Main Page > Vol-26 No.- 2 > Paper 2 (you are here) LinkedIn X (Twitter) Facebook Copy link Share Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26 Number 2 (July - December 2025) Received : Jan 25, 2025; Revised : manuscript received; May 22, 2025 Accepted : June 18, 2025 Published : June 18, 2025 Ref: Mukesh R, Toi PC , Chaudhari VA, Pandiyan KS, Kumaran M. Death due to Clinically Undiagnosed Hematolymphoid Malignancy: An Autopsy Case Report and Review. Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online], 2025 ; Vol. 26, No. 2 (July - December 2025): [about 16 p]. DOI: 10.5281/zenodo.15708004 Available from: https://www.anilaggrawal.com/ij/vol-026-no-002/papers/paper002 Email: mukeshfmt22@gmail.com ( All photos can be enlarged on this webpage by clicking on them ) Death due to Clinically Undiagnosed Hematolymphoid Malignancy: An Autopsy Case Report and Review Abstract B-cell lymphomas, a type of hematolymphoid malignancy, constitute 90% of all lymphomas. We report an autopsy of a 33-year-old male with a clinical history of hypothyroidism and anemia brought unresponsive to casualty. The body exhibited no external injuries. Sparse and fine hairs were present in the face, chest, axilla and pubic region, with reduced right testicular size and scrotal volume. The thyroid gland was grossly not palpable and internally untraceable. The spleen was enlarged and softened with a wedge-shaped infarct in the cortical region and a hilar abscess. Under microscopy, the liver showed periportal chronic inflammation, bridging fibrosis and focal interface hepatitis. Acute tubular necrosis with thyroidization of tubules and focal tubular atrophy was reported in the kidney. Lymphoid infiltrates were found in the testis, brain parenchyma, pituitary, and liver, positive for markers like Tdt (Terminal deoxynucleotidyl transferase), CD34, and CD79a. The cause of death was opined as acute tubular necrosis due to septicemia secondary to B-cell lymphoma. After tissue or organ infiltrations, B-cell lymphomas are frequently linked with immunosuppression and multiorgan dysfunction, leading to death. Postmortem immunohistochemistry has helped in finding the key diagnosis in this case. In cases of unexplained anemia or endocrinological abnormalities, autopsy surgeons should rule out hematolymphoid malignancy. Clinicians must include the workup for hematolymphoid diseases in cases with atypical presentation. Keywords- B cell lymphoma; Splenic infarction; Thyroidization; Immunohistochemistry in lymphoma; Hypothyroidism; Thyroid Dysgenesis; life threatening anemia Glossary Bcl: B-cell lymphoma, a general term for lymphomas affecting B cells. ● CD: Cluster of Differentiation, a system used to classify different types of white blood cells. It was suggested in 1982. ● CD34 – CD 34 is a cell surface protein that is commonly used as a marker to identify hematopoietic stem cells (the cells that give rise to all other blood cells) and endothelial cells. ● Clone QBEnd/10 -A specific monoclonal antibody that targets the CD34 protein. Q is a designation given by the laboratory or company that developed the antibody. BEnd: indicate the target [end part refers to endothelial cells]. CD34 is commonly used to identify endothelial cells. 10 represents a sequential identifier, indicating that this is the 10 th clone developed in a series. ● DIC - Disseminated Intravascular Coagulation ● DLBCL : Diffuse Large B-cell Lymphoma, a common type of Non-Hodgkin Lymphoma. ● ECG: Electrocardiogram ● HLM: Hematolymphoid Malignancy ● IVBCL: Intermediate-grade B-cell Lymphoma, another type of Non-Hodgkin Lymphoma. ● Ki: Ki-67, a protein marker used to assess cell proliferation. ● MUM-1: Multiple Myeloma 1. It plays a role in the differentiation of B-cells into plasma cells. It is often used as a marker in immunohistochemistry to identify certain types of lymphomas and myelomas ● NHL: Non-Hodgkin Lymphoma, a type of cancer affecting the lymphatic system. ● PAX: PAX genes - a family of genes involved in the development ● RBC - Red Blood Cells ● Tdt: Terminal deoxynucleotidyl transferase, an enzyme involved in DNA synthesis. It is a specialized DNA polymerase. TdT is primarily expressed in immature, pre-B, and pre-T lymphoid cells, as well as in acute lymphoblastic leukemia/lymphoma cells ● Thyroidization - Thyroid like appearance in renal tissue Introduction Natural deaths due to disease and senility may be unexplained, where the cause of death is not known or unclear to the treating physician[1,2]. "Sudden unexplained death" refers to an unexpected and sudden death in an individual older than 1 year [3]. Unexplained sudden death (Intrinsic Factor(s) Identified) is a type of cause of death statement when the causality of death can be determined. However, intrinsic natural abnormalities like known intrinsic risk factors for sudden death or those of unknown significance are present. Trauma and other unnatural etiologies are properly excluded in such cases [4,5]. In a study, about 6-12% of cases subjected to medicolegal autopsies were determined to have died of natural causes [6]. About 35% of brought dead cases were reported to have a natural cause of death at autopsy [7]. About 8% of adult cases revealed clinically undiagnosed malignancy in autopsy [8]. About 20% of the clinically unsuspected malignancy was detected at the time of autopsy, while 16% presented with metastasis. Among the autopsy-diagnosed cancers, the primary cause of death was malignancy in 16% of such cases, which also includes hematolymphoid malignancies [9]. Hematolymphoid malignancies (HLM) are primary cancers affecting blood, bone marrow, and lymphoid organs, originating from either myeloid or lymphoid cell lines. Lymphomas, lymphocytic leukemia, myelomas and other plasma cell dyscrasias arise from lymphoid cell lines. In contrast, acute myeloid leukemia (AML), chronic myeloid leukemia (CML), myelodysplastic syndromes (MDS) and other myeloproliferative disorders (MPD) are myeloid in origin. Immunohistochemical markers like CD1a(Cluster of Differentiation 1a), CD3 (Cluster of Differentiation - 3), CD7 (Cluster of Differentiation 7), CD8(Cluster of Differentiation 8), CD20 Cluster of Differentiation 20), CD30 (Cluster of Differentiation 30), CD 34 (Cluster of Differentiation - 34), CD 79a (Cluster of Differentiation -79a), TdT (Terminal deoxynucleotidyl transferase), MIB (Cell Proliferation Marker), LCA (Leucocyte Common Antigen), etc. are used in the biopsy diagnosis of various types of HLMs with their expressivity in staining. Organ infiltration from leukemia, lymphoma, myeloma, and related conditions is less likely to be symptomatic than from carcinoma. Patients with HLM are at risk of complications from the neoplasm and treatment [10]. We present an autopsy case report with a postmortem diagnosis of lymphoma in the deceased, who was brought dead to casualty in our hospital after a brief period of hospitalization in another health care center. Case Report We conducted an autopsy of a moderately built 33-year-old man. The deceased allegedly had anemia and hypothyroidism and was suffering epigastric pain along with reduced urine output for 3 days prior to death. As per the clinical records, prior to death, he was admitted to a hospital for management for 13 days. The lab values during the admission period were as follows: Hb-4.5g%, WBC- 12800/mm3, Neutrophils - 67%, Lymphocytes - 29%, Eosinophils - 4%. T3- 46.96 ng/dl (Normal- 70-204 ng/dl)), T4- 2.6 microgram/dl (Normal- 4.6-10.5 microgram/dl), TSH - 1.76 microIU/ml (normal - 0.4 - 4.2 microIU/ml), Blood urea - 40 mg/dl, Serum Creatinine- 1.2 mg/dl, Blood sugar - 87 mg%. ECG showed T wave inversion in V1-V3. The treatment included diuretics, iron supplementation, packed RBC transfusion, antibiotic prophylaxis, and thyroxine supplementation. On external general examination, the body had no injuries, measuring 165 cm in length and 55 kg in weight. The conjunctiva was pale, while fingernails and toenails had nail paint. Natural orifices were free without any discharges. Sparse and fine hairs were present in the face, chest, axilla and pubic region (Figure 1A, 1B, 1C). The volume of the scrotum appeared relatively reduced (Figure 1C). Fig 1. Immature & sparse hairs: Face (A), Axillary region (B) and Pubic region (C) hairs. Reduced testicular size (Arrow mark in C) On internal exploration, the thyroid was not traceable in the anatomical or reported ectopic locations. In front of the arch of the aorta above the tracheal bifurcation, there was a solid grey-white mass measuring 1.5cm X 0.8cm X 0.8cm situated in the superior mediastinum. The adjacent muscle tissue was flabby and more softened. The spleen was soft with an intact capsule measuring 18cm X 11cm in frontal view and 750 g in weight. The cortex showed a coalesced pale infarct involving the entire organ and a wedge-shaped advanced infarct (Figure 2A). A splenic abscess measuring 3cm X3 cm had developed in the hilar region. Liver was congested with intact capsule. Lungs were congested and edematous (Figure 2B). Most segments were firm in consistency. There were multiple petechial hemorrhages in the right atrium and at the base of great vessels, and coronaries were patent. Examination of the kidneys revealed fatty infiltration with renal pelvis hemorrhage (Figure 2C). The right testis was smaller, measuring 4cm X 2cm X 2cm. Left testis appeared grossly normal. The thoracic cavity contained straw-brown colored fluid estimated to be about 750ml (Figure 2D). Fig 2. Significant internal findings In Figure-2 2A Infected pleural fluid in thoracic cavity (Arrows) 2B Frothy edematous fluid in lungs & trachea (Arrow Heads) 2C Infarcts in spleen (asterisk - advanced) 2D Infarcts (Asterisk) & hemorrhagic extravasation with necrosis (arrow head) in kidney Under microscopy, the lungs showed dilated alveoli with interstitial congestion, chronic inflammatory cells with bacterial clumps, and hemosiderin macrophages. The liver showed chronic inflammation, fibrosis, and sinusoidal dilatation with lymphoid cells. The testes showed atrophy of seminiferous tubules and immature lymphoid cells in the interstitium with thickened tunica (Figure 3A). The thymus showed hyperplasia and thick-walled vessels (Figure 3B). Kidney tubules showed acute tubular necrosis, thyroidization, and atrophy with tubular hyaline casts (Figure 3C). Tonsil showed increased lymphoid cells, while lymph nodes showed reactive changes (Figure 3D). The brain showed dilated vessels filled with lymphocytes and parenchymal lymphocytic infiltrates (Figure 3E). The pituitary showed diffuse infiltration of immature lymphoid cells, highlighted with CD79a. The left ventricle showed pericardial fat with chronic inflammation, interstitial oedema, and lymphoid aggregates. The right ventricle of the heart showed thick- walled vessels and lymphoid aggregates. The aorta shows atherosclerotic changes along with lymphoid aggregates (Figure 3F). The unidentified thick mediastinal mass from the thorax showed interstitial spaces and lymphoid aggregates in the background of skeletal muscle cells. The suitable tissues were subjected to immunohistochemistry. Fig 3. Microscopic examination (Hematoxylin & Eosin) showing lymphoid infiltrates in various oegans: A- Testis (10x) B- Thymus (40x) C- Kidney (10x) D- Tonsil (4x) E- Brain (40x) F- Aortic wall (4x) Immunohistochemical staining with primary and secondary antibodies (PathnSitu Biotechnologies) was performed using Ventana platform for CD3 (clone Polyclonal), CD20 (clone L26), CD34 (clone QBEnd/10), CD79a (clone HM47) and TdT (Polyclonal Rabbit Anti-Human TdT Antibody (Abcam, Cat# ab19515)) in a dilution of 1:200 with standard operating protocol. The moderate intensity of DAB chromogen in the slide image was considered positive expressivity. On immunohistochemistry, Tdt, CD34, and CD79a highlighted the immature (probably blast) cells in the pituitary, liver and testis. CD3 and CD20 were negative in the immature B cells. Hence, the possibility of B cell leukemia or lymphoma was reported from histopathological impressions. Blood and sterile fluid culture showed the growth of Escherichia coli. Toxicological examination did not detect any poison or drugs in this case. The cause of death was opined as acute tubular necrosis due to septicemia as a complication of B cell lymphoma. Discussion More than 30% of HLM cases diagnosed in autopsy, were earlier clinically undiagnosed [10,11]. Diffuse Large B cell lymphoma is the most common type of NHL (Non-Hodgkin Lymphoma), frequently observed in adults, and so is indolent lymphoma [12]. The mean age range of autopsy confirmation of HLM is about 36-46 years [10,11,13], whereas the age of the deceased was 33 years in the present case. Lymphoma may be localized, and it may later tend to be rapidly progressive. Diffuse Large B Cell Lymphoma (DLBCL) involves nodal or extranodal sites, including the Waldeyer ring, lung, bone marrow, spleen, liver, and gut, manifesting as a rapidly growing mass [14,15]. Intravascular B Cell Lymphoma (IVBCL), a rare type of non-Hodgkin lymphoma, primarily invades blood vessels and presents with neurological or hemophagocytic symptoms depending on the variant [16]. The spectrum of clinical features in lymphoma includes low- grade intermittent fever, nausea, oliguria, anorexia, abdominal pain, weight loss, oedema, pallor, progressive dyspnea, cognitive decline, painless lymphadenopathy, splenomegaly and lactic acidosis [17-24]. Lymphoid malignancy may be further clinically associated with anemia, hypertension, hypothyroidism, paraplegia and multiorgan failure [25,26]. The present case had an antemortem diagnosis of anemia and hypothyroidism. T wave inversion in lead V1-V3 ECG is a normal variant in children but indicates cardiac pathology in adults [27], which does not exclude secondaries or lymphoid infiltration in the present case. In aggressive cases of lymphoma, autopsy may reveal septic and disseminated intravascular coagulation- like picture bone marrow hyperplasia and hepatosplenomegaly [18,19]. The correlation of gross autopsy features with histopathological findings remains crucial for diagnosis, especially in cases with atypical presentations of HLMs [17,18,29]. Generally, painless lymphadenopathy is found in most HLMs [17]. Enlargement of peripancreatic, mesenteric, hilar, paratracheal, paraaortic and mediastinal lymph nodes have been reported [10]. In cases of NHL, diffuse infiltration by tumor cells causes complete architectural effacement. In our case, lymph nodes showed reactive changes, which could be attributed to infection. Tonsils, in HLM, may show monomorphic proliferation of large lymphoid cells, distinct plasmacytoid features, eccentrically placed nuclei, thick nuclear membranes, variably prominent nucleoli, clumped chromatin, and copious pyroninophilic cytoplasm [36]. In the present case, diffuse infiltration of immature lymphoid cells was found in the tonsils. Diffuse infiltration with angiotropic features, CD20 positivity and decreased ACTH immunoreactivity in the pituitary with associated hypogonadotropic hypogonadism has been reported [37,38]. Diffuse infiltration of lymphoblast cells is found in the pituitary gland with associated hypogonadotropic hypogonadism. Hatem reported diffuse lymphoid infiltration of skeletal muscle in multiple cores with pseudo-glandular structures and sheets observable in low-power microscopy [39]. Skeletal muscle exhibited immature lymphoblast infiltration, with features like large cells, irregular nuclear contours, vesicular chromatin, prominent nucleoli, and moderate cytoplasm in high-power microscopy. Thyroid dysgenesis, which includes thyroid agenesis, hypoplasia and ectopic thyroid, amounts to 80-85% of congenital hypothyroidism [40,41]. Acute leukemia is linked to autoimmune thyroid diseases like Graves' and Hashimoto's thyroiditis, with hypothyroidism being a common outcome of thyroid lymphoma [42]. Also, secondary hypothyroidism is most commonly associated with pituitary disorders/abnormalities [43, 44]. A case study by Foresti showed a cause-effect relationship between leukemic infiltration of the thyroid gland and hypothyroidism, with progressive reduction in thyroid hormones and increases in TSH levels [45]. In our case, there was no trace of thyroid in the neck or mediastinum. Clinically, the thyroid profile has shown decreased secretion of thyroid hormone levels, suggesting the possibility of ectopic thyroid. However, no glandular tissue was identifiable or appreciable in the usual reported areas of ectopic thyroid during the autopsy [46]. A mediastinal unidentified tissue excised in an autopsy suspected of ectopic thyroid also did not show any histological components of thyroid tissue; only lymphoid aggregates were found in the background of skeletal muscle cells. This is similar to a study by Waghmare TP et al. where 18% of the NHL cases had soft fleshy yellow-white mass [10]. The thymus showed hyperplasia with a preponderance of immature B cells in our case. Lymphoma may cause thymus enlargement either by primary involvement or secondary infiltration following the invasion of adjacent lymph nodes. Medullary B-cell lymphoma in the thymus is found in 2% of cases with NHL [47]. Malignant lymphoma in the thymus can resemble hyperplastic thymus. Histologically proven invasion in the thymus was not revealed even in advanced imaging methods like FDG or chemical shift MRIs.[48]. Petechial hemorrhages in the ventricular subendocardial region and cardiac hypertrophy were reported in the literature [10, 49]. The tumor cell infiltrates are reported in the myocardium, epicardium, conduction pathway [49,50], cardiac septum and valves [10]. In the present case, the heart displayed petechiae, inflammation with interstitial oedema, lymphoid aggregates, thick aortic and vessel walls, myxoid changes, and enhanced fibrosis. Pulmonary nodules, mostly calcified and peripheral lung oedema, have been reported [18,19]. Doran reported extensive neoplastic infiltration, generally filling vessels and spilling out into the alveoli while associated with thrombo-embolism and infection (pneumococcus, aspergillus) in the lungs [51]. Microscopic examination of the edematous lung, in our case, revealed dilated alveoli with interstitial congestion with chronic inflammatory cells with bacterial clumps and hemosiderin macrophages. Reported findings of lymphoma in the liver include neoplastic infiltration, fibrosis, cancerous nodules, necrotic areas, Reed–Sternberg cells, hypocellular regions, diffuse organ filtration by leukemic cells, profound infiltration of CD30 (Ki-1) positive lymphoma cells [11,52,53]. Enlarged hemorrhagic lymph nodes at porta hepatis were also reported by Waghmare TP et al. [10]. Infiltrates in sinusoidal and periportal regions with nodular aggregates were recorded. Liver, in the present case, periportal chronic inflammation with bridging fibrosis, focal interface hepatitis, sinusoidal dilatation with large lymphoid cells, despite normal hepatic architecture. Hemorrhagic splenic infarcts involve vascular congestion, hemorrhage, and necrosis, while septic infarcts involve acute or chronic inflammatory infiltrates. Lymphoma-induced splenic infarctions result from blood flow interruption and hence bland infarcts are pale, wedge-shaped, and subcapsular. Septic infarcts have suppurative necrosis and large depressed scars during healing. Splenic abscesses show chronic inflammatory infiltrates and necrotic cells [54]. In our case, the spleen was enlarged with massive pale infarcts, implying the possibility of splenic vessel thrombosis. About 10% of splenic infarcts progress to bacterial abscesses in immunocompromised individuals [55,56]. In the present case, there was a progression into a splenic abscess in the hilar region. Renal enlargement and deposits are reported in HLM [10], while renal pelvic hemorrhage was found in our case. The microscopic findings include acute tubular necrosis, thyroidisation of tubules and focal tubular atrophy with hyaline casts. Tubular atrophy involving broader areas and delineated interstitial fibrosis along the medullary rays forming a striped scarring pattern suggest chronic ischemia. The thyroidization pattern is often seen in urinary reflux or chronic pyelonephritis [57]. Testicular infiltration in leukemia cases is typically bilateral but asymmetric in severity, starting in one testis before affecting both. Specific size measurements of affected testis were hardly found in autopsy-based literature. Its severity is similar to other sites but can be second only to marrow, lymph nodes, and spleen involvement. Microscopic infiltration is most common in acute leukemia, less common in chronic leukemia, and less frequent in lymphoma [58]. Atrophy of the seminiferous tubules with immature lymphoid cells with thickened tunica was observed in our case. Abnormally small testes, smaller than the 50th percentile for age, can be caused by congenital or acquired factors.[59]. Waghmare & Moller reported leukemic infiltrates in the brain parenchyma, meningeal and Virchow robin space [10,60]. Thirunavukkarasu reported patchy myelin pallor in subcortical areas without over-demyelination due to lymphoma cell infiltration [61]. In our case, cerebral vessels were dilated, along with increased vascular and parenchymal lymphocytic infiltrates. Immunohistochemical studies help to type the tumor cells infiltrating various organs like the lungs, liver, spleen, pituitary gland, ovaries, uterus, and bone marrow. Diffuse large cell B-cell lymphoma (DLBCL) tests positive for CD20, CD79a, bcl-2, and MUM1 but negative for CD3, CD5, CD10, CD 56, bcl-6, and cyclin D1 [20, 26]. Reportedly, diffuse CD20 positivity is found in lymphoid cells in sinusoidal and interstitial sites with a Ki-67 index of about 80% to 90% [26]. The CD20 negative subtype of DLBCL is rare and aggressive, with lesser survival rates [62]. B cell lymphoblastic leukemia also tests positive for TdT, CD34, CD79a or PAX5 [63]. IVLBCL exhibits strong intravascular CD20 and CD45 positivity [21]. In the present case, immature B cells in the pituitary, liver and testis tested positive for Tdt, CD34, and CD79a and negative for CD3 and CD20, suggesting B cell lymphoma or leukemia as a final impression on immunohistochemical confirmation. Following flow cytometry, fluorescence in situ hybridization (FISH) analysis is the method of choice for confirmatory diagnosis [64]. CD34 is a transmembrane phosphoglycoprotein found on cell surfaces in humans and animals, used to identify and isolate cancer stem cells (CSC). It is positive in leukemia, breast and lung cancer, and other types of tumors [65]. Terminal Deoxynucleotidyl Transferase (Tdt) is a DNA polymerase found in high levels in the thymus, low levels in normal bone marrow, and absent in normal peripheral blood leukocytes. In adult leukemias, the Tdt level is elevated primarily in lymphoblastic leukemia and low in myeloblastic leukemia [66]. CD79, pan B-cell marker, is a dimeric, transmembrane protein, which, along with surface immunoglobulin, is expressed from the pre-B stage to the plasma cell stage of differentiation. It is found in B-cell lymphomas, B-cell lines, most acute leukemias of precursor B-cell type, megakaryocytic lesions and certain myelomas [67]. Hematological malignancies exhibit a dynamic spectrum of infections among the affected patients [68]. Most of the infections were either systemic or pulmonary [69]. Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were the most frequent organisms isolated, resulting in mortality rates up to 48% in diagnosed cases of HLMs [70]. Escherichia Coli is isolated from blood and fluid culture in the present case, forming the primary foci for septicemia like in other cases [70-73]. The specific subtype of B-cell lymphoma may also influence the primary cause of death [10,74]. The progression and transformation into aggressive subtypes, such as diffuse large B-cell lymphoma, has an unfavourable prognosis and increased mortality rates [20]. Complications from the disease, treatment-related side effects and comorbidities contribute to mortality [28, 75-77]. Death was commonly caused by Disseminated malignancy followed by fatal respiratory illness or complications [10,71]. Any infiltrative diseases involving the spleen can also lead to spleen rupture, causing intraperitoneal bleeding, shock, and death [78- 80]. Other causes of death include infection, hemorrhagic shock, hemoperitoneum, thromboembolism, increased intracranial tension with cerebral oedema and conduction abnormalities and associated congenital heart disease [10,20]. Significant autopsy findings in cases of septicemia include pulmonary oedema, diffuse alveolar damage with micro- thrombosis, inflammation & ischemic necrosis of cardiac tissues, acute tubular necrosis, cholestatic jaundice, liver necrosis with sinusoidal aggregates, partial liquefaction of spleen, hemorrhagic adrenal gland, cerebral petechiae, sub-serosal or submucosal hemorrhages in the gastrointestinal tract and features of disseminated intravascular coagulation [81]. In the present case, death is attributed to septicemia secondary to B cell lymphoma in its advanced stage involving multiple organs. Multiple conditions, including syndromic abnormalities like hypogonadism and Kallmann syndrome, were in consideration before concluding the autopsy cause of death in this case. However, the findings from ancillary investigations of the tissues and fluids, in corroboration with the gross features of the case, directed the focus of causality towards B cell lymphoma. Conclusion The unexpected discovery of B-cell lymphoma in this 33-year-old man with a history of anemia and hypothyroidism demonstrates th e potential for these conditions to remain undetected until postmortem investigation. The gross findings, extensive lymphoid infiltration observed across multiple organs on microscopy, and immunohistochemical findings provided crucial evidence for diagnosing B-cell lymphoma. Septicemia, the common fatal complication of B-cell lymphoma as in any HLM, had caused death in this case. The case report highlights the importance of comprehensive autopsy examinations in identifying clinically undiagnosed malignancies, particularly HLMs. Limitations The spleen and bone marrow were not subjected to microscopic studies using cytomorphology, histomorphology, and immunohistochemistry, thereby posing difficulty in locating the lymphoma's primary origin. Suggestions For Autopsy Surgeons: The case highlights the importance of autopsy in medical education, quality assurance, and disease understanding. Postmortem diagnosis of B-cell lymphomas can be challenging due to heterogeneity and limited tissue samples. Understanding gross autopsy findings in HLM is crucial for prompt recognition and management. In unexplained anemia or endocrinological abnormalities, an autopsy should also rule out HLM. For Clinicians: The case report emphasizes the importance of clinicians detecting underlying malignancies in cases with atypical presentations or unexplained deterioration. Advancements in diagnostic techniques like noncoding RNAs, Next-Generation Sequencing, and radiomics provide new insights into disease pathogenesis and development, while tissue proteomics and digital pathology can enhance early detection [82-86]. Conflicts of interest The authors have declared no conflict of interest in the submitted work. Funding/services All authors have declared that no financial support or service was received from any organization for the submitted work. Ethical Approval & Informed Consent This article does not contain any studies with animals. This is a retrospective case report of a medicolegal autopsy. The case data has been completely anonymized with proper de- identification of contents in this report. References Hanzlick R, Hunsaker JC, Davis GJ. Guidelines for Manner of Death Classification. Atlanta. GA. National Association of Medical Examiners. 1st ed. 2002. Available online from: Link Our role in investigating deaths [Internet]. Scotland. Crown Office and Procurator Fiscal Service. 2023 June 9 [Updated on 2024 July 16. Cited on 14 September 2024]. 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Main Page > Vol-26 No.- 2 > Paper 2(you are here) Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26, Number 2, July - December 2025 Received: Accepted: Ref: Mukesh R, Toi PC , Chaudhari VA, Pandiyan KS, Kumaran M. Death due to Clinically Undiagnosed Hematolymphoid Malignancy: An Autopsy Case Report and Review. Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online], ---- ; Vol. 26, No. 2 (July - December 2025): [about 6 p]. Available from: https://www.anilaggrawal.com/forensic-medicine-and-toxicology/vol-026-no-002/26-02-paper002 . Published : -----, (Accessed: ---) Email- Dr Mukesh R Dr Pampa Ch Toi Dr Vinod Ashok Chaudhari Dr Karpora Sundara Pandyean Dr Kumaran M Death due to Clinically Undiagnosed Hematolymphoid Malignancy: An Autopsy Case Report and Review Abstract B-cell lymphomas, a type of hematolymphoid malignancy, constitute 90% of all lymphomas. We report an autopsy of a 33-year-old male with a clinical history of hypothyroidism and anemia brought unresponsive to casualty. The body exhibited no external injuries. Sparse and fine hairs were present in the face, chest, axilla and pubic region, with reduced right testicular size and scrotal volume. The thyroid gland was grossly not palpable and internally untraceable. The spleen was enlarged and softened with a wedge-shaped infarct in the cortical region and a hilar abscess. Under microscopy, the liver showed periportal chronic inflammation, bridging fibrosis and focal interface hepatitis. Acute tubular necrosis with thyroidization of tubules and focal tubular atrophy was reported in the kidney. Lymphoid infiltrates were found in the testis, brain parenchyma, pituitary, and liver, positive for markers like Tdt (Terminal deoxynucleotidyl transferase), CD34, and CD79a. The cause of death was opined as acute tubular necrosis due to septicemia secondary to B-cell lymphoma. After tissue or organ infiltrations, B-cell lymphomas are frequently linked with immunosuppression and multiorgan dysfunction, leading to death. Postmortem immunohistochemistry has helped in finding the key diagnosis in this case. In cases of unexplained anemia or endocrinological abnormalities, autopsy surgeons should rule out hematolymphoid malignancy. Clinicians must include the workup for hematolymphoid diseases in cases with atypical presentation. Keywords- B cell lymphoma; Splenic infarction; Thyroidization; Immunohistochemistry in lymphoma; Hypothyroidism; Thyroid Dysgenesis; life threatening anemia Glossary Bcl: B-cell lymphoma, a general term for lymphomas affecting B cells. ● CD: Cluster of Differentiation, a system used to classify different types of white blood cells. It was suggested in 1982. ● CD34 – CD 34 is a cell surface protein that is commonly used as a marker to identify hematopoietic stem cells (the cells that give rise to all other blood cells) and endothelial cells. ● Clone QBEnd/10 -A specific monoclonal antibody that targets the CD34 protein. Q is a designation given by the laboratory or company that developed the antibody. BEnd: indicate the target [end part refers to endothelial cells]. CD34 is commonly used to identify endothelial cells. 10 represents a sequential identifier, indicating that this is the 10 th clone developed in a series. ● DIC - Disseminated Intravascular Coagulation ● DLBCL : Diffuse Large B-cell Lymphoma, a common type of Non-Hodgkin Lymphoma. ● ECG: Electrocardiogram ● HLM: Hematolymphoid Malignancy ● IVBCL: Intermediate-grade B-cell Lymphoma, another type of Non-Hodgkin Lymphoma. ● Ki: Ki-67, a protein marker used to assess cell proliferation. ● MUM-1: Multiple Myeloma 1. It plays a role in the differentiation of B-cells into plasma cells. It is often used as a marker in immunohistochemistry to identify certain types of lymphomas and myelomas ● NHL: Non-Hodgkin Lymphoma, a type of cancer affecting the lymphatic system. ● PAX: PAX genes - a family of genes involved in the development ● RBC - Red Blood Cells ● Tdt: Terminal deoxynucleotidyl transferase, an enzyme involved in DNA synthesis. It is a specialized DNA polymerase. TdT is primarily expressed in immature, pre-B, and pre-T lymphoid cells, as well as in acute lymphoblastic leukemia/lymphoma cells ● Thyroidization - Thyroid like appearance in renal tissue Introduction Natural deaths due to disease and senility may be unexplained, where the cause of death is not known or unclear to the treating physician[1,2]. "Sudden unexplained death" refers to an unexpected and sudden death in an individual older than 1 year [3]. Unexplained sudden death (Intrinsic Factor(s) Identified) is a type of cause of death statement when the causality of death can be determined. However, intrinsic natural abnormalities like known intrinsic risk factors for sudden death or those of unknown significance are present. Trauma and other unnatural etiologies are properly excluded in such cases [4,5]. In a study, about 6-12% of cases subjected to medicolegal autopsies were determined to have died of natural causes [6]. About 35% of brought dead cases were reported to have a natural cause of death at autopsy [7]. About 8% of adult cases revealed clinically undiagnosed malignancy in autopsy [8]. About 20% of the clinically unsuspected malignancy was detected at the time of autopsy, while 16% presented with metastasis. Among the autopsy-diagnosed cancers, the primary cause of death was malignancy in 16% of such cases, which also includes hematolymphoid malignancies [9]. Hematolymphoid malignancies (HLM) are primary cancers affecting blood, bone marrow, and lymphoid organs, originating from either myeloid or lymphoid cell lines. Lymphomas, lymphocytic leukemia, myelomas and other plasma cell dyscrasias arise from lymphoid cell lines. In contrast, acute myeloid leukemia (AML), chronic myeloid leukemia (CML), myelodysplastic syndromes (MDS) and other myeloproliferative disorders (MPD) are myeloid in origin. Immunohistochemical markers like CD1a(Cluster of Differentiation 1a), CD3 (Cluster of Differentiation - 3), CD7 (Cluster of Differentiation 7), CD8(Cluster of Differentiation 8), CD20 Cluster of Differentiation 20), CD30 (Cluster of Differentiation 30), CD 34 (Cluster of Differentiation - 34), CD 79a (Cluster of Differentiation -79a), TdT (Terminal deoxynucleotidyl transferase), MIB (Cell Proliferation Marker), LCA (Leucocyte Common Antigen), etc. are used in the biopsy diagnosis of various types of HLMs with their expressivity in staining. Organ infiltration from leukemia, lymphoma, myeloma, and related conditions is less likely to be symptomatic than from carcinoma. Patients with HLM are at risk of complications from the neoplasm and treatment [10]. We present an autopsy case report with a postmortem diagnosis of lymphoma in the deceased, who was brought dead to casualty in our hospital after a brief period of hospitalization in another health care center. Case Report We conducted an autopsy of a moderately built 33-year-old man. The deceased allegedly had anemia and hypothyroidism and was suffering epigastric pain along with reduced urine output for 3 days prior to death. As per the clinical records, prior to death, he was admitted to a hospital for management for 13 days. The lab values during the admission period were as follows: Hb-4.5g%, WBC- 12800/mm3, Neutrophils - 67%, Lymphocytes - 29%, Eosinophils - 4%. T3- 46.96 ng/dl (Normal- 70-204 ng/dl)), T4- 2.6 microgram/dl (Normal- 4.6-10.5 microgram/dl), TSH - 1.76 microIU/ml (normal - 0.4 - 4.2 microIU/ml), Blood urea - 40 mg/dl, Serum Creatinine- 1.2 mg/dl, Blood sugar - 87 mg%. ECG showed T wave inversion in V1-V3. The treatment included diuretics, iron supplementation, packed RBC transfusion, antibiotic prophylaxis, and thyroxine supplementation. On external general examination, the body had no injuries, measuring 165 cm in length and 55 kg in weight. The conjunctiva was pale, while fingernails and toenails had nail paint. Natural orifices were free without any discharges. Sparse and fine hairs were present in the face, chest, axilla and pubic region (Figure 1A, 1B, 1C). The volume of the scrotum appeared relatively reduced (Figure 1C). Fig 1. Immature & sparse hairs: Face (A), Axillary region (B) and Pubic region (C) hairs. Reduced testicular size (Arrow mark in C) On internal exploration, the thyroid was not traceable in the anatomical or reported ectopic locations. In front of the arch of the aorta above the tracheal bifurcation, there was a solid grey-white mass measuring 1.5cm X 0.8cm X 0.8cm situated in the superior mediastinum. The adjacent muscle tissue was flabby and more softened. The spleen was soft with an intact capsule measuring 18cm X 11cm in frontal view and 750 g in weight. The cortex showed a coalesced pale infarct involving the entire organ and a wedge-shaped advanced infarct (Figure 2A). A splenic abscess measuring 3cm X3 cm had developed in the hilar region. Liver was congested with intact capsule. Lungs were congested and edematous (Figure 2B). Most segments were firm in consistency. There were multiple petechial hemorrhages in the right atrium and at the base of great vessels, and coronaries were patent. Examination of the kidneys revealed fatty infiltration with renal pelvis hemorrhage (Figure 2C). The right testis was smaller, measuring 4cm X 2cm X 2cm. Left testis appeared grossly normal. The thoracic cavity contained straw-brown colored fluid estimated to be about 750ml (Figure 2D). Fig 2. Significant internal findings 2A Infected pleural fluid in thoracic cavity (Arrows) 2B Frothy edematous fluid in lungs & trachea (Arrow Heads) 2C Infarcts in spleen (asterisk - advanced) 2D Infarcts (Asterisk) & hemorrhagic extravasation with necrosis (arrow head) in kidney Under microscopy, the lungs showed dilated alveoli with interstitial congestion, chronic inflammatory cells with bacterial clumps, and hemosiderin macrophages. The liver showed chronic inflammation, fibrosis, and sinusoidal dilatation with lymphoid cells. The testes showed atrophy of seminiferous tubules and immature lymphoid cells in the interstitium with thickened tunica (Figure 3A). The thymus showed hyperplasia and thick-walled vessels (Figure 3B). Kidney tubules showed acute tubular necrosis, thyroidization, and atrophy with tubular hyaline casts (Figure 3C). Tonsil showed increased lymphoid cells, while lymph nodes showed reactive changes (Figure 3D). The brain showed dilated vessels filled with lymphocytes and parenchymal lymphocytic infiltrates (Figure 3E). The pituitary showed diffuse infiltration of immature lymphoid cells, highlighted with CD79a. The left ventricle showed pericardial fat with chronic inflammation, interstitial oedema, and lymphoid aggregates. The right ventricle of the heart showed thick- walled vessels and lymphoid aggregates. The aorta shows atherosclerotic changes along with lymphoid aggregates (Figure 3F). The unidentified thick mediastinal mass from the thorax showed interstitial spaces and lymphoid aggregates in the background of skeletal muscle cells. The suitable tissues were subjected to immunohistochemistry. Fig 3. Microscopic examination (Hematoxylin & Eosin) showing lymphoid infiltrates in various oegans: A- Testis (10x) B- Thymus (40x) C- Kidney (10x) D- Tonsil (4x) E- Brain (40x) F- Aortic wall (4x) Immunohistochemical staining with primary and secondary antibodies (PathnSitu Biotechnologies) was performed using Ventana platform for CD3 (clone Polyclonal), CD20 (clone L26), CD34 (clone QBEnd/10), CD79a (clone HM47) and TdT (Polyclonal Rabbit Anti-Human TdT Antibody (Abcam, Cat# ab19515)) in a dilution of 1:200 with standard operating protocol. The moderate intensity of DAB chromogen in the slide image was considered positive expressivity. On immunohistochemistry, Tdt, CD34, and CD79a highlighted the immature (probably blast) cells in the pituitary, liver and testis. CD3 and CD20 were negative in the immature B cells. Hence, the possibility of B cell leukemia or lymphoma was reported from histopathological impressions. Blood and sterile fluid culture showed the growth of Escherichia coli. Toxicological examination did not detect any poison or drugs in this case. The cause of death was opined as acute tubular necrosis due to septicemia as a complication of B cell lymphoma. Discussion More than 30% of HLM cases diagnosed in autopsy, were earlier clinically undiagnosed [10,11]. Diffuse Large B cell lymphoma is the most common type of NHL (Non-Hodgkin Lymphoma), frequently observed in adults, and so is indolent lymphoma [12]. The mean age range of autopsy confirmation of HLM is about 36-46 years [10,11,13], whereas the age of the deceased was 33 years in the present case. Lymphoma may be localized, and it may later tend to be rapidly progressive. Diffuse Large B Cell Lymphoma (DLBCL) involves nodal or extranodal sites, including the Waldeyer ring, lung, bone marrow, spleen, liver, and gut, manifesting as a rapidly growing mass [14,15]. Intravascular B Cell Lymphoma (IVBCL), a rare type of non-Hodgkin lymphoma, primarily invades blood vessels and presents with neurological or hemophagocytic symptoms depending on the variant [16]. The spectrum of clinical features in lymphoma includes low- grade intermittent fever, nausea, oliguria, anorexia, abdominal pain, weight loss, oedema, pallor, progressive dyspnea, cognitive decline, painless lymphadenopathy, splenomegaly and lactic acidosis [17-24]. Lymphoid malignancy may be further clinically associated with anemia, hypertension, hypothyroidism, paraplegia and multiorgan failure [25,26]. The present case had an antemortem diagnosis of anemia and hypothyroidism. T wave inversion in lead V1-V3 ECG is a normal variant in children but indicates cardiac pathology in adults [27], which does not exclude secondaries or lymphoid infiltration in the present case. In aggressive cases of lymphoma, autopsy may reveal septic and disseminated intravascular coagulation- like picture bone marrow hyperplasia and hepatosplenomegaly [18,19]. The correlation of gross autopsy features with histopathological findings remains crucial for diagnosis, especially in cases with atypical presentations of HLMs [17,18,29]. Generally, painless lymphadenopathy is found in most HLMs [17]. Enlargement of peripancreatic, mesenteric, hilar, paratracheal, paraaortic and mediastinal lymph nodes have been reported [10]. In cases of NHL, diffuse infiltration by tumor cells causes complete architectural effacement. In our case, lymph nodes showed reactive changes, which could be attributed to infection. Tonsils, in HLM, may show monomorphic proliferation of large lymphoid cells, distinct plasmacytoid features, eccentrically placed nuclei, thick nuclear membranes, variably prominent nucleoli, clumped chromatin, and copious pyroninophilic cytoplasm [36]. In the present case, diffuse infiltration of immature lymphoid cells was found in the tonsils. Diffuse infiltration with angiotropic features, CD20 positivity and decreased ACTH immunoreactivity in the pituitary with associated hypogonadotropic hypogonadism has been reported [37,38]. Diffuse infiltration of lymphoblast cells is found in the pituitary gland with associated hypogonadotropic hypogonadism. Hatem reported diffuse lymphoid infiltration of skeletal muscle in multiple cores with pseudo-glandular structures and sheets observable in low-power microscopy [39]. Skeletal muscle exhibited immature lymphoblast infiltration, with features like large cells, irregular nuclear contours, vesicular chromatin, prominent nucleoli, and moderate cytoplasm in high-power microscopy. Thyroid dysgenesis, which includes thyroid agenesis, hypoplasia and ectopic thyroid, amounts to 80-85% of congenital hypothyroidism [40,41]. Acute leukemia is linked to autoimmune thyroid diseases like Graves' and Hashimoto's thyroiditis, with hypothyroidism being a common outcome of thyroid lymphoma [42]. Also, secondary hypothyroidism is most commonly associated with pituitary disorders/abnormalities [43, 44]. A case study by Foresti showed a cause-effect relationship between leukemic infiltration of the thyroid gland and hypothyroidism, with progressive reduction in thyroid hormones and increases in TSH levels [45]. In our case, there was no trace of thyroid in the neck or mediastinum. Clinically, the thyroid profile has shown decreased secretion of thyroid hormone levels, suggesting the possibility of ectopic thyroid. However, no glandular tissue was identifiable or appreciable in the usual reported areas of ectopic thyroid during the autopsy [46]. A mediastinal unidentified tissue excised in an autopsy suspected of ectopic thyroid also did not show any histological components of thyroid tissue; only lymphoid aggregates were found in the background of skeletal muscle cells. This is similar to a study by Waghmare TP et al. where 18% of the NHL cases had soft fleshy yellow-white mass [10]. The thymus showed hyperplasia with a preponderance of immature B cells in our case. Lymphoma may cause thymus enlargement either by primary involvement or secondary infiltration following the invasion of adjacent lymph nodes. Medullary B-cell lymphoma in the thymus is found in 2% of cases with NHL [47]. Malignant lymphoma in the thymus can resemble hyperplastic thymus. Histologically proven invasion in the thymus was not revealed even in advanced imaging methods like FDG or chemical shift MRIs.[48]. Petechial hemorrhages in the ventricular subendocardial region and cardiac hypertrophy were reported in the literature [10, 49]. The tumor cell infiltrates are reported in the myocardium, epicardium, conduction pathway [49,50], cardiac septum and valves [10]. In the present case, the heart displayed petechiae, inflammation with interstitial oedema, lymphoid aggregates, thick aortic and vessel walls, myxoid changes, and enhanced fibrosis. Pulmonary nodules, mostly calcified and peripheral lung oedema, have been reported [18,19]. Doran reported extensive neoplastic infiltration, generally filling vessels and spilling out into the alveoli while associated with thrombo-embolism and infection (pneumococcus, aspergillus) in the lungs [51]. Microscopic examination of the edematous lung, in our case, revealed dilated alveoli with interstitial congestion with chronic inflammatory cells with bacterial clumps and hemosiderin macrophages. Reported findings of lymphoma in the liver include neoplastic infiltration, fibrosis, cancerous nodules, necrotic areas, Reed–Sternberg cells, hypocellular regions, diffuse organ filtration by leukemic cells, profound infiltration of CD30 (Ki-1) positive lymphoma cells [11,52,53]. Enlarged hemorrhagic lymph nodes at porta hepatis were also reported by Waghmare TP et al. [10]. Infiltrates in sinusoidal and periportal regions with nodular aggregates were recorded. Liver, in the present case, periportal chronic inflammation with bridging fibrosis, focal interface hepatitis, sinusoidal dilatation with large lymphoid cells, despite normal hepatic architecture. Hemorrhagic splenic infarcts involve vascular congestion, hemorrhage, and necrosis, while septic infarcts involve acute or chronic inflammatory infiltrates. Lymphoma-induced splenic infarctions result from blood flow interruption and hence bland infarcts are pale, wedge-shaped, and subcapsular. Septic infarcts have suppurative necrosis and large depressed scars during healing. Splenic abscesses show chronic inflammatory infiltrates and necrotic cells [54]. In our case, the spleen was enlarged with massive pale infarcts, implying the possibility of splenic vessel thrombosis. About 10% of splenic infarcts progress to bacterial abscesses in immunocompromised individuals [55,56]. In the present case, there was a progression into a splenic abscess in the hilar region. Renal enlargement and deposits are reported in HLM [10], while renal pelvic hemorrhage was found in our case. The microscopic findings include acute tubular necrosis, thyroidisation of tubules and focal tubular atrophy with hyaline casts. Tubular atrophy involving broader areas and delineated interstitial fibrosis along the medullary rays forming a striped scarring pattern suggest chronic ischemia. The thyroidization pattern is often seen in urinary reflux or chronic pyelonephritis [57]. Testicular infiltration in leukemia cases is typically bilateral but asymmetric in severity, starting in one testis before affecting both. Specific size measurements of affected testis were hardly found in autopsy-based literature. Its severity is similar to other sites but can be second only to marrow, lymph nodes, and spleen involvement. Microscopic infiltration is most common in acute leukemia, less common in chronic leukemia, and less frequent in lymphoma [58]. Atrophy of the seminiferous tubules with immature lymphoid cells with thickened tunica was observed in our case. Abnormally small testes, smaller than the 50th percentile for age, can be caused by congenital or acquired factors.