last five days for which she was getting treatment from a private practitioner. She had been prescribed NSAIDs and antispasmodics for the same. However, she was not investigated upon and no attempt was made by the practitioner to arrive at any diagnosis. The autopsy was conducted on the next day and at autopsy, about two-and-a-half liters of blood was present in the abdomen and pelvic cavity. Careful internal examination revealed a ruptured ectopic pregnancy as the source of bleeding. The case is discussed with regard to establishing whether the death could have been natural, due to the negligence of the treating doctor or due to contributory negligence. However, even in cases of contributory negligence, the “last chance doctrine” may not save the physician.

Teaching, training and practice of forensic medicine in India - An overview.

Forensic medicine & Toxicology, an important and integral part of medical education, has been a silent spectator to its ups and downs in the recent past. Having had its glory at times, playing pivotal role at places in aiding criminal justice, it has unfortunately failed to sustain the impetus and its importance. Furthermore, Medical Council of India (MCI) - the national medical supreme body, has come down heavily on this specialty in general and on its curriculum in particular at the undergraduate level, pushing it down to the cross roads. The increasing legal awareness among the masses, frequent unsavory remarks on the doctors by the judiciary, bringing medical profession under the purview of the Consumer Protection Act in contrast to the decreasing of importance of the subject in the medical curriculum coupled with casual approach to the subject both by the teacher and the taught have all culminated into a situation where fate of the subject befits the words of Sir Winston Churchill, "This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Fatal gastro-intestinal bleeding: A complication following spinal injury.

On 30.08.2003, a 20-year-old boy met with a vehicular accident and sustained spinal injury and left upper limb fracture. He was immediately hospitalized and seemed to recover well after treatment for a period of 15 days, when just before discharge he suddenly had hematemesis and bleeding per rectum and succumbed within another 24 hours. The case is discussed in detail.