1. The weapon – The type, nature and extent of an injury depends greatly on the type of the weapon. It is important, whether the weapon is blunt or sharp edged, whether pointed. If sharp edged, whether one edge or both edges are sharp. The weight of the weapon-whether it is heavy, moderately heavy or light. If it is a firearm weapon, then whether it is a rifled or smooth bored gun. What is the type of the projectile or the ammunition used ? What was the relative position between the assailant and the victim ? In case of firearm weapon the distance of firing is also important.
2. Which part of the body has been affected ?
3. The sex and age of the victim.
4. The physical condition of the victim.
5. In case of injury due to heat, whether it is dry heat or moist heat.
6. In case of injury due to either heat or cold, the duration of exposure to heat and cold.
7. Whether the body was covered with clothes at the time of sustaining the injury. What was the type of the covering ?
8. What was the amount of force applied ?
FACTORS WHICH INFLUENCE THE PROCESS OF HEALING OF AN INJURY
1. Type of the injury.
2. Number and dimensions.
3. The part of the body involved.
4. Whether the injury got infected.
5. Physical condition of the victim.
6. Treatment given.
7. Age of the injured.
OTHER MEDICOLEGAL ASPECTS OF INJURY
IMPORTANT MEDICOLEGAL QUESTIONS WHICH ARE ASKED TO A DOCTOR –
1. How many injuries were present in the body ?
2. What was the type of each of them ?
3. What was the dimension of each of them ?
4. Their locations on or in the body.
5. What was the type of weapon used ?
6. How was the injury caused ? Was it caused by striking with the weapon, by drawing the weapon on the body of the victim, by sawlike movement, by pushing the weapon, by pushing the victim on some object, due to fall of the victim, due to an explosion, by being knocked down or runover by a vehicle etc. ?
7. Was the injury simple, grievous or dangerous ?
8. Time lapsed after infliction of the injury.
9. What were the relative positions of the assailant and the victim ?
10. What was the direction of application of the force ?
11. Was the number of assailant one or more than one ?
12. Did the victim offer any resistance ?
13. Was the victim given any treatment ?
14. Was there any corresponding tear or cut on the covering dress ?
15. Has there been any fabrication of the wound ?
16. Was there any defence wound ?
17. In which precise manner, the injury or the injuries might have caused death ?
18. Was the injury ante-mortem or post-mortem ?
19. For what period the victim survived after sustaining the injuries ?
20. Which of the injuries sustained, were fatal ?
21. Was the injury or were the injuries sufficient to cause death in ordinary course of nature ?
22. Whether any other factor contributed to the cause of death ?
23. Whether die injuries were self-inflicted or inflicted by others or were they accidental in nature ?
24. Did the injuries indicate anything about a specific method applied to cause death (viz. injuries on the neck In case of death due to strangulation) ?
25. Did the injuries give indication of any other offence ? E.g., abrasions or bruises on the breasts and near the private parts of a girl may indicate sex offence having been committed on her.
26. Did anything on the injury tell anything about the place of sustaining the injury ? E.g., dust particles on the wound may tell about the site where the person sustained the wound.
27. Was the complication complained of, the result of some injury ?
28. Has the complication arisen due to negligence during examination and treatment ?
29. Power of volitional act in case of sustaining a fatal injury.
EXAMINATION AND CERTIFICATION OF AN WOUND
Examination of a victim of injury –
The attitude and approach of the medical man should obviously be different, when he examines a living subject than, when he examines a dead body. In case of examination of a living person, it goes without say that, the doctor should give priority to the safety and well being of the injured. Thus, on the basis of the severity of the wound and the general condition of the injured, he must assure optimum treatment that can be offered to him. If and when necessary, after administering first aid, the doctor may refer the case to a nearby hospital for better treatment. This must not be done in haste, to avoid a litigacy, which may rather badly implicate the doctor in a “negligence” case.
While dealing with an injury case, the medical man should record the name, address, age and sex of the victim and brief history of the case as to when and how the person sustained the injuries. Before examination, he should take the consent of the injured, for examination. The victim of an injury case should not be examined without his consent. But in case of an accused person certain amount of force can be applied for his examination, if a magistrate so orders. For an under-aged person, consent may be taken from the accompanying guardian. If no guardian is accompanying and available then court’s order may act for this purpose, or the person under whose custody and care the boy or the girl, legally is at the material time should give the consent. If an adult-injured is not in a position to give consent, then he may be examined and treated without his consent. The injury report in such a case should be submitted only with the consent of the injured when he recovers and is able to give consent or by order from the court or for the purpose of police investigation. In case of death of the person of course, the doctor should send the report to the proper authority in any circumstance. If there is any impending danger to the life of the injured, then the doctor must arrange for the record of a dying declaration from the injured.
Observation during the physical examination, and general condition of the patient should have mention in the report.
He should note the number, type, size and site of the injury or injuries and should give his opinion as to the nature of the injury, whether self-inflicted, or inflicted by other or accidental in origin. He should suggest the type of the weapon which might have been used. He should mention whether the injuries were still painful or tender, the colour and other features of the wounds, the stage of healing, whether bleeding or oozing still continues, whether any foreign body is present in the wound, the nature of staining and tear or cutmarks on the dress, peculiar marks on the wound and the dress etc. He should also mention whether the wound is simple, grievous or dangerous, and the time passed after its infliction. The doctor should mention in the record about the treatment given by him with recommendation of further investigation and treatment, if any.
The doctor should collect the signature or thumb impression of the person examined, on the body of the certificate and should himself sign his name with mention of date, hour and place of examination, name of the person who accompanied the injured and the name of the person who was present during examination (in case of a female victim).
In the “type of injury” column it should be mentioned, whether it is abrasion, bruise or incised wound etc.
To describe the size of the injury, bruises and abrasions should be described in two dimensions (i.e. length x breadth) and all others should be described in three dimensions (i.e. length x breadth x depth).
The site or location of the injury should be described in relation to two external anatomical landmarks of the body. For example, the site of an injury on the anterior wall of the abdomen may be described as “3 cm. left of midline and 5 cm. below the level of the umbilicus”.
To opine whether an wound is simple or grievous, the list of grievous wounds under sec. 320 I.P.C. should be remembered. X’ray examination must be advised in doubtful cases of fracture. Wounds involving vital organs or those which affect the vital functions of the body or cause excessive loss of blood or multiple simple injuries involving wide areas of the body, by their collective action may pose danger to the life of the injured. About the weapon of infliction, it should be mentioned whether the weapon could be a blunt, hard and blunt, sharp-cutting, pointed, heavy, moderately heavy or light one. About the manner of infliction, whether the injury has been caused by striking with the weapon or by drawing the weapon or saw like movement of the weapon on the body, should be noted. If the injury is due to the result of fall on the ground or some material, that also should be noted.
In the column ‘remarks’, the colour of the injury, bleeding and other features of the injury along with the time of infliction, whether self inflected or inflicted by others or otherwise, the treatment given, further recommendation about the treatment and investigation and any other point of medical and medicolegal interest should be mentioned.
While issuing an injury certificate, two points must be remembered. 1. Deep extravasations may appear late as delayed bruise. 2. Deep dangerous wounds inside the chest, abdominal or cranial cavity may occur without any superficial or surface injury.
Another important precaution, the doctors must take is that, in case of punctured wound, he must not use a probe to know the depth of the wound. Probing may increase the depth of the wound, may injure a vital organ and may cause fresh bleeding, if depth of the wound cannot be visualised and if the patient is to be operated upon then the depth can be measured during the operation.