[59]. Waghmare & Moller reported leukemic infiltrates in the brain parenchyma, meningeal and Virchow robin space [10,60]. Thirunavukkarasu reported patchy myelin pallor in subcortical areas without over-demyelination due to lymphoma cell infiltration [61]. In our case, cerebral vessels were dilated, along with increased vascular and parenchymal lymphocytic infiltrates. Immunohistochemical studies help to type the tumor cells infiltrating various organs like the lungs, liver, spleen, pituitary gland, ovaries, uterus, and bone marrow. Diffuse large cell B-cell lymphoma (DLBCL) tests positive for CD20, CD79a, bcl-2, and MUM1 but negative for CD3, CD5, CD10, CD 56, bcl-6, and cyclin D1 [20, 26]. Reportedly, diffuse CD20 positivity is found in lymphoid cells in sinusoidal and interstitial sites with a Ki-67 index of about 80% to 90% [26]. The CD20 negative subtype of DLBCL is rare and aggressive, with lesser survival rates [62]. B cell lymphoblastic leukemia also tests positive for TdT, CD34, CD79a or PAX5 [63]. IVLBCL exhibits strong intravascular CD20 and CD45 positivity [21]. In the present case, immature B cells in the pituitary, liver and testis tested positive for Tdt, CD34, and CD79a and negative for CD3 and CD20, suggesting B cell lymphoma or leukemia as a final impression on immunohistochemical confirmation. Following flow cytometry, fluorescence in situ hybridization (FISH) analysis is the method of choice for confirmatory diagnosis [64]. CD34 is a transmembrane phosphoglycoprotein found on cell surfaces in humans and animals, used to identify and isolate cancer stem cells (CSC). It is positive in leukemia, breast and lung cancer, and other types of tumors [65]. Terminal Deoxynucleotidyl Transferase (Tdt) is a DNA polymerase found in high levels in the thymus, low levels in normal bone marrow, and absent in normal peripheral blood leukocytes. In adult leukemias, the Tdt level is elevated primarily in lymphoblastic leukemia and low in myeloblastic leukemia [66]. CD79, pan B-cell marker, is a dimeric, transmembrane protein, which, along with surface immunoglobulin, is expressed from the pre-B stage to the plasma cell stage of differentiation. It is found in B-cell lymphomas, B-cell lines, most acute leukemias of precursor B-cell type, megakaryocytic lesions and certain myelomas [67]. Hematological malignancies exhibit a dynamic spectrum of infections among the affected patients [68]. Most of the infections were either systemic or pulmonary [69]. Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were the most frequent organisms isolated, resulting in mortality rates up to 48% in diagnosed cases of HLMs [70]. Escherichia Coli is isolated from blood and fluid culture in the present case, forming the primary foci for septicemia like in other cases [70-73]. The specific subtype of B-cell lymphoma may also influence the primary cause of death [10,74]. The progression and transformation into aggressive subtypes, such as diffuse large B-cell lymphoma, has an unfavourable prognosis and increased mortality rates [20]. Complications from the disease, treatment-related side effects and comorbidities contribute to mortality [28, 75-77]. Death was commonly caused by Disseminated malignancy followed by fatal respiratory illness or complications [10,71]. Any infiltrative diseases involving the spleen can also lead to spleen rupture, causing intraperitoneal bleeding, shock, and death [78- 80]. Other causes of death include infection, hemorrhagic shock, hemoperitoneum, thromboembolism, increased intracranial tension with cerebral oedema and conduction abnormalities and associated congenital heart disease [10,20]. Significant autopsy findings in cases of septicemia include pulmonary oedema, diffuse alveolar damage with micro- thrombosis, inflammation & ischemic necrosis of cardiac tissues, acute tubular necrosis, cholestatic jaundice, liver necrosis with sinusoidal aggregates, partial liquefaction of spleen, hemorrhagic adrenal gland, cerebral petechiae, sub-serosal or submucosal hemorrhages in the gastrointestinal tract and features of disseminated intravascular coagulation [81]. In the present case, death is attributed to septicemia secondary to B cell lymphoma in its advanced stage involving multiple organs. Multiple conditions, including syndromic abnormalities like hypogonadism and Kallmann syndrome, were in consideration before concluding the autopsy cause of death in this case. However, the findings from ancillary investigations of the tissues and fluids, in corroboration with the gross features of the case, directed the focus of causality towards B cell lymphoma. Conclusion The unexpected discovery of B-cell lymphoma in this 33-year-old man with a history of anemia and hypothyroidism demonstrates the potential for these conditions to remain undetected until postmortem investigation. The gross findings, extensive lymphoid infiltration observed across multiple organs on microscopy, and immunohistochemical findings provided crucial evidence for diagnosing B-cell lymphoma. Septicemia, the common fatal complication of B-cell lymphoma as in any HLM, had caused death in this case. The case report highlights the importance of comprehensive autopsy examinations in identifying clinically undiagnosed malignancies, particularly HLMs. Limitations The spleen and bone marrow were not subjected to microscopic studies using cytomorphology, histomorphology, and immunohistochemistry, thereby posing difficulty in locating the lymphoma's primary origin. Suggestions For Autopsy Surgeons: The case highlights the importance of autopsy in medical education, quality assurance, and disease understanding. Postmortem diagnosis of B-cell lymphomas can be challenging due to heterogeneity and limited tissue samples. Understanding gross autopsy findings in HLM is crucial for prompt recognition and management. In unexplained anemia or endocrinological abnormalities, an autopsy should also rule out HLM. For Clinicians: The case report emphasizes the importance of clinicians detecting underlying malignancies in cases with atypical presentations or unexplained deterioration. Advancements in diagnostic techniques like noncoding RNAs, Next-Generation Sequencing, and radiomics provide new insights into disease pathogenesis and development, while tissue proteomics and digital pathology can enhance early detection [82-86]. Conflicts of interest The authors have declared no conflict of interest in the submitted work. Funding/services All authors have declared that no financial support or service was received from any organization for the submitted work. Ethical Approval & Informed Consent This article does not contain any studies with animals. This is a retrospective case report of a medicolegal autopsy. The case data has been completely anonymized with proper de- identification of contents in this report. References 1. Hanzlick R, Hunsaker JC, Davis GJ. Guidelines for Manner of Death Classification. Atlanta. GA. National Association of Medical Examiners. 1st ed. 2002. Available online from: Link 2. Our role in investigating deaths [Internet]. Scotland. Crown Office and Procurator Fiscal Service. 2023 June 9 [Updated on 2024 July 16. Cited on 14 September 2024]. Available at: Link 3. 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Spontaneous splenic rupture: case report and review of literature. Pan Afr Med J. 2020;37(1). https://doi.org/10.11604/pamj.2024.48.190.43645 80. Stassi C, Mondello C, Baldino G, Ventura Spagnolo E. Post-mortem investigations for the diagnosis of sepsis: a review of literature. Diagnostics. 2020;10(10):849. http://doi.org/10.3390/diagnostics10100849 . 81. Scott DW, Wright GW, Williams PM, et al. Determining Cell-of-Origin Subtypes of Diffuse Large B-Cell Lymphoma Using Gene Expression in Formalin-Fixed Paraffin-Embedded Tissue. Blood. 2014;123(8):1214-7. https://doi.org/10.1182/blood-2013-11-536433 82. Lawrie CH, Gal S, Dunlop HM, Pushkaran B, Liggins AP, Pulford K, Banham AH, Pezzella F, Boultwood J, Wainscoat JS, Hatton CS. Detection of elevated levels of tumor‐associated microRNAs in serum of patients with diffuse large B‐cell lymphoma. Br J Haematol. 2008;141(5):672-5. https://doi.org/10.1111/j.1365-2141.2008.07077.x 83. Gillies RJ, Kinahan PE, Hricak H. Radiomics: images are more than pictures, they are data. Radiology. 2016;278(2):563-77. https://doi.org/10.1148/radiol.2015151169 84. Griffin J, Treanor D. Digital pathology in clinical use: where are we now and what is holding us back? Histopathology. 2017;70(1):134-45. https://doi.org/10.1111/his.12993 85. Zheng GX, Terry JM, Belgrader P, Ryvkin P, Bent ZW, Wilson R, Ziraldo SB, Wheeler TD, McDermott GP, Zhu J, Gregory MT. Massively parallel digital transcriptional profiling of single cells. Nat commun. 2017;8(1):14049. https://doi.org/10.1038/ncomms14049 *Corresponding author and requests for clarifications and further details: Dr Mukesh R, Assistant Professor, Department of Forensic Medicine & Toxicology, JIPMER, Pondicherry. Mail at: mukeshfmt22@gmail.com

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Main Page > Vol-26 No.- 2 > Paper 3(you are here) Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26, Number 2, July - December 2025 Received: Accepted: Ref: Kumar J, Khan IA, Reyazuddin M, Haroon A, Khan FA. Proposing a Single centre as a Drug and Toxicology Unit for Complete Care of Substance Abuse and Poisoning Patients at Tertiary Care Centers. Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online], ---- ; Vol. 26, No. 2 (July - December 2025): [about 6 p]. Available from: https://www.anilaggrawal.com/forensic-medicine-and-toxicology/vol-026-no-002/26-02-paper003 . Published : -----, (Accessed: ---) Email- Jitendra Kumar Irfan Ahmad Khan Mohammed Reyazuddin Afzal Haroon Farhan Ahmad Khan Proposing a Single centre as a Drug and Toxicology Unit for Complete Care of Substance Abuse and Poisoning Patients at Tertiary Care Centers Abstract A Registered medical practitioner is qualified to manage all the cases of poisoning and substance abuse after passing their graduate medical education. The qualification of managing poisoning cases comes from Toxicology taught to them under the subject "Forensic Medicine and Toxicology". At tertiary care centres, the post-graduates in Internal Medicine manage poisoning and substance abuse cases under emergency care based on the knowledge they received during their undergraduate studies. However, the Teacher who taught the subject is practically not involved in managing such patients, i.e. preaching without practice. This results in a gross deficiency in the quality of care for poisoning cases. To overcome this, we propose one centre as a Toxicology unit at every tertiary care centre, corroborating Medicine, Forensic Medicine, Pharmacology, Psychiatry and various other disciplines dealing with all the aspects of Substance abuse and Poisons. With the help of this unit, we can run a single centre catering to the management of poisoning and substance abuse patients, their mental health, diagnostic centres for drugs and poisons, drugs and poison information centre (DPC) including drugs de-addiction and treatment centre (DDAC), an integrated rehabilitation centre for addicts (IRCA), Outreach and Drop-in centres (ODIC), De-addiction drug pharmacy and various training courses to the health care professionals. Keywords: Toxicology, Poisoning, Substance abuse, Mental health, Suicide Introduction Suicide is one of the preventable forms of death. Suicide is not only a personal tragedy that takes the life of an individual prematurely, but it has a continuing ripple effect, affecting the lives of families, friends and communities. The global burden of death due to suicide is more than seven lakhs per year (1). Suicide is among the top 20 leading causes of death in the world (WHO) and among the top 10 leading causes of death in India (NCRB data) (2). Although we don't have actual data on the suicide attempters, as per WHO, for each suicide, there are likely more than 20 suicide attempts (3). In that way, if we consider suicide as a preventable disease, then this will become the most prevalent disease in the world, and 2nd commonest will be far behind. Sadly, 77% of global suicide occurs in middle- and low-income countries. Suicidal behaviour is a complex phenomenon that demands a holistic approach of care and support by multiple agencies. Mental Health Care Act, 2017 and India Under Indian Penal Code (IPC) section 309, the attempt to commit suicide is a criminal offence and is punishable with one-year imprisonment with or without a fine. With the implementation of the Mental Health Care Act 2017 (4), Section 309 of IPC was decriminalized, and it was stated that "Any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress. And the appropriate government shall have a duty to provide care, treatment and rehabilitation to a person having severe stress and who attempted to commit suicide to reduce the risk of recurrence of attempt to commit suicide”. This has changed the approach of every stakeholder towards suicide patients. Although suicidal behaviour was seen as a mental illness, treatment for the same is provided by the Psychiatry department of the hospital for a long apart from their regular treatment (5-9). But with this commendatory step taken under the Mental Health Care Act, every attempt of suicide shall now be seen as a disease rather than an offence for which the appropriate government and healthcare provider will provide proper care, treatment and rehabilitation as per the standard guidelines. Poisoning and Mental Health It has been observed that most of those patients who survive suicide and get admitted to the hospital, the majority of them are with poisoning incidences, and poisoning is the most typical method practised. Also, it has been reported that most of the poisoning cases are suicidal (More than 75%), followed by accidental (10, 11). In view of this, the majority of cases of poisoning need care of their mental health. Substance Abuse, Mental Illness and Toxicology Substance abuse, i.e., the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs, is a form of toxicity itself and is an essential part of pharmacology and toxicology. They are taught to undergraduates under the drug dependence chapter of Forensic Medicine and Toxicology. The emergency care of such patients is done at casualty by post-graduates in Internal Medicine and further care in the Psychiatry department. At present, we don't have substance abuse testing labs in hospitals. Essential care of such patients in a routine manner is avoided due to medico-legal reasons. Substance abuse is a shared Medicine, Pharmacology, Forensic Medicine and Psychiatry domain. So, a multi-disciplinary approach is essential for proper care of such patients. Pharmaceutical Drugs, Environmental Poisons and Toxicology lab Indiscriminate use of drugs without proper prescription is rampant in the society. This results in toxicity, resistance, chronic renal diseases and various other pathologies. We don't have toxicology labs even at the tertiary care centre for the testing of chronic drug toxicity. Similarly, air pollution, water pollution, household poisons, and other factors resulting in chronic diseases and ill health are totally ignored areas of toxicology management. We need toxicology labs and research in this part to provide proper care for such cases. Present practice in the care of Poisoning cases and Forensic Medicine and Toxicology Understanding of the management of poisoning cases is developed among Indian medical graduates through their teaching of the Subject "Forensic Medicine and Toxicology" during their second or third professional. However, Forensic Medicine and Toxicology faculties are not practically involved in the care of poisoning patients. They develop their training only theoretically. Poisoning cases at tertiary care centres are dealt mainly as emergency cases. Post-graduates in Internal Medicine provide emergency symptomatic care to the patients along with other routine emergency patients. At our hospital, ACMO (Assistant Casualty Medical Officer, mostly Post-graduate students of different disciplines posted temporarily in the casualty) sees all patients coming to casualty first, including poisoning cases. In poisoning cases, ACMO takes the patient's history, notes vitals, and categorizes the patient as stable or unstable. In case of an unstable poisoning patient, he gives a distress call to Anesthesia. The Anesthesia team does resuscitative measures and accordingly takes to a ventilator or stabilizes the patient. Once the patient is stable, Gastric lavage is done, and the patient is referred to the Medicine unit in case of an adult. Most antidotes for poisoning are unavailable. Routinely, Normal saline and sometimes charcoal are used. In the Medicine unit, routine blood testing for non-critical poisoning cases includes CBC, LFT, KFT, ABG and ECG (sometimes) are done. If nothing abnormal in the above parameters, only symptomatic supportive treatment is given, and the patient is observed for up to 24 hours and then discharged. In case of any abnormal parameters, the patient is managed in the ICU or CCU ward. In most cases, no MLC is prepared, and neither gastric lavage is preserved for MLC purposes. Also important to note is that all the care related to poisoning is done along with other emergency or ward cases. Poisoning cases in government or private are medico-legal cases, whether accidental, suicidal or homicidal. This becomes another reason for the cold approach in the care of such patients. Proper Medico-legal formalities are not done, and cases are usually sent to the home after recovery without proper medico-legal formalities. Also, the doctors of Internal Medicine don't get any separate training for poisoning cases, but they manage patients like other routine emergency cases based on the knowledge of Forensic Medicine and Toxicology taught long back. So, overall, poisoning management is developed more theoretically than practically, i.e. preaching without practice. This results in a gross deficiency in the quality of care for poisoning cases. Most tertiary centres face the unavailability of toxicology management related medicines like activated charcoal, various antidotes, etc., as well as the availability of other resources and space constraints. To overcome this, Faculties and Residents of Forensic Medicine and Toxicology need to be involved in managing poisoning patients and dedicated centres for the care of Toxicology patients are the need of the hour, particularly at the tertiary care centres. Since toxicology care is multi-disciplinary, we propose a Drug and Toxicology unit. Drug and Toxicology Unit We are proposing one single centre as a Drug and Toxicology unit at every tertiary care centre, corroborating Internal Medicine, Forensic Medicine and Toxicology, Pharmacology, Psychiatry and various other disciplines dealing with all the aspects of Substance abuse, Drugs and Poisons for better care and compliance with such patients. It shall be established near the hospital's emergency department for better patient care and to admit patients of the above categories after their emergency care. The unit shall have The Drug and Toxicology Division and the Substance Abuse and Mental Health Division. The following parts shall be attached to each division, as shown in Fig. 1. Figure 1: Different centres under the Drug and Toxicology Division and Substance Abuse and Mental Health Division Drug And Toxicology Division Drug and Toxicology out-patient department Drug and Poison Information Centre (DPC) Diagnostic lab (Drug level estimation) Diagnostic lab (Poison level estimation) Drug and toxicology ward (Min. 20 bed) Antidote Bank Substance Abuse And Mental Health Division Substance abuse out-patient department Drug de-addiction centre and treatment (DDAC) Outreach and drop-in centres (ODIC) De-addiction drug pharmacy Integrated rehabilitation centre for addicts (IRCA) Objectives A single centre dealing in all aspects of Drugs, Poisonous Substances, Substance abuse and mental health for the convenience of the patients and administration. Human resource and workforce development by training medical undergraduates, post-graduates, research scholars, and other staff in all aspects of drugs and toxicology for better running of such centers. Benefits The facility will support the hospital and the public in better diagnosis and management of drug-related events, poisoning cases and substance abuse cases. It will have a Drug and Poison information centre that will provide knowledge about all the aspects of Drugs, Poisonous substances and Substance abuse to the public and health care providers, which will save the lives of many. All the drug and toxicology-related investigations shall be available in the Drug and toxicology unit. The earliest diagnosis of the Poison can help save the lives of many and support the investigating agencies in regulating the availability of such poisons. Unit shall estimate the drug levels through therapeutic drug monitoring (TDM) in case of life-threatening events and low therapeutic index drugs. De-addiction and treatment centre (DDAC), an integrated rehabilitation centre for addicts (IRCA), and Outreach and Drop-in centres (ODIC) will be beneficial in the prevention and management of Substance abuse cases. A de-addiction pharmacy and antidote bank will provide de-addiction drugs and poison antidotes that will be very helpful in patient care and compliance. De-addiction drug pharmacies will be very supportive of patient of substance abuse to avail their prescribed drugs at ease with following norms as per the NDPS Act, 1985. Teaching and training medical undergraduates and post-graduates in clinical pharmacology and toxicology can be imparted. Various courses like DM (Pharmacology), DM (Toxicology), DM (Psycho-pharmacology), DM (Addiction Psychiatry) along with PhD programs, MSc, DMLT and other related courses in clinical pharmacology, toxicology and Substance abuse may be undertaken. New Research avenues may be inculcated through this unit. We can collaborate with institutes of high eminence for further enhancement. We can also generate good revenue from various sources, as mentioned in Table 1. For substance abuse management and care, the Department of Social Justice and Empowerment provides massive funding to such centres. Table 1: Revenue for the above unit can be generated from the below sources. Drug And Toxicology Division Ward