Pages From Forensic Medicine &Toxicology - Dr.P.C. Ignatius (2)

Bite Marks

• Types of Bite Marks:

  • Love Bite Marks:

    • Also known as suction petechiae or superficial bites.

    • Usually present on breasts, face, and shoulders.

    • Not deep; may appear as superficial bruises with intradermal infiltration.

  • True Bite Marks:

    • Deep impressions of teeth caused by forcible bites.

    • Commonly found on breasts, neck, chest wall, lower abdomen, and thighs.

    • May result in severe injuries, such as bitten-off nipples.

• Examination & Evidence Collection:

  • Swabbing:

    • Wet and dry swabs from bite marks should be taken to detect saliva, group, and DNA.

  • Contusions:

    • May appear anywhere on the body, particularly on upper arms (six penny bruise) from forceful restraint.

  • Abrasions and Bruises:

    • Commonly found on the back, chest, buttocks, and legs due to contact with rough surfaces.

  • Documentation of Injuries:

    • Injuries must be described in detail (size, shape, position).

    • Note the age of injuries for correlation with the timing of the incident.

    • Use diagrams to mark injuries clearly.

    • Minimal injuries may indicate victim incapacitation or overpowering.

  • Photography:

    • Consent from the victim is necessary for photographing injuries, particularly bite marks, for future identification.

Local Examination for Genital Injuries

• Examination Protocol:

  • Conduct under good lighting; patient in lithotomy position for examination.

  • Approach should be empathetic and considerate to the victim.

  • Menstruation is not a barrier to examination.

• Evidence Collection:

  • Look for matted hairs at the external genitals due to recent intercourse; cut with scissors.

  • Loose pubic hairs should be collected carefully.

  • Dried seminal stains should be scraped off with a clean blunt knife for laboratory analysis.

• Examination Of Genitals:

  • Assess labia majora for contusions, lacerations, or tenderness.

  • Examine the vaginal wall for lacerations and hymen status.

    • Note presence, type, and condition of the hymen.

    • Take swabs before assessing the hymen, followed by high vaginal swabs.

  • Use a small vaginal speculum for examining vaginal wall injuries.

  • In young children, severe injuries require anesthesia for examination.

Issues Related to Examination

• Colposcopic Examination:

  • Utilizes a colposcope for detailed assessment of genital injuries. Some colposcopes can take photographs concurrently.

  • Glaister-keen globe: Used to examine the margin of the hymen and vaginal structures.

• Microscopy of Vaginal Secretions:

  • Vaginal secretions examined microscopically for motile spermatozoa to determine intercourse timing (within 12 hours).

  • Staining with eosin-hematoxylin or Papanicolaou smears can be performed.

  • Vaginal aspirate involves injecting saline into the vagina for analysis of sperm viability.

Sexual Assault Forensic Evidence Collection

• SAFE Kit:

  • Developed for trace evidence collection in sexual assault cases, includes necessary tools (swabs, vials, envelopes, forms).

• Venereal Disease Assessment:

  • Examine any discharge for nature and color; necessary swabs for microscopy and cultures.

  • HIV testing should be considered after a window period (approx. 4 weeks).

Rape of a Virgin

• Hymen Examination:

  • Separation of labia for examining hymen status; rupture indicates first intercourse.

  • Rupture of hymen most often occurs posteriorly (5-7 o’clock positions).

  • Initial findings include reddened, swollen margins with possible bleeding.

• Notes on Injuries:

  • In children, hymen may remain intact despite external injuries; severe penetrating force can cause significant internal damage.

  • Blood clots may be present in the vagina; posterior vaginal wall tears are common.

  • It's important to note that rape is a legal term, not a medical one, and absence of physical injuries does not negate the possibility of rape.

Comprehensive Evidence Gathering

• Specimens to Collect:

  • Vaginal swabs, smears, and swabs from the introitus.

  • Swabs from bite marks, nail clippings, and foreign hairs.

  • Blood stains and samples for grouping and DNA analysis.

  • Consent-based photography of bite marks for suspect identification.

  • Use a Wood's lamp for detection of invisible stains.

Drug-Facilitated Rape

• Common Drugs:

  • Flunitrazepam (Rohypnol) and GHB are used to impair victims.

  • Effects include loss of resistance and altered consciousness, facilitating assault.

Rape Trauma Syndrome (RTS)

• Phases of RTS:

  1. Acute Disorganization Phase: Emotional responses include anxiety, tension headaches, and depression.

  2. Later Reorganization Phase: Victims work to readjust; possible anxiety neuroses, nightmares, and phobias.

• Treatment Approaches:

  • Psychotherapy and drug therapy with SSRIs.

  • Cognitive Behavioral Therapy is noted to be more effective than drug therapies.

• Rape Crisis Centers: Available in some countries for victim support and rehabilitation.