admission charges OPD charges Drug and poison estimation charges Therapeutic Drug Monitoring charges Different academic and training courses Antidote bank charges Substance Abuse And Mental Health Division Ward admission charges De-addiction pharmacy EEG Bio-feedback MBT (Aversive Therapy) Motivational enhancement therapy Social skill Training Funding by department of Social justice and empowerment. Our Proposal under HEFA Higher Education Financing Agency (HEFA) is a joint venture of the Ministry of Education, Government of India and Canara Bank to finance the creation of capital assets in premier educational institutions in India. This idea of the Drug and Toxicology unit evolved from inter-departmental activity that started while preparing such proposals that will be a revenue-generating model. HEFA provides funds for infrastructure and equipment, with the condition that they return 10% of the amount in 10 years. In brief, we have proposed an infrastructure with the Ground and first floors having the Drug and Toxicology division and the Second and third floors having the Substance abuse and Psychiatry division (as shown below in Fig. 2-5). Ground Floor Figure 2 : Layout plan for ground floor Figure 3 : Layout plan for first floor First Floor Second Floor Figure 4 : Layout plan for second floor Figure 5 : Layout plan for third floor Third Floor Tentative Cost And Revenue Generation We estimated the cost of infrastructure and equipment separately as per government norms for both divisions, along with tentative revenue generation as shown in Table 2. Table 2: Tentative cost and revenue generation for the Drug and Toxicology unit as calculated for our proposal under HEFA Similar Successful Projects As per our information, we could not find any such unit that incorporates drugs, toxicology and Substance abuser care under one centre all over India. However, many centres run separately for each division, with limited facilities. Drug and Toxicology Division All India Institute of Medical Sciences, Raipur, has started caring for poisoning patients under the Forensic Medicine Department and is also running a DM course in toxicology with two intakes per year. They are taking patients with poisoning cases after the emergency stabilization. The Poison Information Centre is being run at various centres, mainly under the Pharmacology department like AIIMS, New Delhi, which runs the National Poison Information Centre with toll-free (1800 116 117). Amrita School of Medicine, Cochin, runs the Poison Control Centre and Clinical Forensic Medicine with an Analytical toxicology laboratory attached and accredited by the NABL under the Forensic Medicine department. They are not directly involved in the treatment of patients. Substance Abuse and Mental Health Division National Drug Treatment Centre, Ghaziabad (NDDTC), under AIIMS, Delhi, has been established as the apex centre for the management of drugs and substance abuse disorders in India. The centre provides clinical care to patients through community-based OPD and In-patient care, speciality clinics, wards, etc. Health education & preventive measures for substance abusers are done on a community basis. The centre works as a nodal centre for evaluating the prevalence of addiction in society. The centre is involved in staff training and human resources development to cater to such services nationwide, apart from testing, documentation and research in substance abuse disorders. PhD Programme and DM in the area of Addiction Psychiatry running under this centre. Also, they are designated as a WHO Collaborating Centre on Substance Abuse (12). Further, 90 DDAC, 95 ODIC, and 375 IRCA are running under the Ministry of Social Justice and Empowerment all over the country at present (13). Healthcare management is interdisciplinary and involves teamwork rather than individual activity. Both the poisoning patients and patients of substance abuse need the care of their mental health. All the poisoning cases and substance abuse cases are medico-legal cases and need the support of Forensic Medicine and Toxicology for Management and other formalities. Hence, the proposed Drug and Toxicological unit at tertiary care centres, with the collaboration of the Departments of Internal Medicine, Pharmacology, Forensic Medicine & Toxicology and Psychiatry for effectively managing substance abuse and poisoning patients, can be paramount. Also, their support in estimating the drug and poison level will help adequately plan healthcare management. Such centres can be nodal centres for the training and research on all aspects of substance abuse and toxicology, including general, pharmaceutical, occupational, environmental, household and others. Conclusion 1. What is already known on the topic? Answer: Poison information centre is a known concept where the diagnostic facility is also provided at many centres run under Pharmacology and Forensic Medicine. Various centres for the care and management of Substance abuse are also running under the various social initiatives by the WHO and the Government of India. 2. What this study adds? Answer: The paper puts forward a concept of a single centre for the care and management of poisoning cases, substance abuse cases and accessibility of all the aspects of toxicology under a single umbrella, like a One-stop center in case of sexual assault cases. This will improve the quality of care of poisoning and substance abuse case. Also, this paper highlights the need of involvement of Forensic Medicine and Toxicology Department in the management of poisoning cases. 3. Suggestions for further development. Answer: Such a Toxicology unit may be proposed under the different health schemes and government policies to be established at tertiary care centres for streamlined management of poisoning and substance abuse cases. References 1. World Health Organization: WHO. Suicide. Who.int. Published July 8, 2019. [Link ] . 2. Sharma S. The top 10 causes of death in India. https://www.hindustantimes.com/. Published September 30, 2017. Accessed April 10, 2019. [Link ] 3. World Health Organization. “Suicide.” World Health Organization, World Health Organization: WHO, 28 Aug. 2023, [Link ] 4. The Mental Healthcare Act, 2017|Legislative Department | Ministry of Law and Justice | GoI. [Link ] . 5. Carrigan CG, Lynch DJ. Managing Suicide Attempts: Guidelines for the Primary Care Physician. Prim Care Companion J Clin Psychiatry. 2003 Aug;5(4):169-174. doi: 10.4088/pcc.v05n0405. PMID: 15213779; PMCID: PMC419387. 6. Sarkhel S, Vijayakumar V, Vijayakumar L. Clinical Practice Guidelines for Management of Suicidal Behaviour. Indian J Psychiatry. 2023 Feb;65(2):124-130. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_497_22. Epub 2023 Jan 30. PMID: 37063624; PMCID: PMC10096207. 7. Wasserman, D., Rihmer, Z., Rujescu, D., Sarchiapone, M., Sokolowski, M., Titelman, D., . . . Carli, V. (2012). The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. European Psychiatry, 27(2), 129-141. doi:10.1016/j.eurpsy.2011.06.003 8. Hill, N.T.M., Shand, F., Torok, M. et al. Development of best practice guidelines for suicide-related crisis response and aftercare in the emergency department or other acute settings: a Delphi expert consensus study. BMC Psychiatry 19, 6 (2019). [Link ] 9. Jacobs DG, Baldessarini RJ, Conwell Y, et al. Assessment and Treatment of Patients with Suicidal Behaviors WORK GROUP on SUICIDAL BEHAVIORS.; 2006. [Link ] 10. Das A, Datta A, Nath A, Bhowmik A. Profile of poisoning cases treated in a teaching hospital of Northeast India with special reference to Poison severity score: A cross-sectional study. J Family Med Prim Care. 2022 Nov;11(11):7072-7076. doi: 10.4103/jfmpc.jfmpc_1076_22. 11. Patel NS, Choudhary N, Choudhary N, Yadav V, Dabar D, Singh M. A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh. J Family Med Prim Care. 2020 Jun 30;9(6):3010-3014. doi: 10.4103/jfmpc.jfmpc_306_20. 12. “National Drug Dependence Treatment Centre.” AIIMS NEW, [Link ] . Accessed 31 Oct. 2023. 13. Department of Social Justice and Empowerment National Action Plan for Drug Demand Reduction (NAPDDR) Nasha Mukt Bharat Abhiyaan (NMBA): Annual Action Plan (2021-22) for 272 Most Affected Districts. [Link ] *Corresponding author and requests for clarifications and further details: Dr. Jitendra Kumar Assistant Professor, Department of Forensic Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh Email- dr.jitendrak2@gmail.com

Explore a unique collection of forensic science fiction curated by Dr. Anil Aggrawal. Blending medical accuracy with thrilling narratives, these stories captivate students, professionals, and lovers of scientific mysteries alike. Anil Aggrawal's Forensic Science Fiction Page Hi, I am Professor Anil Aggrawal from India. I teach forensic medicine and toxicology at the Maulana Azad Medical College, New Delhi. I love reading and writing science fiction, especially that related to forensic medicine. My favorite SF author is....yes, you guessed it right- Isaac Asimov! Unfortunately he was not a forensic man, and so not many stories related to forensic medicine exist in current SF literature. Although I am no Asimov, I have made a humble attempt and tried to fill up this gap by writing SF stories related to forensic medicine. Some of these stories have been hosted on the net by science fiction enthusiasts. Anyone wishing to exchange ideas with me on forensic medicine, science, and science fiction is welcome. Many of my Science Fiction stories have been published in Spandan, the inhouse magazine published by the students association of Maulana Azad Medical College. You may want to go to this site for some other very interesting articles. My favorite science fiction pages Isaac Asimov Check Website The mysterious old man The Freak A tale of detection The New Antibiotic The mystery of the drowned man The mystery of the burnt bride The mystery of the electrocuted man The mystery of the slain General The mystery of the dead infant The mystery of the assassinated prince (one) - Dr. Anil Aggrawal I met him at a party. He was surrounded by a few friends and they were all laughing their heads off. No doubt the booze was showing its effect. The party was entering into its second phase- phase of loosening inhibitions. People would take off their masks during this phase and would show them as their real self. The man whom I am going to talk about, had a sort of magnetism around him. He was about 5'10", lean and thin, with a thick white hair, a goatee and a glowing face with wrinkles just appearing. From his looks he appeared to be no more than 50, but being a medical man I knew he had crossed sixty. I found myself drifting towards him. The party looked up at me. Everyone except him knew me. "Come on Dr. Aggrawal", said one of them,"Meet Mr Quatra her. A company executive." "Dr. Aggrawal. Professor of forensic medicine", I said and thrust my hand forward. He took my hand in both of his and pumped them till I thought he wanted them pulped. His hands seemed unusually warm. "Quatra here. Working with Jaykay exporters." There was an aura of mystery around him. From his looks, I could guess he was an unusual man. I am not sure what made me think that. Probably an intuition only. I looked again at him. No, I couldn't be wrong. This man had an ace up his sleeve. What? "Gentlemen! Now I am going to demonstrate something special to you", Mr. Quatra said. There were some groans around. Then some one said,"No card tricks for God's sake. We have had enough of that. Everyone seems to be demonstrating that in the recreational session of the party" "Bring me a glass of water", he said, completely ignoring the comment. This engendered some curious looks around. A waiter was passing around with a tray of drinks. Someone picked up a glass of whisky and thrust it towards him. "No, not alcohol. It could be dangerous. I want just plain water". Plain water was brought. The old man put the glass of water on the table. Then he looked around with an aura of mystery and then declared, "Gentlemen, I am going to boil this water without any heat whatsoever" Again there were may groans around. Then someone said, "Okay, Okay, we have seen enough of that vacuum business. You simply create some kind of partial vacuum somehow, and since water boils at a lower temperature in a partial vacuum, it begins to boil at the room temperature" "No, not that at all. That is high school physics. The thing I am going to show you is unexplainable. This is real magic; or perhaps mystery you can say. Definitely it does not involve any science trick." "Okay show it to us," Goldie said, pouting her beautiful breasts in a low cut blouse forwards for everyone to see. She was perhaps disconcerted that people had started taking more interest in that wrinkled old man than her frontal eminence. "Gentlemen, I am going to dip my hands in this water", said Mr Quatra, completely ignoring what the young lady had to offer,"and you will all see, it would become warmer." "Okay go ahead you stuntman", I said to myself,"You can't make it warmer than 370 C, the temperature of the human body. I would be damned if you do that." He dipped his right hand in water and then closed his eyes as if in meditation. After about a minute, he asked me to dip my index finger in the glass of water. I found the water somewhat warmer. But skin temperature is only around 300 C. If the water was even at, say 340 C, it would appear warmer to everyone. No magic whatsoever. He continued for some more time and then asked someone else to dip his finger. He immediately retracted the finger in amazement. "It's warm, very warm!" he exclaimed. "Fools!" I thought, "He is keeping his hand long enough till the water comes to 370 C. Water at this temperature would seem warm to any human being, for the simple reason that skin is at a lower temperature. Water is getting the heat from his blood. Not so easy to do for every human being however. May be he has done some practice and can apparently do it with much ease." After 2 minutes he invited me to dip my fingers in it again. I advanced my fingers to the bowl quite nonchalantly and dipped them deep inside the bowl. Immediately I had to jerk them out. The water was unbearably hot. I found myself sucking at my fingers. Soon fumes started appearing at the surface of water. Everyone of us had had enough of that. We asked him to stop. With a victorious grin, that almost reached his ears, he took off his hand, and mopped it with a handkerchief. "Can you give me your card?" I asked him, still dazed. "Sure" he dished out his visiting card from his wallet. After that he left quietly. (Two) A battery of tests conducted on him showed some unusual results. Thankfully, next day when I had 'phoned him and had asked him if he could make himself available for some lab tests, he readily agreed. Radiographs of the blood vessels of his right hand (after injecting a radio opaque dye in his brachial artery) showed an unusual rich network of arteries there. That was one reason why he could bring so much warmth in his right hand. Still, causing water to boil? That couldn't be explained. For a whole week I couldn't sleep. My friends at the party asked me to forget the incident. "People can do a lot of things with yoga" they said. But I shook them off. Finally I called him one day. "Mr Quatra", I said," I want to take a few cells from your hypothalamus. Would you allow me to do that? It is a small area of the brain sitting at the base of the skull. I would use the nasal route. Don't worry. Nothing would happen to you. With advanced techniques available now, I would just pick up about fifty odd cells which is about one millionth of the total cells you have in your hypothalamus." "Do whatever you like doctor", he said gleefully. "I am all for the advancement of science". I studied the cells for 2 weeks. I did everything possible on them; histology, histochemistry, physiology, radio-nitrogen tagging, everything; but didn't get any clues. Nothing had perturbed me more in life than this problem. Then one night when I was sleeping and dreaming, suddenly the solution came to my mind like the flash of a lightning. I immediately woke up with a start, and thought of the solution from every angle. The more I thought about it, the more I got convinced that I had indeed found the correct solution. So confident was I that I decided to present the results of my findings to the next international science conference I was attending in Geneva. Mr. Quatra was a mutant! Which means he had an altered thermostat. Well, I won't go in details. You all know about hypothalamus and built-in thermostats. The hypothalamus of all human beings has a built-in thermostat which is "pre-programmed" to keep the body temperature at 370 C. If there is cold outside, one would start shivering to generate more heat in order to maintain this temperature. On the other hand if it is too hot outside, one would start sweating. Like the thermostat of an electric appliance, it is the hypothalamic thermostat which decides the human body temperature. In all human beings this thermostat is set at a temperature of 370 C. But this man could apparently set his thermostat at a higher level- at will. The biochemistry of his hypothalamic cells led me to that. To be sure, setting of the body's thermostat at higher level is not abnormal. It happens in ordinary day-to-day life. Bacterial toxins set it at a higher level. That is why one gets fever in bacterial infections. In almost all infections- malaria, pneumonia, typhoid- it would be set at a higher level and then the body's temperature would rise. No man could however do it at will. What was most astounding was that this man could apparently do it at will. Some kind of chemical - a hormone probably- would be released from his brain and set it at a higher level. The mystery was that his whole body temperature would not rise appreciably. Only his right hand's temperature would rise. Admittedly this stumped me. May be a good concentration of capillaries there had something to do with it. I presented the findings of my investigation in the international conference the next month. But contrary to my expectations, the paper was booed over. It was taken to be a paper in pseudo-science. I swallowed the insult with a dismal heart. (Three) Next week I got the startling news that Mr Quatra was dead. He was found burnt in his study. The police was suspecting homicide. That is why they called for me immediately. I visited the place at once. The scene was familiar to me- in fact to all forensic experts. The torso had burnt beyond recognition. In fact there was merely ash where the torso should have been. The legs below the level of knees were almost unharmed. My brain started ticking... Spontaneous human combustion! Undoubtedly. This was the classic picture of Spontaneous human combustion. I assured the police officers, it was neither a case of homicide, nor suicide. It was a rare phenomenon, seen once in a century probably. And then I left his house and pressed down the accelerator viciously. I had to reach my lab soon. Lot of work was pending. Besides, I wanted to forget this witch of a man. But somehow my brain was going back to Mr Quatra again and again. Was there something I was missing completely? A missing link perhaps? One which could link all the bizarre facts nicely and logically? My brain felt as if it was full of jig-saw puzzles, needing to be adjusted in their proper order. Suddenly the solution came to my mind. It gave me such a shudder, I lurched forward. I couldn't help it. The car swerved here and there violently till I slammed over the brakes. That jig-saw puzzle! It had been solved! Suddenly all the pieces seemed to fall together in their right places. That gave me this unexpected shivering. Spontaneous human combustion is an unexplained phenomenon for many centuries. Charles Dickens even mentioned the phenomenon in one of his novels. Various theories have been advanced but none seemed satisfactory. There have been for instance, theories regarding building up of high concentrations of combustible substances in the body; high phosphorus levels in bodies, high alcohol levels in alcoholics and the like. Well, these theories do look attractive, but they don't explain everything properly. If you dip a piece of meat in alcohol and burn it, it would burn only till the alcohol is present in the piece of meat. After that the fire would extinguish. Then there are theories regarding high voltages being built inside the body by walking on things like carpets and so on. But now I knew what really goes on. These people are really mutants. And very rare ones at that. For one thing that explains the rarity of the phenomenon of Spontaneous Human Combustion. The mutation enables the affected persons to set their hypothalamic thermostats at a higher level- at will. Even at levels of 3000 C as in the case of Mr Quatra. You may find it unbelievable but I have the biochemistry reports to show you just that. Some of these people can do it at will while others can't, but in all cases this thermostat gets set at a higher level automatically on a very cold chilly night (perhaps to keep them warm). That's why you get spontaneous combustions on cold chilly nights only. Usually however, their thermostats would be set normally. Raising the thermostat to 3000 C would mean that the body would catch fire, as fat catches fire at 2930 C. That is the gist of my whole theory. I know questions are lurking in your minds. What is the exact biochemistry? How is the thermostat set at a higher level? Why would only the hand get warmer and not the rest of the body? Well, I can't explain all that in this short report which I am writing merely because Mr. Suneel Galgotia, the publisher of this book requested me to do so. In any case they are merely trifling details. The main gist should satisfy most people. Even then, I would not disappoint the scientifically minded people. They can fruitfully scan through the following papers, which I wrote subsequently. Aggrawal A. A Biochemical explanation of Spontaneous Human Combustion. New England Journal of Medicine. 311: 1072-1074, 1999 Aggrawal A. Spontaneous Human Combustion. Do the thermostats go awry? British Medical Journal. 321: 72-87,1999 I hope these should satisfy the more scientifically minded of you. Thanks. This story was published in Published in Spandan (Maulana Azad Medical College's Magazine) 1989-90 on Pages 43-46 - Dr. Anil Aggrawal I was surprised. Extremely surprised. Never before had a patient come to me with such a complaint. I asked him again. "Are you sure, you keep moving back and forth in time? Just how do you know?" Rajiv coughed nervously. "All of a sudden sometimes, I feel dizzy. Then I feel as if I am falling in ordinary three dimensions. In an abyss. Rapidly. But it's not the height I loose. I find I have gone back in time. I see all sorts of things. Mughal splendor. Coming of the English people. Freedom struggle. Everything." "Are you sure you are not hallucinating? I am asking this because people of your species can control movement in time you see." "Yes, we four-dimensionals are not like you. Sure enough we can control movements in time just as you can in space. But I just don't know what's the trouble with me. I just can't control it. Look at this ancient coin. I brought it yesterday, when I tipped back in time." I looked carefully at the coin. A rare gold circlet from the reign of Akbar. There was no mistake about it. This four-dimensional sure enough meant business. He wasn't joking. In the last twenty years of my practice, I must have treated thousands of people - both three dimensionals as well as four-dimensionals. But never before had I seen such a patient. There wasn't much of a difference in the anatomy and physiology of the two major human species currently living on earth. Just a little difference here and a little there - so that the four dimensionals could adapt to their special needs and requirements. Four dimensionals were so called mainly because they had a special ability to move back and forth in time at will. We three dimensionals could do so only in three ordinary dimensions. How the four-dimensionals had come to live on earth is a long story. Centuries before, a space ship went from earth in search of intelligent life. After some years of departure, the radio contact between the space ship and the earth broke down and despite best efforts could not be re-established. God knows what happened to those humans, but when they came back some years ago, inhabitants on earth found they had acquired a new ability - to move back and forth in time at will. They couldn't tell anything as they didn't seem to know much. Exobiologists surmised that their forefathers- the ones that left the earth- must have been captured by a super intelligent race and they must have used them as guinea pigs for their genetic experiments. Most probably the ability to move back and forth in time had come as a result of massive genetic alteration by those super-intelligent beings. Anyway the fact was that their genetic makeup had been substantially altered - so much so that they couldn't interbreed with ordinary three-dimensionals. In spite of my best efforts, I couldn't treat Rajiv. He kept falling back and forth in time. The best I could do was to administer antihistaminics like Avomine so he wouldn't feel dizzy. But that wasn't much help as everybody would agree. Then one day I received the sad news that Rajiv had expired. I was shocked. Worst of all, I had to conduct a post-mortem examination and find the cause of death. I opened the body and as expected found petechial hemorrhages in all internal organs-liver, spleen, heart, brain, everywhere. Hemorrhages of the shape of pin-point. The cause of death was clear. He had been falling continuously over long periods. Small Hemorrhages kept on accumulating everywhere and their effect on the brain was devastating. Tried hard as I did, I couldn't locate any other abnormality. I started closing the body when suddenly I was gripped with a strange curiosity. Could I find the cause of his uncontrollable movements in time? I had more working space now. I had his entire dead body. I could examine all his organs in detail. I might hit upon some curious finding. Besieged with this strange curiosity, I ripped open the stitches and took out all the organs once again. Then I donned my researcher's hat and got down to work. Till late night I had made sections of all his major body organs and examined them under the microscope in great detail. I could find nothing. Tired, I decided to call it a day. I asked my assistant to wrap up the body in formalin and keep it in the cold room. I would have a last go tomorrow. And then I went to sleep. At 4 am I woke up with a start. My subconscious mind must have been working at the problem. That's why I had this ridiculous dream. I thought I had found out the cause of his strange abnormality. I couldn't contain my anxiety, and wanted to test the hypothesis right away. I took out my car and headed for the mortuary in the darkness. The roads, drowned in darkness at that time of the night appeared unusually spooky. At the mortuary, as expected, I found everything closed. The assistant had locked up the main gate, mortuary doors, cold rooms, everything- and had gone away to his house. I took out my duplicate set of keys and opened the mortuary. In the cold room, I opened catacomb number 13, the one where Rajiv was resting. Needless to say, my hands were trembling; perhaps both from fear and from the anxiety of making an unknown discovery. I took out the body myself and laid it out neatly at the table. The skull cap and brain matter were already removed. I looked at the base of skull- at the petrous part of the temporal bone. The one that forms the roof of the middle and inner ear. The mystery could be lying there, I told myself. Gradually and neatly I started chiselling away the temporal bone, so that none of the inner ear structures would be damaged. And then with great precision I took out the inner ear contents. The cochlea, the utricle, the saccule and the semicircular canals, along with vestibular nerves. I kept the whole complex under a simple hand lens and examined it - especially the semicircular canals. Suddenly I found myself trembling in excitement. My conjecture was correct. There were only three semicircular canals in his body, while actually there should have been four. The three semicircular canals are at right angles to each other, each representing a single dimension of space. Whenever someone tips in one or the other dimension, the otoliths inside the appropriate semicircular canal would start moving and activate the vestibular nerve which would send the information to the brain immediately. The brain would then send orders to proper muscles and joints to correct the body position. Those who had a disease of semicircular canals would not be able to stand erect properly. Since each semicircular canal represented one dimension, four dimensionals must have four canals, all perpendicular to each other. Three dimensionals like us, of course had only three canals. My reasoning was this. If Rajiv tipped slightly in the fourth dimension and didn't have the fourth semicircular canal representing the fourth dimension of time, the brain wouldn't get the necessary information and he would keep on falling in that dimension. Of course when he started seeing ancient scenario, he realized he was falling and could thus consciously control the fall. But by that time he would have gone quite far back in time and had to come forward in time on his own. This was the reason for his constant trippings in time. One last thing. How could one have four canals perpendicular to one another in ordinary three dimensions? One may wonder, where exactly I expected to see the fourth canal. Well, a four dimensional cube can be projected in three dimensions as a tesseract. What I expected to see was a tesseract of the semicircular canals, but there was none. There were just three semicircular canals. The finding has since been confirmed by dissection of other four-dimensionals. They all show their semicircular canals as a tesseract. They have four mutually perpendicular canals alright, but they show up as a tesseract, in ordinary three dimensions. This unexpected discovery gave me much satisfaction in itself. But the thing that surprised me most was to find my name in the Padma Shree winners of next year. *** This story was Published in July 1988 issue of 2001 (Science Today) on centerfold page under the title Time and Again - Dr. Anil Aggrawal The man had been dead for five days! At least that is what the forensic pathologist Dr. Chandra would have everyone believe. The body was in an advanced state of putrefaction and there were maggots over the body. Every pathologist knows that flies lay eggs in and around natural orifices of the dead body a little after about 3 days and maggots hatch in another two days. So if a body is found full of maggots, it must be dead five days before. All evidence pointed towards Papi Singh as the killer. He and Bachan Singh, the dead man had been sworn enemies. They both ran rival gambling dens and when two months back Bachan Singh spat over Papi Singh after a drunken brawl, Papi Singh had sworn to get even with him. Everybody knew about that. The body of Bachan Singh was found of the night of 27th May. That put the time of death round about the night of 22nd May. Throughout the proceedings Papi Singh kept asserting he hadn't killed Bachan Singh. Some of his cronies swore they had seen Bachan Singh roaming around on the night of 23rd May with a lady of ill repute but nobody believed them. In fact nobody could think of suspecting Dr. Chandra's judgement. But the defence lawyer Basu was a shrewd man. He was a man of multiple interests and had his fingers in several pies. He studied the autopsy report in great detail and found that the main reason for Dr Chandra's judgement was the presence of maggots on the body. All the putrefactive changes plus the maggots put the time of death as five days, but the same changes minus the maggots put the time of death as merely three days and put the date of death as the night of 24th May. That suited his client Papi Singh, as he had left for Chandigarh on 24th morning by train making his alibi watertight. Everybody knew about it, and furthermore he had the train tickets to prove that. Papi Singh even had some minor scuffle with the guard of the train, and the guard remembered it. Even he could be called as a witness to say that Papi Singh had indeed made the journey to Chandigarh on the morning of 24th May. This was as good an alibi as could possibly be. In essence, Papi Singh could be saved from the gallows, if it could somehow be proved that Bachan Singh had died just 3 days before and not 5 days before as Dr. Chandra had indicated in his post-mortem report. But from where did the maggots emerge? That was the sixty-four thousand dollar question. The answer began emerging in Basu's mind a few days later. While reading the latest issue of the American Journal of Ornithology he read with interest the report of an Indian ornithologist who had reported finding a new species in India called Passeriformes peculiaris. The females of the species ate small seeds while the males ate eggs of insects. This in itself was not a very startling or amazing finding as the same situation is prevalent in many known species. Male anopheles for instance sucks flower juice while the female anopheles sucks blood. The real amazing find was that if by mistake the female bird swallowed the insect eggs which look very much like the seeds it ate, it would not be able to digest them. It would be able to keep the eggs in its gizzard as long as they did not hatch. But once the maggots hatched, they would start irritating the gizzard, and the bird would be forced to disgorge the maggots immediately. Still more surprisingly, the bird would search for decaying flesh, so that it could get nauseated strong enough and be able to evacuate its gizzard as completely as possible. The female of the species seemed to have a kind of aversion for these maggots, so to say. What Basu decided was this. Bachan Singh was killed on 24th night by someone else, and his body thrown away in the open. As the species Passeriformes peculiaris was rather abundant in the region where the body was found, some birds, which had earlier ingested the insect eggs accidentally, disgorged some of the maggots on the decaying flesh. In other words flies never laid eggs on the corpse. Quite simply, the body had not been dead long enough for that to happen. Maggots were directly disgorged upon it by the female Passeriformes peculiaris, and that put the time of death as just 3 days. Maggots were in fact only artifacts. But in the court everybody laughed at this outlandish conjecture. New reports had to be taken with a pinch of salt, they said. However the defence kept harping on the authenticity and reputation of the journal. Finally the judge appointed a committee of ornithologists, entomologists and forensic experts to look into the issue and give its report. The main task of course was to look into whether such a bird really disgorges maggots on decaying flesh or not. And when finally the report came after a month, it acquitted Papi Singh. It said laconically, "The girly bird retches the worm!" *** This story was published in Published in Spandan (Maulana Azad Medical College's Magazine) 1990-91 on Page 8 - Dr. Anil Aggrawal AIDS had struck planet Akashgriha too! It was AD 2073. Man had colonized about 500 odd planets of the Milky Way and more than 200 planets belonging to other galaxies of the universe. Planet Akashgriha was one of the farthest planets man had colonized. It was at a distance of 15 million light-years, located in a galaxy named Doosra Akash. Such a large distance meant that light with its fantastic velocity of about 2 lakh kilometres per second would have taken about 15 million years to reach that galaxy! Population on earth had increased beyond all projections. In late 1990s, the world population was increasing at a rate of 170 people a minute. According to these figures, scientists in 1990s calculated that the world population would reach about 12.5 billion in AD 2050. But the population increased much beyond those levels, thanks to the advent of interplanetary travel and colonization. In AD 2050, the total number of human beings anywhere in the universe were a staggering 125 billion! Of these, less than 4 billion were living on earth, meaning thereby that there were lesser number of human beings on earth in AD 2050, than there were in AD 1990! No scientist in 1990s could have imagined that. Effective antibiotics for AIDS had been discovered by an Indian scientist Dr. Shekhar in AD 2001. It had rightly been named Amrit Jal. Mankind on earth was free from AIDS by AD 2010. No one going to other planets used to carry Amrit Jal with him, because it was considered a useless accompaniment. But now the denizens of Akashgriha were in real trouble. They had no supply of Amrit Jal and AIDS was spreading fast on their planet. The disease must have entered the planet through interplanetary human travellers from other planets, where the disease was not yet extinct. An emergency message was sent to earth. Urgent supplies of Amrit Jal were requested on an urgent basis. The authorities on earth acted fast. There was one problem though. How to trasport Amrit Jal to Akashgriha? The enormous distance of that planet meant that even light at its fantastic speed would take 15 million years to reach that planet. Will this remedy be of any use at that time? Of course there was a way out. The medicine would be sent through the same route, through which humans had gone there to colonize those planets - through Black Holes. As we all know, Black holes are supercompressed stars, which distort the time and space around them to an unimaginable degree. If someone could enter a black hole and somehow manage to keep him intact, he would enter the so-called 4th dimension. Thus his travelling distance would be greatly shortened. An analogy could perhaps make things easier to understand. Cosider an ant resting of a big piece of paper, who wants to travel to the other side of the paper. The only way it can do so is to travel to the edge of the paper first and then travel all the way back to where it was stationed, but on the opposite side of the paper. All this involves useless travel. If the ant could somehow pierce the paper, which is equivalent to travelling in the 3rd dimension, it would not have to take all that useless journey. All it would do would be to pierce the paper and voilà, it would be on to its destination! Amrit Jal was sent to Akashgriha through the Black hole Maha Chakra, which was stationed just on the fringe of Milky Way. The inhabitants of Akashgriha were very grateful to earth and its authorities. However to the astonishment of all, the antibiotic failed to work. No matter how much antibiotic was given to the patient, it would have no effect on the virus. Nobody knew why the antibiotic was not working. All communications with earth, failed to find an answer. The batch was fresh, and had been tested in the laboratory on lab-cultivated viruses, before being dispatched to Akashgriha. Dr. Ghosh, who was in-charge of the whole operation contacted Tarun, the space chemist, to solve this riddle. Tarun heard the whole problem patiently, and then tested the antibiotic in his lab. Finally he smiled as he seemed to have found an answer. "Dr. Ghosh, a strange thing has happened during the transportation of Amrit Jal to this planet. We should have guessed it earlier actually. We transported the antibiotic through the black hole-isn't it? When you enter into a black hole you enter the forth dimension, right. Now when a particular thing is stationed in four dimensions, it can accidentally take a turn in the forth dimension and become a mirror image of itself. It is just as if you flipped an 8-anna coin on your table, so that it shows tails instead of heads. It is surely the same coin, but it shows a differet face to you. You could flip it back anytime. But imagine what would happen if you were prevented to flip it back. It would be an entirely new coin. A shopkeeper who has only seen the "heads" surface of the coin, may refuse to accept it when he sees a new surface - the "tails". Something similar has happened to Amrit Jal. It is a giant molecule, having more than 10,000 atoms of various kinds. It has its own 3-dimensional structure. When it is stationed in a 3-dimensional world, no matter how you rotate it, it remains the same molecule, because it can be rotated back to its original configuration. While it was being transported through the black hole, it made an accidental turn in the forth dimension. When it landed on our planet, it was in its new configuration. Since it is now in a 3-dimensional world again, it can not flip itself back to regain its original configuration. The result is that it is an entirely new molecule now, with entirely new physical and chemical properties. That is why it has failed to act against the AIDS virus." "Ingenious!", said Dr. Ghosh, " but what do we do now"? "I will have it sent to my space lab, orbiting round this planet. It is very close to a mini-black hole. We are actually using that mini-black hole to investigate the various properties of the forth dimension. The drug would be recycled through that mini-black hole. Once the antibiotic is in the mini-black hole, we will instruct our computer to give it a command to flip it back to its original configuration. That way when the drug emerges from the black hole, it should be its original self." Sure enough, the trick worked and the antibiotic started working on AIDS patients as effectively as it was supposed to. To prevent the recurrence of such an occurrence later on, Dr. Ghosh advised the authorities on earth to put this label on all future batches of the drug. " Warning! Transport carefully, if using a black hole as a short-cut to destination. The drug may alter during travel in the forth dimension. Preferably check for chemical properties at the destination. The authorities on earth assume no responsibility for damage, if the drug is accidentally altered during transportation due to carelessness." *** This story was originally published in Hindi as Black Hole ke us paar in the newspaper Aaj on 3 February 1996 on page 12 - Dr. Anil Aggrawal The man had been drowned for five days! At least that is what Dr. Khanna made me believe. Dr. Sunil Khanna as we all know is a leading forensic expert of our country and his opinion had to be respected. Well! before proceeding further, I shall explain what forensic experts are. They are doctors who, among other things, cut up dead bodies and try to find out the cause and manner of death. After we completed our graduation in medicine, we decided to devote our energies to the detection of crime, rather than to the routine, drab, utterly boring checking of festering sores, furred tongues, missed heart-beats, aberrant pulse rates and bizarre temperature patterns. Coming back to our case. The man was ultimately identified as one Ramlal. When the police made investigations, they came up with some rather dubious evidence that Ramlal had been killed by Jagga and then thrown in the Indian Ocean, off the coast of Gujrat. It is well-known that in our country, criminals often kill their victims and then do dispose of the body by throwing it in this manner in deep ocean, river, lake or pond or some such similar body of water where it would be difficult to retrieve the body for quite some time. But it so happened that I personally knew Jagga and was quite convinced that Jagga could not kill anybody. I talked to Jagga, and after talking to him, I became all the more convinced that Jagga was not the killer. When I talked to Jagga, he categorically denied his hand in Ramlal's killing. He requested me to save him from the clutches of the law. Well then, if Ramlal had not been killed by Jagga, how had he died. I surmised that Ramlal must have gone to the sea shore for a bath and then must have been carried away by the tidal waves. He thus drowned accidentally. But I was told that Ramlal was an accomplished swimmer. If this was true how could he drown accidentally? Well, even accomplished swimmers have been known to drown in sea water. The tidal waves are really very strong, and can carry the person deep inside the ocean in no time. Before the person has time to think, he finds himself deep inside in the sea. The waves are so forceful that they do not allow him to swim back to the shore. The person gets exhausted and ultimately drowns. This is what should have happened to Ramlal. But the law wants solid proof. The courts do not pay attention to mere conjectures. If I wanted to save Jagga, I had to produce some real good scientific evidence in favour of my theory of accidental drowning. The police was bent upon implicating Jagga. They had even requested the court and taken him in police remand for a period of 15 days. I had to do something fast. I consulted Dr. Khanna and he suggested me that our question basically boiled down to proving that Ramlal's drowning was a case of antemortem drowning. If the police version was correct, then Ramlal's drowning was a case of post-mortem drowning. Before proceeding further, I must tell you a little bit about ante-mortem drowning and post-mortem drowning, in case you are unaware of it. This is an age old question in forensic medicine and one for which no satisfactory answer has been found yet. Basically ante-mortem drowning means that the person drowned when he was still alive. Post-mortem drowning on the other hand, means that the person was first killed by someone and then thrown in water to conceal crime. While post-mortem drowning almost certainly points to homicide, ante-mortem drowning could be anything; accidental, suicidal or homicidal, roughly in that order. It is rather difficult for someone to drown a conscious adult person with homicidal intent, so on the face of it, a case of ante-mortem drowning goes against homicidal drowning. I had to do an autopsy on the dead body of Ramlal and find out the cause and manner of his death. Now if I could prove that it was a case of antemortem drowning, it would go in favour of my theory that Ramlal had died accidentally while taking a swim. If on the other hand the autopsy showed it to be a case of post-mortem drowning, it would be a very strong evidence in favour of the police theory that Jagga had done him to death and then thrown away the dead body in the ocean. Of course we forensic scientists know that one of the best ways to differentiate between ante-mortem and post-mortem drowning is to conduct the so-called diatom test. I won't bother you with details, but just give you the outline of the principle of this test so that you could follow the story better. In all bodies of water- in rivers, lakes, ponds, oceans, even in tap water- are present some minute microscopic unicellular organisms called diatoms. These are microscopic algae with hard and highly refractile silicon shells. They come in all kinds of shapes; in fact about 15,000 different species are known. Under the microscope they all appear very beautiful and symmetrical, presenting rather a kaleidoscopic picture. Diatoms are quite abundant. A mere c.c. of water would contain literally thousands of diatoms. Now if a man drowns while he is still alive, he would make violent efforts to respire. Water would enter his respiratory passages along with respiratory air, and would reach the alveoli, the fine balloon like terminals of the lungs. Sure enough diatoms would also reach the alveoli along with the water. Due to the violent respiratory efforts, some of the alveoli would get ruptured causing the water (and the diatoms along with it) to be sucked in the tiny blood vessels lining the alveoli. From here they would find their way to the left chamber of the heart and from there the aorta would pump this water (and the diatoms along with it) to all the conceivable organs of the body- liver, spleen, brain, bone marrow, everywhere. In case the person was thrown in the water when he was already dead, neither his lungs, nor his heart would be functioning. Thus in the first place almost no diatoms would enter the lungs. If due to sheer pressure of water, some diatoms did enter the lungs, they would not be able to penetrate the alveolar wall. Further, for the sake of argument if we assume that the water pressure was enough to break some of the alveoli, and some diatoms did enter the alveolar blood vessels, they couldn't be pumped to all the systemic organs for the simple reason that the heart would not be beating. Thus a simple test to prove a case of antemortem or postmortem drowning was simply to look for diatoms in some internal organ, say liver or spleen or brain. If you found diatoms there, it was a case of antemortem drowning; if you didn't find any, it was of course a case of postmortem drowning. When I conducted a post mortem on the body of Ramlal, I found all his internal body organs literally infested with diatoms. Diatoms were to be found everywhere- in his liver, spleen, brain, bone-marrow, everywhere. This naturally made me very jubilant, as this proved beyond doubt that my theory was correct and Ramlal had indeed died while he was alive. But when I contacted Dr. Khanna with these findings, he seemed doubtful. He reminded me that the diatom test was in fact challengeable. Well, I will digress for a moment and tell you why he said so. It so happens that the diatoms are rather ubiquitous; they are present in all bodies of water- even in the tap water as I have already said. Now imagine a situation when a person has been drinking tap water all his life. Suppose he has an ulcer in his stomach (or for that matter, even some minor abrasion anywhere in his gastrointestinal tract) the diatoms would be entering his circulation all his life and be pumped throughout his internal organs. The internal organs of such a person would show diatoms irrespective of the cause of his death. Such a person might die of, say, electrocution and yet his internal body organs would show diatoms. Dr. Khanna rightly told me that my findings could be challenged by a well-informed prosecution. I could see his point, especially as I knew the prosecution was taking the help of Dr. George Paul, another well-known medico-legal expert of our country. Certainly Dr. George Paul, when called to the court would rip my theory apart. What should I do then? This question gave me many restless moments. Then like a flash of lightning, a possible solution crossed my mind. I recalled that a few days back, there had been a big oil spill off the coast of Gujrat. A big oil tanker had been bringing crude petroleum somewhere from the Gulf, when just off the coast of Gujrat, a crack appeared on the bottom of the tanker and many thousand tonnes of crude oil leaked into the sea. This incident had been the talk of several environmentalists, especially as this was causing threat to marine life. Well, if there was crude oil in the sea water, and if Ramlal was breathing at the time of immersion (as I believed), then some petroleum must have seeped into his circulation, through the same route as the diatoms would normally take in a breathing man. This would result in traces of petroleum being present in his internal body organs. If I found traces of petroleum in, say, liver or spleen, I could prove my point beyond doubt. In that case, Dr. George Paul was definitely going to have a hard time explaining how it reached there, otherwise than what I was suggesting. We all know that petroleum is not a normal constituent of the body and no sane person drinks petroleum, so indeed there was no conceivable way for the petroleum to reach the internal body organs other than through ante-mortem drowning. This naturally made me very jubilant, and I used our newly acquired Gas-Liquid Chromatograph to determine petroleum in Ramlal's body organs. But contrary to my expectations, Ramlal's internal body organs failed to show any trace of petroleum. What had gone wrong? Well, Dr. Khanna suggested that may be I was wrong from the very beginning. Ramlal was indeed killed by Jagga first and then thrown in sea water. Otherwise why didn't I find petroleum in Ramlal's internal organs? Failure to find petroleum there meant only one thing- that Ramlal was not respiring at the time of his immersion in water. But I refused to believe Dr. Khanna. Something deep inside my heart told me that Jagga was innocent. But if he was innocent why was I not getting any traces of petroleum in Ramlal's internal body organs? That was the sixty-four thousand dollar question. Soon I forgot the question anyway. Meanwhile Dr. Khanna and I jointly started an ICMR project in which we intended to find out the etiology of solvent abuse or glue sniffing. It is a poorly understood phenomenon, in which the addict gets an inordinate pleasure in sniffing various hydrocarbons. Most commonly sniffed substances include various glues, paint thinners, gasoline, chloroform, carbon tetrachloride and so on. We were trying to find a biological cause for this phenomenon. It so happened that one day I was talking casually to Dr. S.K.Gupta, Professor of Biochemistry in our college. He was working on some new cellular enzymes, and his work was being internationally appreciated. While talking to him, suddenly a weird thought crossed my mind, and I ran back to my department, silently crying "Eureka", much in Archimedean fashion. Thank God I had my clothes on! I retrieved some of Ramlal's tissues I still had in bottles, and brought them back to Dr. Gupta. I asked him to look for a specific cellular enzyme, which had not been discovered till then. Dr. Gupta, as is his wont, told me I was a fool, but I let that pass, and asked him to look for that enzyme anyway. But after a few days, Dr. Gupta was quite surprised that I was right. He could indeed find the enzyme I had asked him to look for. In fact he reported that the cells were very rich in that enzyme. I know you are getting curious. What was that enzyme, you may ask. You will laugh at what I will tell you, but you can confirm it from Dr. Gupta who has lab reports to confirm my statement. In fact even he would not have believed me, had he not found the enzyme himself. This was an entirely new enzyme. An enzyme which metabolizes hydrocarbons! Dr. Gupta suggested that we should call it Petroleum dehydrogenase. Dr. Gupta found 50 microgrammes of Petroleum dehydrogenase per c.c. of tissue, which is quite high as you can understand. A minor mutation in Ramlal's body gave rise to that enzyme. He was a mutant in other words. Well, how does this fact fit in our story. I will tell you shortly. But first things first. While talking to Dr. Gupta, I was subconsciously working on my own multifarious problems and suddenly it occurred to me that the solution to my problems lay in the realm of biochemistry. Perhaps Ramlal had an enzyme in his tissues which metabolized any petroleum that had seeped in his body cells during drowning. Now we were indeed able to find that enzyme in Ramlal's body cells. This changed our investigation much in our favour. I will tell you what happened. Ramlal was indeed breathing at the time of immersion. Some petroleum did seep inside his circulation and got deposited in his internal organs as explained earlier. Molecular death, as we all know occurs a few hours after the somatic death. Somatic death is the time when a doctor pronounces a person dead. But we all know that molecular activity continues for a few hours after that. During the interval between the somatic and the molecular death, the enzyme Petroleum dehydrogenase metabolized any traces of petroleum that had seeped in Ramlal's body tissues. That was the reason why we did not find any traces of petroleum in Ramlal's body despite the fact that he died while still breathing. You might say this is spurious reasoning. It is quite possible that there was no petroleum in Ramlal's tissues in the first place. Merely the fact that the enzyme Petroleum dehydrogenase had been discovered in Ramlal's tissues does not necessarily mean that this was responsible for the absence of crude petroleum in his tissues. This was certainly one of the possibilities but the possibility of crude petroleum being absent in Ramlal's tissues from the very beginning could not be ruled out. I knew if confronted with my new findings, Dr. George Paul would certainly come up with this question. So I decided to play one up on him from the very beginning. I took out Ramlal's preserved tissues once again, and looked for the metabolites of Petroleum in them. I had worked out its metabolites in detail, and one of them was 2-Butyne. In my renewed analysis with my Gas-Liquid Chromatograph, I looked not for petroleum but for its metabolites, mainly 2-Butyne. You can perhaps imagine my joy when I found fairly rich quantities of 2-Butyne in Ramlal's tissues. Earlier when I was not specifically looking for it, I met with failure, but now I knew what I had to look for and sure enough I got it. All of us know that 2-Butyne is not a normal constituent of body cells. Thus the only way it could have accumulated in the tissues is through metabolism of crude petroleum by the enzyme Petroleum dehydrogenase. This was the final vindication of my theory. Of course if Ramlal had survived longer, even 2-Butyne would have got metabolized further to carbon dioxide and water. Petroleum dehydrogenase was capable of metabolizing all hydrocarbons down to their very basic elements. I knew I had killed two birds with one stone. I enquired from his family members and was quite satisfied to find out that Ramlal was a glue sniffer. In fact I was quite sure of this fact when I was submitting his tissues to Dr. Gupta. I will tell you now what happens in a glue sniffer. These glue sniffers are all mutants. They have the enzyme Petroleum dehydrogenase in their body cells. Petroleum dehydrogenase is able to metabolize not only petroleum products but all hydrocarbons, liberating a good amount of energy in the process. These glue sniffers sometime during the course of their life discover accidentally that sniffing hydrocarbons gives them a renewed sense of well-being. What actually happens is that they are able to metabolize the hydrocarbons quite effectively which gives them short bursts of energy, which they construe as a sense of rejuvenation or well-being. They ultimately get addicted to the hydrocarbons. So now Dr. Khanna and I had hit upon an entirely new and novel theory of glue-sniffing. Initially Dr. Khanna was quite hesitant about accepting it, but I am happy to tell you that since my fateful meeting with Dr. Gupta, I have submitted blood samples of more than 50 glue sniffers to Dr. Gupta and he has found Petroleum dehydrogenase in all of them, which is a good confirmation of my theory! Thanks to Ramlal's death mystery, we found out a solution to an age old forensic question. Oh, yes, I must also tell you that the court admitted my findings and released Jagga. But the thing that satisfied me most, was that when Dr. Khanna read our paper on glue sniffing at The International Conference on Drug Addiction at Tokyo next year, it was adjudged the best paper of the conference! *** This story was published in Spandan, 1995-96 on Pages 13-17 - Dr. Anil Aggrawal When I was called at Sarita's house, she was already dead! To be sure I didn't expect anything better. They don't call forensic pathologists when people are still alive. The very fact they had called me, meant that someone had died. That's in our fate you see. Sometimes I take perverse pleasure in describing myself as one who is called in when all doctors have failed! As you can plainly see I do not have any wrong intentions, but the people tend to get misguided somehow. Whenever I say this, I get appreciative glances from everyone around. I frankly do not know what they make of my statement. Although I love forensic pathology, and would love to fiddle around with dead bodies, some forensic pathologists do want to shed off the image of the "doctors of the dead", and want to do some clinical work. Not that forensic medicine does not provide a scope for this. In fact there is enough scope for this. For instance there is a whole lot of toxicology, which we can dabble with. We can treat patients suffering from poisons, and can devise new treatments for them. But as I told you earlier, I would rather fiddle around with dead bodies. I love dissection you see. I want to see the intricacies of the human body, and no one can do that better than a forensic pathologist- or perhaps an anatomist. But Dr. Sunil Khanna, professor of forensic medicine in our department does not share my views. He is constantly seeking to excel in the clinical sciences. He has several patents to his credit, and his recent research concentrates on finding an effective treatment of some poisonings, especially poisonings by asphyxiants such as carbon monoxide. In fact he has contacted me several times with a request to start a joint project on this, but I have always declined it, as I have no aptitude for clinical work at all. But of course I am taking interest in his work and am aware of all the developments he is making. But coming back to our case. The moment I reached the spot, I was inundated with the usual questions. How had she died.... who killed her.... was her death suicidal or homicidal and so on and so forth. Let me tell you a few details about Sarita. She had married only a year ago. Her husband Ramesh was a petty clerk in a private company, but they were carrying on very well. Of course there was a dowry problem in the family in the beginning, but everything had settled by now, and apparently the couple was living together in good harmony. But the police would have nothing of this. They cooked up a theory that Sarita had been burnt by her in-laws. To be sure they were in a kind of bind. According to recent legal amendments, if a bride dies within 7 years of marriage, the case has to be registered as a murder. To the legally minded, I may add that the relevant section is 304B of Indian Penal Code, and it is entitled "Dowry Death". It was introduced as an amendment in 1986 when dowry death cases had increased to enormous proportions. In all such cases the presumption is that the husband or some of his relative has murdered the bride, and the onus of proving himself innocent lies on the husband or his relative. This is a lot tougher situation than the normal. Normally a person is deemed to be innocent and the prosecution has to prove otherwise. When the presumption is the other way round and you have to prove yourself innocent, things become lot tougher. This was the situation in which Ramesh and his family found themselves. It so happened that I personally knew Ramesh. I also knew that there had been some minor dowry problem in the house, but it had settled. In any case, I was not prepared to believe that he or any of his relatives could go to the extent of killing Sarita for bringing insufficient dowry. Of course there are people who do it, but Ramesh definitely was not among them. I talked to Ramesh in isolation, and took him in confidence. He told me that Sarita was rather a sentimental girl. She used to get depressed very soon. Recently the results of her MA exams had been declared and she had failed miserably. She used to remain too depressed after that and that was perhaps the reason she had burnt herself. Sounded like a fair reason to me. Sentimental people often do take their lives for petty reasons. I am personally aware of several youngsters who have committed suicide when they could not get admission to a medical or an engineering college. But there was a snag. Such people often leave a suicide note, and in Sarita's case, no suicide note had been found. I asked about this from Ramesh and he couldn't explain about it to me either. Well, I let it leave at that. Although suicide notes are usually found in suicidal deaths, they are not invariably found in all suicide cases. In any case, I made up my mind to defend Ramesh. When I examined the scene of death, it did not appear to be too disturbed to me. You see, things like turned up chairs, fallen flower pots, rumpled up bedsheets and so on. Such a set up often points to violent struggle having taken place soon before death, which in turn could strongly point to homicide. Since the scene was too "clean", I made up my mind that it indeed had to be taken as a case of suicide. Of course there are snags to this too. Murderers can set up a scene after having committed a murder. They can place everything back in order so that no one gets other ideas. But in such cases, I can often read it in murderer's faces. This is due to my long experience you see. I could see none of that in Ramesh or his family member's faces. But you would surely agree, I couldn't defend Ramesh in a court of law on hunches. I had to produce sound scientific evidence to be produced in court. But what was it going to be? I must admit, I had no idea of that at that point in time. Fortunately for me (and my case), the police had formed a rather weird theory of murder. They asserted that Sarita had first been killed by Ramesh and her family members by some means, such as gagging and then had been burnt by them, to give it the color of suicidal burning. Normally of course bride burnings occur when the bride is still alive. The traditional theory is that the mother-in-law comes surreptitiously from behind, pours kerosene on the hapless girl, and then someone lights a match. You might tend to believe that the police was foolish in building up this theory in the first place, but I wouldn't blame them. Sarita had died at about 11 am on Sunday, when every one is up and about. If they had developed a theory of traditional bride burning, some of their neighbors would of course had heard her cries, and other sounds of scuffle, but no one had heard such sounds. Indeed this was another factor which helped convince me towards a suicidal theory. Since no one had heard her cries, the police were a lot better off theorizing that Sarita was already dead when she was burnt. How could any forensic pathologist prove or disprove police theory? Gagging as we all know, doesn't leave any remarkable tell-tale signs of its own, especially when the gagging cloth has been removed from the mouth, and the body has been burnt subsequently. So an autopsy was not likely to prove with any conviction that the death had occurred because of gagging. In such circumstances, the only way the police theory could be proved was by showing that Sarita's was a case of post-mortem burning. On the contrary, if Ramesh and his family members' theory of suicide was correct, then Sarita's was a case of antemortem burning. So basically the question boiled down to this: Was this a case of antemortem or postmortem burning? I wouldn't bother you with details, but in a single line would tell you what these dreadful terms mean. An antemortem burning refers to a case of burning when the person was still alive, while postmortem burning refers to a case where the person was already dead when his body caught fire. While post-mortem burning almost certainly points to homicide, a case of ante-mortem burning could be anything- accidental, suicidal or homicidal- roughly in that order. There are some very clever ways to differentiate antemortem from postmortem burning. One of them - and one on which I rely heavily - is the finding of carboxyhemoglobin in the blood. During burning of any carbonaceous object, especially if the burning has taken place in closed surroundings, lot of carbon monoxide is produced. If the victim was alive at the time of burning he would be respiring and would invariably inhale some of the carbon monoxide (or CO for short). CO binds very strongly to hemoglobin to form carboxyhemoglobin. This bond is almost 200 times stronger than that made with oxygen. Because of this, carboxyhemoglobin does not "break up" even after death and can be detected by forensic pathologists. On the contrary, if the victim was already dead at the time of burning, he wouldn't be respiring and would thus not inhale any carbon monoxide. What does this piece of information lead us to? Simple. Do an analysis of the blood of the victim, and try to find out if there are appreciable amounts of carbon monoxide in his blood or not. By "appreciable amounts", I mean about 15-20% or more. People living in cities do tend to have small amounts of carbon monoxide in their blood anyway. With the vehicular pollution showing a steady rise - outdoing even our national economic growth rate- we couldn't expect anything better. Cities like Delhi would beat Hitler's gas chambers hands down any day. But I am straying away from the main line again. Let us come back to it. I brought Sarita's body to my mortuary, took some blood from her iliac vessels and got down to work straightaway. I almost certainly expected to find carboxyhemoglobin in her blood, but try hard as I would, I couldn't find even traces of it. I tried again, with more sophisticated methods, with spectrophotometer, with everything else I could lay my hands on, but try hard as I would, I couldn't find any carboxyhemoglobin. As you can imagine, this had grave repercussions for Ramesh and his family. Not finding carboxyhemoglobin in Sarita's blood could only mean one thing- that she was already dead at the time of burning. And that raised a very strong accusing finger towards Ramesh and his family. To tell you the truth, the finding did send me in a bout of confusion. I tried hard to explain the absence of carboxyhemoglobin but couldn't, except assuming that she was already dead at the time of burning. If I assumed her to be alive at the time of burning, there was no way I could explain the absence of carboxyhemoglobin. I was sitting confused in my anteroom thinking over the problem while the body lay in the mortuary. At five O' clock, the attendant came and informed me that he was leaving. I told that I would shut the department and asked him to leave. I came home and continued racking my brains over the problem. The next day was a public holiday and then there was a Sunday. After that a public holiday once again, made a continuous break of three days. It was only on the morning of the fourth day- the day when I was to go to the department once again- that I realized that I had left Sarita's body on the mortuary table itself! I should have transported the dead body to the cold room before leaving the mortuary. The mortuary attendants always do that. But on that Friday evening, I had stayed in the mortuary longer than usual; the mortuary attendant had left and I had promised him that I would do the needful before leaving the department. But I am not used to closing the mortuary. Coupled with this was the fact that I was quite puzzled that evening. That was the reason, I forgot to put back Sarita's dead body in the cold room. It was horrifying to even think of the consequences. The body would be badly putrefied now. In this summer heat, three days could play havoc with a dead body. At best, it would be a swollen, greenish-black putrid and badly smelling mass of organic matter. Of course things could be a lot worse. There could be maggots crawling all over the body for instance. What worried me was not the bad state of the body I would be confronted with, but that the putrefaction would blot out all medical evidence pointing to the mystery of her death. There was absolutely no hope of unearthing any more useful evidence now. With the worst fears in my mind, I opened the door of the mortuary, and expected a strong gush of revolting smell to hit my nose. I was mentally prepared for it. But nothing of that sort happened. I looked at the table where I had left Sarita's body, and was nonplussed to see the body there with almost no putrefactive change! Now I do believe in wonders, but not in wonders of this sort. I mean the ones, which defy logic and science. Sarita's body was lying there out in the open on the mortuary table and had not putrefied in the least! This was a wonder I could not believe. Something extraordinary had happened. But what could have happened? I started thinking about the problem, but couldn't come to an answer. Finally I took some of her muscle tissue and took it to Dr. S.K. Gupta, professor of biochemistry in our own college. Everybody knows he is a genius, and I personally believe he is made of Noble Prize stuff. In fact it is a mystery to me why he has not been able to get it till now. Well let us not digress from the main point. I submitted the tissue to him, and asked him to look for anything abnormal. I was a little surprised when two days later, he told me he had found abnormally high amounts of formaldehyde in the tissues. In fact so high was the amount that he asked me if I had preserved the body in formalin. I surely hadn't, but perhaps Jamman Singh, the attendant who left the mortuary on that Friday evening had done it before leaving. That was perhaps the reason, the body had not putrefied. I went to Jamman Singh and asked if he had sprinkled formalin over the dead body before leaving, but he informed me he hadn't done so. Why would he do so, when we have an excellent facility of a cold room? This confused me a lot more- and I had one more problem on my hands- to explain the presence of formalin in Sarita's body. Sarita surely hadn't ingested formalin. She had no access to it, and it couldn't have been given to her by Ramesh and his family members as a homicidal poison. Formalin has a strong smell and a very acrid taste, and because of these properties, it is a very poor homicidal poison. All homicidal poisons must be tasteless and odorless. If you tried to kill me by putting formalin in my milk, I would know somebody had put something in it and I wouldn't drink it. Of course I would do so, if you put arsenic trioxide in it, because it is colorless, odorless and tasteless. So if you wanted to kill me you would be much better off with arsenic trioxide than with formalin. The problem before me was how formalin reached her tissues. I thought for the problem for a few hours, and then a possible solution flashed in my brain, like the stroke of a lightning. Well, the train of my reasoning was this. There should have been carbon monoxide in Sarita's blood and muscles, but it wasn't there. And there should have been no formalin in her muscles, but it was there. Was it possible that carbon monoxide in her body had somehow converted to formaldehyde? Well, chemically it is not impossible. Formaldehyde is chemically HCHO, while carbon monoxide is CO. Plainly and simply, if CO can combine with water - which is quite abundant in human body- it can extract two hydrogen atoms from there and get converted to HCHO, while releasing the single oxygen atom free. Theoretically it is possible, but can it occur actually? I am no chemist, and surely I did not know the answer to this. To find the solution to this, I had to see no farther than my own home. My wife is a professor of chemistry (besides being a great cook, just in case you are reading it), and one fine day when I returned from college, the first thing I asked her was if that was possible. You can do that, she told me, but it is not simple. You have to have high temperatures and pressures and costly catalysts. Trickier is the situation in a human body- dead or living- where you have no catalysts, no high temperatures, no high pressures and so on. Why don't we have catalysts in the body, I asked her. Catalysts are not merely the domain of chemists. We do have our own catalysts. They are the various enzymes in the blood and in the body cells. And they can do seemingly impossible jobs. Like burning glucose so slowly and deftly that the body does not get burnt. Instead a fairly equable temperature is maintained. Is there any catalyst with the chemists which could even come anywhere near it? Of course she did not have to answer that, because she had gone to the kitchen to make a cup of tea for me, but her statement had already set me thinking. I couldn't kid myself with the weird notion, that an enzyme existed in human body which could convert carbon monoxide to formaldehyde, but what I came up with was the thought that perhaps Sarita was a mutant and such an enzyme existed in her body. Now why would such an enzyme creep up in the human body, you may ask. We all know that mutations do keep occurring in our bodies constantly, and they can lead to the formation of new proteins and enzymes. That is how evolution has occurred. Most mutations are of course deleterious to the body, but some are quite useful. Take for instance the enzyme which could convert carbon monoxide to formaldehyde in a body. Both are poisons, but the body finds it harder to deal with carbon monoxide, especially because it sticks so strongly to hemoglobin. On the contrary, formaldehyde is much easier for the body to tackle. This mutation could be quite helpful to Sarita if she had survived, and perhaps had been doing good to her all her life. It is a built in mechanism to protect you from the carbon monoxide of this increasingly polluting city. But we are again digressing from the main issue. The main point was whether or not Sarita had such an enzyme in her tissues. If I could positively prove that, only then could I simultaneous solve all my problems. In fact, the more I thought about it, the more I got convinced that this indeed was the solution. In science, the best solution is that which simultaneously solves several problems, however weird that may appear in the first instance. And once again I found myself in the lab of Dr. S.K. Gupta, but with a different request this time. He is an expert in cellular enzymes, and if there was one person on earth who could help me, it was he. I asked him to look at the muscle tissues once again and tell me if there was an unusual enzyme in it, especially one which had the property to convert carbon monoxide to formaldehyde. Now Dr. Gupta knows for sure that I am a little soft in the head, but he also knows that I can turn violent, if my genuine hunches are not attended to. They have to be either proved or disproved. So despite thinking that I was turning senile, he preferred to keep quite and got to work. He was in for a surprise. He did find an enzyme next day with exactly the same properties that I had predicted. It could effectively convert carbon monoxide to formaldehyde. He preferred to call it carbon monoxide reductase. He also told me that it was a completely unexpected finding- one that would stun the biochemical world. All my problems were solved now. I now knew that Sarita was a mutant. There was a unique enzyme in her blood, which converted the carbon monoxide of her blood in formalin, and that is why her body was so remarkably preserved. The presence of carbon monoxide in her blood meant that she was alive at the time of burning, and this in turn meant that she had committed suicide. One could of course argue that there was no carbon monoxide in her body from the beginning, but if we assumed that, we could not explain the presence of formaldehyde in her blood and muscles. So we had to assume that there was carbon monoxide in her blood to start with which got converted to formaldehyde. The court accepted my findings and conclusions and set Ramesh and his relatives free. But the biggest surprise was when I found that Dr. Khanna had lapped up my findings and was trying to make an useful drug aimed to treat carbon monoxide poisoning. He got Dr. Gupta to decode the chemical structure of this new enzyme and got him to make samples of it in his laboratory. He is trying to give injections of artificially prepared carbon monoxide reductase to patients of carbon monoxide poisonings and see if it helps them. The initial reports are encouraging. He has published several papers on this. Some have been written with me as a co-author. I wrote some on my own, and some with Dr. Gupta. I am giving you the references for some of the more interesting papers. Interested readers may look for details in the said references. 1. Khanna S.K., Aggrawal Anil. The role of carbon monoxide reductase in carbon monoxide poisonings. Journal of the American Medical Association 1998; 247: 1471-1475 2. Aggrawal Anil, Gupta S.K. The story of the discovery of Carbon monoxide reductase. Medical History 1999; 145: 365-377 I hope these papers would satisfy the curiosity of the more scientific minded people. But I must tell you that the thing that surprised me most was when Dr. Gupta was called by the European Academy of Biochemists to give them a series of lectures on the new enzyme, and Dr. Khanna got a call from the American Medical Association to tell them of his latest developments on the treatment of carbon monoxide poisoning. As for me, I was being burdened with more autopsies! Well, I asked for it!! *** This story was published in Spandan'97 (1996-97) , on Pages 53-57 - Dr. Anil Aggrawal DO YOU HAVE AN INTERESTING TALE TO TELL? E-MAIL ME, AND I WILL PUT YOUR STORY ON THE WEB WITH CREDIT TO YOU. YOU WILL FIND NEW STORIES ON THIS PAGE VERY OFTEN. 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ANIL AGGRAWAL'S PAGE OF FORENSIC QUOTES AND APHORISMS About Myself Hi, I am Professor Anil Aggrawal from India. I am working as a Professor of Forensic Medicine at the Maulana Azad Medical College, New Delhi-110002, India. I love to exchange ideas on Forensic Medicine, Forensic Pathology and Forensic Toxicology. I love quotes. There are all kinds of quotation books available in the market, but unfortunately none caters exclusively to Forensic Quotes. This page is a modest effort to fill this gap. It includes quotes which I have collected during the last 25 years of my experience in Forensic Medicine. It also includes quotes submitted by several of the discerning readers. All contributions by the web surfers have been added with due acknowledgements. I hope to put the collective wisdom of all of us on the net for the benefit of all. After all that is why the God invented the internet, isn't it! So if you remember any of the witty forensic quotes that you heard somewhere, E-mail it to me, and I will put it on the internet with due credits. My E-mail is dr_anil@hotmail.com. All quotes submitted by readers will be put on the web with due credit. Please don't forget to mention the source of the quotes. That will make my work that much easier. If you have enjoyed these pages (or even if you haven't), please be good enough to leave your comments in the guestbook. These are my only rewards. It keeps me on track (your criticisms), and keeps my morale high (your appreciations). Thanks! Guestbook Statistics Our Valued Contributors A B C D E F G H I J K L M N O P Q R S T U V W X Y Z ABORTION I will not aid a woman to produce abortion. - Hippocratic Oath All your better deeds shall be in water writ. - Philaster II, IV (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 88, in Chapter 5 entitled "Abortion and its complications") ACCIDENTS Now and then there is a person born who is so unlucky that he runs into accidents which started out to happen to somebody else. - Don Marquis, archys life of mehitabel AGE ESTIMATION (MEDICOLEGAL ESTIMATION OF AGE) Attempting to estimate the age of a person from the closure of his skull sutures is no less hazardous than doing so from graying of his hair; the only difference is that the former appears more technical! - Anil Aggrawal, Professor of Forensic Medicine, Maulana Azad Medical College, New Delhi, India If the first permanent molar hath not protruded, you can have no hesitation in affirming that the culprit has not passed his seventh year. - A.T. Thomson in his classical paper written as far back as 1836. The full quotation of the paper is "Thomson AT. (1836). Lectures on medical jurisprudence now in course of delivery at London University. Lancet 1:281-286 (This quote is reproduced in "Developmental Juvenile Osteology" by Louise Scheuer and Sue Black, Academic Press 2000 on page 12) ALCOHOL Candy is dandy, but liquor is quicker. - Don Marquis, archys life of mehitabel The trouble with liquor is that one drink makes a new man out of you, and then the new man has to have another drink! - Alvy Moore Not drunk is he who from the floor Can rise alone and still drink more, But drunk is he who prostrate lies Without the power to drink or rise. - Thomas Love Peacock (1785-1866): English novelist and poet A drunkard is like a whiskey bottle; all neck and belly and no head! - Austin O'Malley In vino veritas (in wine there is truth) - Old Roman saying ANAESTHETIC DEATHS There are many minor operations, but no minor anesthesias. - Kenneth Heard (1897-1948) (Quoted in "Historical Medical Classics involving new drugs, by John C. Krantz, Jr. Ph.D. on page 112) Care charming sleep, thou loser of all woes. - Valentinion V (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 79, in Chapter 4 entitled "Respiration". This quote appears at the top of a sub-chapter entitled "Anaesthesia for dental treatment") ANALYSIS AND DEDUCTION I have no data yet. It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories instead of theories to suit facts. - Sherlock Holmes in "A Scandal in Bohemia", when Dr. Watson asks him what he makes of a mysterious note which had just arrived. Whenever you have excluded the impossible, whatever remains, however improbable, must be the truth. - Sir Arthur Conan Doyle (The Adventures of Sherlock Holmes - "The Adventures of the Beryl Coronet" -Quoted on the front page of "An Introduction to Forensic DNA Analysis" by Keith Inman and Norah Rudin) Like all other arts, the Science of Deduction and Analysis is one which can only be acquired through long and patient study. - Sherlock Holmes in Sir Arthur Conan Doyle's "The Book of Life" (Quoted in "Hard Evidence" By David Fisher at page 1) ARSON AND FIRE INVESTIGATION The person who reports finding an arson is usually the person who set the fire. - Contributed by Harold J. Porter, Crown Counsel, Newfoundland, Canada (Address: Harold J. Porter, Department of Justice , Civil Division, 4th Floor , East Block,Confederation Building, St. John's Newfoundland A1B 4J6, TEL 709-729-1179, FAX 709-729-2129. Mr. Porter goes on to add "this is not a well-known maxim, but an accurate one, in my limited experience". The quote was sent on 20 December 1999. To me this quote sounds much like "The murderer always returns to the scene of crime". Visitors to this page are welcome to send relevant comments) Time is an enemy to the fire investigator. - Paul E. Pritzker, P.E. (quoted on page 37 in Chapter 3 written by him on "fire investigation" in the book "Forensic Engineering" by Kenneth L. Carper (CRC Press 1998)) (Pritzker follows up the quote with this explanation: When one is called late to investigate a fire, physical evidence may have been altered or may have deteriorated) Wellington once said that the Battle of Waterloo was won on the playing fields of Eaton. It is important to prepare before arrival at the fire scene! - Paul E. Pritzker, P.E. (quoted on page 35 in Chapter 3 written by him on "fire investigation" in the book "Forensic Engineering" by Kenneth L. Carper (CRC Press 1998)) ASPHYXIA The term "Asphyxia" is a partial misnomer, as many of the conditions described under this heading are not truly asphyxial in nature; the term is both inappropriate and inaccurate. - Bernard Knight (Forensic Pathology, 2nd Edition, page 345) Anoxia begets anoxia. - G.K. Dinker Petechial hemorrhages, congestion and edema, cyanosis, engorgement of the right heart and fluidity of the blood are the obsolete diagnostic quintet of asphyxial deaths. - Lester Adelson ( Quoted by Bernard Knight in his Forensic Pathology, 2nd Edition at page 347) Traumatic asphyxia provides the most extreme demonstration of the classic signs of asphyxia. - Bernard Knight (Forensic Pathology, 2nd Edition, page 358) His face is black and full of blood, His eye balls farther out than when he lived, Staring full ghastly, a strangled man, His hair upreared, his nostrils stretched with struggling, His hands abroad displayed, as one that grasped, And tugged for life, and was by strength subdued. - William Shakespeare I thought I could not breathe in that fine air, That pure severity of perfect light. - Tennyson (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 204) (N.B. Please also look up quotes under "Hanging") ASPHYXIA, AUTOEROTIC Those kids are stupid. They don't know what they're doing. - A 16 year old boy to his mother, who showed him an article about autoerotic deaths in a newspaper (Reproduced from "Practical Homicide Investigation-Tactics, Procedures, and Forensic Techniques", Second Edition, by Vernon J. Geberth, page 278) (N.B. Interestingly, the boy himself was engaged in such activities, and was found dead two weeks later) Vladimir: “What do we do now?” Estragon: “Wait.” Vladimir: “Yes, but while waiting.” Estragon: “What about hanging ourselves?” Vladimir: “Hmm. It’d give us an erection.” Estragon: (highly excited) “An erection! ... Let’s hang ourselves immediately!” - Samuel Beckett, Waiting for Godot (reproduced also at page 10 of "Autoerotic Asphyxiation: Forensic, Medical, and Social Aspects" by Sergey Sheleg and Edwin Ehrlich. Wheatmark, Inc. 2006) ASSAULTS A certain man went down from Jerusalem to Jericho, and fell among thieves, which stripped him of his raiment, and wounded him, and departed, leaving him half dead. - Luke 10:30 (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 109) AUTOPSY The next time I see a doctor, it had better be for an autopsy. - A.J. Duhe, linebacker for the Miami Dolphins, after his fifth knee operation, 1985 (Quoted in "The Autopsy-Medical Practice and Public Policy" by Rolla B. Hill and Robert E. Anderson; Butterworths 1988, page 157) In some autopsy laboratories, the most significant breakthrough during the last 100 years has been the introduction of disposable gloves! - Jan Vincents Johannessen et al. 1979 (Quoted in "The Autopsy-Medical Practice and Public Policy" by Rolla B. Hill and Robert E. Anderson; Butterworths 1988, page 175) There's nothing like an autopsy for prognosis. - Anonymous (Contributed by Dean H. Garrison, Jr., Crime Scene Technician.) Often the autopsy reveals the diseases and lesions that the person lived with, rather than those that killed him! - Anonymous If an autopsy is worth doing at all, it is worth doing right the first time. - LeMoyne Snyder in his book "Homicide Investigation", (Third Edition, May 1977) Published by Charles C. Thomas, Springfield, Illinois, USA, on page 158, in chapter 7 entitled "Homicide due to Gunshot Wounds" A good pathologist holds a knife just like a violinist holds a bow. - Contributed by Dr. Gyan Fernando, Home Office accredited Consultant Forensic Pathologist for Devon & Cornwall Constabulary We have plenty of post-mortem examinations but often these are useless because the history of the case is not known. - J. Kerr Love (1897). Some Modern Aspects of Deaf-Mutism, J. Laryngology, 12, 593 (Quoted in Pathology of the Ear by I. Friedmann, 1974, Blackwell Scientific Publications) (N.B. This short and pithy quote, although more than 100 years old, remains valid even today.) AUTOPSY RISKS There is still not a single documented case of a pathologist or a technician getting AIDS from their professional activities. - Contributed by Dr. Gyan Fernando, Home Office accredited Consultant Forensic Pathologist for Devon & Cornwall Constabulary The fact that I have never caught anything from an autopsy in 25 years of carving in two different parts of the world should put everyone's mind at ease. - Contributed by Dr. Gyan Fernando, Home Office accredited Consultant Forensic Pathologist for Devon & Cornwall Constabulary You are more likely to injure yourself with blunt knives than with sharp ones! - Contributed by Dr. Gyan Fernando, Home Office accredited Consultant Forensic Pathologist for Devon & Cornwall Constabulary BATTERED BABY SYNDROME Spare the rod! - Title of a paper by James E. George of the Emergency Department, Underwood Memorial Hospital, Woodbury, N.J. (U.S.A.) on Battered Baby Syndrome published in Forensic Science, 2 (1973) 129-167 Hark ye, good parents, to my words true and plain, When you are shaking your baby, you could be bruising his brain. So, save the limbs, the brain, even the life of your tot; By shaking him never; never and not. - a quatrain from the paper “On the Theory and Practice of Shaking Infants” published in Amer. J. Dis. Chil,. on page 169. Full reference of the article is this: Caffey, John. On the Theory and Practice of Shaking infants. Amer. J. Dis. Child. August 1972, Vol. 124, no. 2, Pp 161-169 Whiplash-shaking is practiced commonly in a wide variety of ways, under a wide variety of circumstances, by a wide variety of persons, for a wide variety of reasons. - John Caffey of “Caffey’s syndrome” fame in his paper: On the Theory and Practice of Shaking infants. Amer. J. Dis. Child. August 1972, Vol. 124, no. 2, Pp 161-169, on page 161 BLOOD STAINS Out damned spot! Out, I say Here's the smell of the blood still, All the perfumes of Arabia will not Sweeten this little hand. Oh, Oh, Oh! - William Shakespeare Blood though it sleeps a time, yet never dies, The Gods on murtherers fix revengeful eyes. - Dryden (The Cock and the Fox) Any butcher is just as good an expert on that as this witness. - Commonwealth v. Sturtivant (1875) (Quoted in “Scientific and Legal Applications of Bloodstain Pattern Interpretation” Ed. Stuart H. James, page 122) (N.B. A little background above the above quote may be appreciated. In this case, the Massachusetts Supreme Judicial Court addressed the admissibility of blood spatter interpretation and the qualifications of an “expert”. The witness, a chemist accustomed to chemical and microscopic examination of blood and bloodstains, testified for the prosecution as to directionality; i.e., “if the force of a stream of liquid, whatever it may be, and especially blood, be from below upward, the heaviest portion of the drop will stop at the further end of the stain; if from above downward, it will stop below.”. Defence counsel objected to this testimony at trial, stating, “That is pure opinion as to a matter of mechanics, not chemistry. Any butcher is just as good an expert on that as this witness.”) When blood is their argument. - King Henry V, iv, i (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 161, in Chapter 9 entitled “Immunoserology”) (N.B. See also under “Disputed paternity”) BRUISES It is impossible to comment on the age of a bruise less than 24 hours since infliction. - Bernard Knight (Forensic Pathology, 2nd Edition, page 143) It is not practicable to construct an accurate calendar of the color changes of bruises, as was done in older textbooks. - Bernard Knight (Forensic Pathology, 2nd Edition, page 143) If anyone thinks that he can accurately tell you the age of a bruise based on its appearance, he needs to have some serious re-education. - Jo Duflou, in an E-mail to a Forensic Discussion Group on Fri, 27 Oct 2000 NSW Institute of Forensic Medicine BURNS AND SCALDS Traditionally most authors claim that differentiation can be made between an ante-mortem and a post-mortem blister by an analysis for protein and chloride in the fluid; but I have yet to meet a pathologist who does this as a routine! One suspects that the test is another of the apocryphal procedures that have been handed down from textbook to textbook without verification. - Bernard Knight (Forensic Pathology, 2nd Edition, page 310-1) The exposed skin surface may be reddened in both ante-mortem and post-mortem burns; the classical distinction of a "red flare" or "vital reaction" is unsafe as an index of infliction before death. - Bernard Knight (Forensic Pathology, 2nd Edition, page 310) Can a man take fire in his bosom, and his clothes not be burnt? - Proverbs 6:27 (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 178) CAPITAL PUNISHMENT Don’t hang me too high.... for the sake of decency. - Mary Blandy, who murdered her father with arsenic to her executioner in 1775 (quoted in “Murder - Whatdunit” by J.H.H. Gaute and Robin Odell, page 40) CARDIAC AND VASCULAR LESIONS I would not have such a heart in my bosom for the dignity of the whole body. - Anonymous (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 17, in Chapter 3 entitled "Cardiology and Vascular Lesions") CAUSE OF DEATH The causes of death appear, unto our shame, perpetual. - Winter’s Tale (Quoted in “The Pathology of Trauma” 2nd Edition, Edited by J.K.Mason, page 1) Coronary atherosclerois is the Captain of the Men of Death. - Partially modified from a statement in Bernard Knight’s “Forensic Pathology”, 2nd Edition, page 488 Never diagnose two diseases when one will account for all the findings. -A common teaching (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 221, in Chapter 13 entitled “Medico-Legal aspects of Exotic Diseases”) (N.B. This quote comes with an interesting rider. The author goes on to say,”When dealing with patients who have travelled in the less developed parts of the world this rule should be reversed; never be satisfied that you have made a complete diagnosis when you have only found one abnormality.”) CHILD ABUSE Child abuse is the difference between a hand on the bottom and a fist in the face. - Henry Kempe COMPUTERS AND FORENSICS I’ll never write to my mistress using the wife’s PC again! - A Security Manager in a large company who witnessed computer forensic techniques in action (Quoted in “Computer Evidence: A Forensic Investigations Handbook” by Edward Wilding, page 183, on the last page of chapter 6 entitled “The Forensic Examination of PCs”) CRIMINAL INTERROGATION And He said,“Who told thee that thou wast naked? Hast thou eaten of the tree, whereof I commanded thee that thou shouldest not eat?” - Genesis 3:11 (Quoted by LeMoyne Snyder in his book “Homicide Investigation”, (Third Edition, May 1977) Published by Charles C. Thomas, Springfield, Illinois, USA, on page 87, in chapter 6 entitled “Scientific Criminal Interrogation”. This, according to the author, is the earliest example of Criminal Interrogation.) You are going to have to talk to people.. .. talk to people and make them feel like people.. .. you get a lot of results that way.. .. very smooth, very quiet. - E.W.Count, Cop Talk, Pocket Books, 1994 (Quoted in “Criminal Investigation - Basic Perspectives” by Paul B. Weston, Charles Lushbaugh and Kenneth M. Wells, eighth edition, 2000, Prentice Hall, page 134) CUTIS ANSERINA (See Drowning) DACTYLOGRAPHY Fingerprints can not lie, but liars can make fingerprints. - Paraphrase of a Old Proverb “Figures do not lie, but liars can do figures” (Reproduced in the “Journal of Forensic Sciences” Vol 44, No. 5, September 1999, on page 963, at the top of the Paper “A chronological Review of Fingerprint Forgery” by B. Geller et al.) Jekyll’s finger patterns remain the same when he transforms himself into Hyde! - Henry Faulds (1843-1930), one of the founders of the science of dactylography, commenting on the famous story “The Strange case of Dr. Jekyll and Mr. Hyde” by Robert Louis Stevenson, stressing that despite a complete change in appearance, the person could still be caught by the science of dactylography. (Quoted in “Suspect Identities - A History of Fingerprinting and Criminal Identification” by Simon A. Cole, Harvard University press, 2001, Page 3) Every human being carries with him from his cradle to his grave certain physical marks which do not change their character, and by which he can always be identified - and that without shade of doubt or question. These marks are his signature, his physiological autograph, so to speak, and this autograph can not be counterfeited, nor can he disguise it or hide it away, nor can it become illegible by the wear and mutations of time. This signature is not his face - age can change that beyond recognition; it is not his hair, for that can fall out; it is not his height, for duplicates of that exist; it is not his form, for duplicates of that exist also, whereas this signature is this man's very own - there is no duplicate of it among the swarming populations of the globe. This autograph consists of the delicate lines or corrugations with which Nature marks the insides of the hands and the soles of the feet. - Samuel Clemens, writing as Mark Twain, in The Tragedy of Pudd’nhead Wilson, 1894 (Quoted by Colin Beavan, at the beginning of his book “Fingerprints - The origins of crime detection and the murder case that launched forensic science”, Hyperion, New York, 2001 A fingerprint expert can tell apart the marks of two digits more easily than he can differentiate two people’s faces. - Colin Beavan, on page 11 of his book “Fingerprints - The origins of crime detection and the murder case that launched forensic science”, Hyperion, New York, 2001 A person’s fingerprint set is like a biological seal which, one impressed, can never be denied. - Colin Beavan, on page 11 of his book “Fingerprints - The origins of crime detection and the murder case that launched forensic science”, Hyperion, New York, 2001 Fingerprints are like pages from the Recording Angel’s book of deeds. - Colin Beavan, on page 14 of his book “Fingerprints - The origins of crime detection and the murder case that launched forensic science”, Hyperion, New York, 2001 The glands make each finger like a self-inking rubber stamp, leaving calling cards on every surface it touches. - Colin Beavan, on page 14 of his book “Fingerprints - The origins of crime detection and the murder case that launched forensic science”, Hyperion, New York, 2001 But by far the most beautiful and characteristic of all superficial marks are the small furrows, with the intervening ridges and their pores that are disposed in a singularly complex yet regular order on the under surfaces of the hands and feet. - Francis Galton in his lecture “Personal Description and Identification” at the weekly evening meeting of the Royal Institution on May 25, 1888. Quoted by Colin Beavan, in his book “Fingerprints - The origins of crime detection and the murder case that launched forensic science”, Hyperion, New York, 2001, page 105 No scientific basis exists for requiring that a pre-determined minimum number of friction ridge features must be present in two impressions in order to establish a positive identification. - The “Ne’urim Declaration” 1995 (Quoted in “Suspect Identities - A History of Fingerprinting and Criminal Identification” by Simon A. Cole, Harvard University press, 2001, Page 259) I at first had little faith in this expert evidence, but after the experiment conducted by Lieutenant Faurot in the court-room, in the presence of the Court and jury….. when he was able to designate the person who made the imprint on the glass, I became satisfied that there is something to this science. - Judge Otto A. Rosalsky, sentencing hearing, “People of the State of New York v. Carlo Crispi, 1911 (Quoted in “Suspect Identities - A History of Fingerprinting and Criminal Identification” by Simon A. Cole, Harvard University press, 2001, Page 168) DIATOMS There is hardly a medicolegal journal that has not taken part in the “war of diatoms” in one way or another. - Spitz and Fisher in their book “Medicolegal Investigation of Death” 2nd Edition, page 360 The forensic pathology community has been, historically, polarized in its general acceptance of the diatom test as a definitive diagnostic test for drowning. - Michael S. Pollanen in his excellent book “Forensic Diatomology and drowning”, Elsevier, 1998 at page 6 DISPUTED PATERNITY A trial of bastardy is a trial of the blood. - Y.B., 12 Edw. 2, 388 (ed. 1679 from Sergeant Maynard’s MS) (From “Legal Medicine Annual, 1976, page 239, appearing at the top of the article “Paternity Actions - A matter of opinion or a trial of blood?” by Michael J. Beautyman) DISSECTION AND OBSERVATION Those who have dissected or inspected many bodies have at least learnt to doubt; while others who are ignorant of anatomy and do not take the trouble to attend it are in no doubt at all. - Giovanni Battista Morgagni (1682-1771); Italian Anatomist and Pathologist The corpse is a silent witness who never lies. - Anonymous Pay attention to the little things, and the big things will take care of themselves. - S. Venston Oh! Look, the dead teach the living! - Winternitz Taceant colloquia. Effugiat risus. Hic locus est ubi mors gaudet succurrere vitae. (Let conversation cease. Let laughter flee. This is the place where death delights to help the living) - Latin Proverb (Quoted in Bernard Knight’s “Forensic Pathology” at the Title Page. This quote is also supposed to have been inscribed on the lobby wall of Milton Helpern’s new office building {Milton Helpern was the third Chief Medical Examiner of the City of New York}) Mortui vivos docent - The dead teach the living. - Anonymous (Quoted in "The Autopsy-Medical Practice and Public Policy" by Rolla B. Hill and Robert E. Anderson; Butterworths 1988, page 191) Only the living have problems with the dead. Death is a mystery only to the living, and the living look to death for help - (From the frontpage of a forensic medicine practical notebook prescribed for undergraduate students at the Department of Forensic Medicine, Al-Ameen Medical College, Bijapur, India) Death comes to the aid of life. - An inscription in a Paris dissecting room I see no more than you, but I have trained myself to notice what I see. - Sherlock Holmes, "The Adventure of the Blanched Soldier" (Quoted in "Forensic Investigation of Explosives" Ed. Alexander Beveridge. Page 101 What the mind knows, the eyes will detect - (From the frontpage of a forensic medicine practical notebook prescribed for undergraduate students at the Department of Froensic Medicine, Al-Ameen Medical College, Bijapur, India) Dead body is extremely eloquent and honestly informative, if one exercises patience in listening to it. - Anonymous No autopsy should be taken as trivial; even those appearing most routine may throw up unexpected surprises. - Anil Aggrawal DNA TECHNOLOGY We wish to suggest a structure for the salt of deoxyribonucleic acid (DNA)…. - James D. Watson and Francis H.C. Crick in a scientific article published in “Nature” on April 23, 1953 (N.B. This quote is given in the book “DNA Technology - The Awesome skill” by I. Edward Alcamo, at the top of the Preface section. The author goes on to say that this article - with this opening sentence - stimulated a revolution in science and medicine. 31 years later - in 1984 - (Sir) Alec Jeffreys would develop the first DNA profiling test.) DNA technology could be the greatest single advance in the search for truth, conviction of the guilty, and aquittal of the innocent since the advent of cross-examination. - Judge Joseph Harris (1988) in People vs Wesley, 140 Misc. 2d 306, 533 N.Y.S. 2d 643 (Co. Ct. 1988) (Quoted in “DNA Fingerprinting- An introduction” by Lorne T. Kirby page xv: Stockton Press, 1990) DNA technology is the most awesome skill acquired since the splitting of the atom. - Editorial in a major news magazine (Reproduced on the back jacket of the book “DNA Technology - The Awesome skill” by I. Edward Alcamo) We have the potential within our grasp of a technology that in routine investigations will identify suspects as reliably as fingerprints. - Jeremy Travis, Director, National Institute of Justice (quoted in “Blood Trail - True crime mysteries solved by DNA Detectives” by Judge Gerald Sheindlin and Catherine Whitney on page 117) If we had called this “idiosyncratic Southern blot profiling,” nobody would have taken a blind bit of notice. Call it “DNA fingerprinting,” and the penny dropped. - Alect Jeffreys, 1996 (Quoted in “Suspect Identities - A History of Fingerprinting and Criminal Identification” by Simon A. Cole, Harvard University press, 2001, Page 287) Our genetic differences are at the heart of one of the most fascinating paradoxes of the human condition: that we are all different, yet we are all the same. - Geneticist Mary-Claire King, 1993 (Quoted in “Suspect Identities - A History of Fingerprinting and Criminal Identification” by Simon A. Cole, Harvard University press, 2001, Page 303) DROWNING Odysseus bent his knees and sturdy arms, exhausted by his struggle with the sea. All his flesh was swollen and streams of brine gushed from his mouth and nostrils. Winded and speechless he lay there too weak to stir, overwhelmed by his terrible fatigue. - The Odyessey, Calypso (Book V), Homer (Quoted in the Preface in “Forensic Diatomology and drowning” by Michael S. Pollanen) Lord, Lord! methought what pain it was to drown, What dreadful noise of water in mine ears! What sights of ugly death within mine eyes. - Shakespeare, Richard III (1 iv), (Quoted in “Medicine, Science and the Law” (1980), Vol 20, No. 4, page 254; and also in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 214) If the man go to the water and drown himself, it is, will he, nill he, he goes. - Hamlet, Act V, Scene I (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 70, in Chapter 4 entitled “Respiration”. This quote appears at the top of a sub-chapter entitled “Immersion in fluids”) The ability to swim is not an important correlate of drowning since most victims of drowning are able to swim. - Michael S. Pollanen in his book “Forensic Diatomology and drowning”, Elsevier, 1998 at page 8 Cutis anserina or gooseflesh (is) due to postmortem rigidity of short muscle fibers in the skin. - Caption to figure II-2, on page 15 in “Medicolegal Investigation of Death”, by W.U. Spitz and Russell S. Fisher, 2nd Edition, 1980, Charles C. Thomas, Springfiled, Illinois, USA Cutis anserina - or ‘goose flesh’ - is a common finding in immersed bodies.. ..It is often stated that rigor mortis can produce this goose-flesh appearance, but this is doubtful, as rigor does not shorten muscles appreciably. - Bernard Knight in his “Forensic Pathology” 2nd Edition 1996, page 391 (N.B. Last two quotes are antethetical in nature - and both are from contemporary books - meaning thereby that this controversy is far from over) DYADIC DEATHS “I kissed thee ere I killed thee. No way but this, Killing myself to die upon a kiss.” (He falls over her and dies) - Othello exclaiming after killing Desdemona and stabbing himself. Othello, Act 5, Scene 2, William Shakespeare (Quoted in “Combined Homicide-Suicide in Galveston County” by Alan R. Felthouse et.al. J. Forens. Sci. 2001, 46(3) 586-592”. This quote appears on page 586) EMBOLISM BULLET Missiles often attain more curious places by accident than they could by design. - Sir John Bland-Sutton in his classic paper “A lecture on missiles as emboli”. Lancet, i:773, 1919 (This interesting quote is reproduced in the paper“Rich N.M. et. al. Missile Emboli. The Journal of Trauma, 1978, Vol 18. No. 4, on page 237) The occurrence of free projectiles in the bloodstream, although doubtless very rare, has already become something more than a surgical curiosity, and its possibility may well be borne in mind by those who observe anomalous symptoms after gunshot wounds, especially when the projectile is not found. - Editorial: Migration of projectiles in the blood stream. Lancet, ii: 395, 1917 (This interesting quote is reproduced in the paper “Rich N.M. et. al. Missile Emboli. The Journal of Trauma, 1978, Vol 18. No. 4, on page 237) Understandably, the literature on bullet embolism consists of a number of single case reports. - Lam, C.R. and McIntyre, R. Air pistol injury of pulmonary artery and aorta: Report of a case with peripheral embolization and pellet and residual aorticopulmonary fistula. J. Thorac. Cardiovascular Surg., 59: 729, 1970 (This interesting quote is reproduced in the paper “Rich N.M. et. al. Missile Emboli. The Journal of Trauma, 1978, Vol 18. No. 4, on page 236) An aura of mystery and intrigue often surrounds these unusual lesions. - Norman M. Rich, in his paper “Rich N.M. et. al. Missile Emboli. The Journal of Trauma, 1978, Vol 18. No. 4, on page 236” PULMONARY Pulmonary embolism is the most underdiagnosed cause of death, where no autopsy is performed. - Bernard Knight (Forensic Pathology, 2nd Edition, page 334) EXHUMATION Those who arrange exhumations, and doubtless sleep through them, have always assumed that if timed at the crack of dawn an exhumation will be quiet, private affair. - Professor Keith Simpson, in his autobiography “Forty Years of Murder”, Grafton Books 1978, at page 234) EXPERT TESTIMONY The role of the expert witness is not to provide the evidence which supports the case for the Crown nor for the defence, unless that opinion is objectively reached and has scientific vailidity. - Practice Guidelines of the Police Advisory Board in Forensic Pathology of the British Home Office (Quoted in Bernard Knight's Forensic Pathology, 2nd Edition, Preface) A good medical expert must serve but one client, and that client should be truth. - Erle Stanley Gardner If the law has made you a witness, remain a man of science; you have no victim to avenge or guilty or innocent person to ruin or save. You must bear testimony within the limits of science. - Dr. P.C.H. Brouardel( Late 19th century French Medico-Legist)(Reproduced in “Forensic Radiology” by B.G. Brogdon, at page 364. Also quoted in “The American Journal of Forensic Medicine and Pathology”, Vol 20, Number 1, March 1999 at page 17, where it is attributed to Paul H. Broussard, Chair of Forensic Medicine, Sorbonne, 1897) The conscience is a thousand witnesses. - Richard Taverner Let no man swear on oath falsely, even in a trifling matter, for he who swears on oath falsely, is lost in this world and after death. - Manu (Ancient Hindu Law giver) You can lead a jury to the truth, but you can’t make them believe it. - Herbert Leon Macdonell (Quoted at the opening page in his book “The Evidence never lies”) An expert, as the word imports, is one having had experience. No clearly defined rule is to be found in the books what constitutes an expert. Much depends upon the nature of the question in regard to which an opinion is asked. - Oil Co. v. Gilson, 63 Pa. St. 146, 150 (1869) (Quoted in “Scientific and Legal Applications of Bloodstain Pattern Interpretation” Ed. Stuart H. James, page 131) "..the thing from which the deduction is made must be sufficiently established to have gained general acceptance in the particular field in which it belongs" - (Frye v. United States (1923), often known as "The Frye Standard". In this case, the scientific evidence being presented was the theory underlying lie-detector testing. It ultimately was not admitted and remains inadmissible to this day in law courts) "For gauging the scientific validity of evidence, it should be seen whether the technique in question can be or has been tested; whether the technique has been subjected to peer review and publication; its known or potential error rate; the existence of standards controlling its operation and whether the methodology in question has attracted widespread acceptance within the relevant scientific community." - US Supreme Court in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S.C.T. 2786 (1993); popularly referred to as the “Daubert Standard” There is nothing worse than a pompous expert. - Judge Haskell M. Pitluck (Reproduced in “Forensic Radiology” by B.G. Brogdon, at page 372) Expert witnesses should refrain from conducting themselves as though their service is a contest between themselves and some other party. - Reproduced from the document entitled “Recommended Practices for Design Professionals Engaged as Experts in the Resolution of Construction Industry Disputes” prepared by The Association of Soil and Foundation Engineers (ASFE) (quoted on page 353 in the book “Forensic Engineering” by Kenneth L. Carper (CRC Press 1998)) The witness must never be considered an advocate, and should always “call the shots as they are”. - Joseph S. Ward, P.E. (quoted on page 336 in Chapter 12 written by him on “The Engineer as Expert Witness” in the book “Forensic Engineering” by Kenneth L. Carper (CRC Press 1998)) For every expert there is an equal and opposite expert. - Contributed by Mike Duxbury Direct questioning in the initial stages of a trial is like a walk in the park when compared with the antagonistic manner evident in cross examination. - Tom Bevel and Ross M. Gardner in “Bloodstain pattern analysis” CRC Press, 1997, page 271 What the doctor puts into his report at the time of examination must be of sufficient resilience to survive intense cross-examination in the court room many months later. - Bernard Knight in “The Estimation of the Time Since Death in the Early Postmortem Period”, Edward Arnold, 1995, page 2 FALL FROM HEIGHTS Falls from heights represent the third most common cause of accidental death in the United States. - National Safety Council. Accidental Facts, 1985 Chicago. National Safety Council, 1985 (Quoted in the paper "The Investigation of Fatal Falls and Jumps from Heights in Maryland (1987-1992)" by Ling Li and John E. Smialek. American Journal of Forensic Medicine and Pathology 15(4):295-299, 1994) FOETUS, AGE OF Morphological measurements are by no means infallible indicators of chronological age. - Bernard Knight (Forensic Pathology, 2nd Edition, page 444) The time of appearance of ossification centers (in a foetus) is no longer as uniform as once thought. - Bernard Knight (Forensic Pathology, 2nd Edition, page 444) FORENSIC ANTHROPOLOGY That's how I feel about the skeletons in my laboratory. These have tales to tell us, even though they are dead. It is up to me, the forensic anthropologist, to catch their mute cries and whispers, and to interpret them for the living, as long as I am able. - William R. Maples (1937-1997), the famous Forensic Anthropologist, in his book "Dead Men do tell tales" at page 280 (published by Doubleday, New York, 1994) For me, every day is Halloween. - William R. Maples in his book "Dead Men do tell tales" at page 2 FORENSIC ART AND ILLUSTRATION It has been said that pen is mightier than the sword.. .. if used correctly, so is the pencil.. . - Karen T. Taylor in her book "Forensic Art and Illustration", CRC Press 2001, at page 561 FORENSIC BALLISTICS A cartridge case at the scene of offence could prove as incriminating as if the murderer had left his visiting card! - Sir Sydney Smith Second only to motor vehicles as instruments of death, firearms will kill more than 32,000 Americans this year. - (National Research Council 1985: Reproduced in "Gunshot Wounds - Pathophysiology and Management" by Kenneth G. Swan & Roy C. Swan. 2nd Edition, 1989, Yearbook Medical Publishers Inc. Chicago, at page ix) Gunshot wounds are now becoming almost a distinct branch of surgery - (J.A. Hunter in "Treatise on the Blood, inflammation and Gunshot wounds: London, G. Nicol, 1794: Reproduced in "Gunshot Wounds - Pathophysiology and Management" by Kenneth G. Swan & Roy C. Swan. 2nd Edition, 1989, Yearbook Medical Publishers Inc. Chicago, at page 1) We are aware of no report of a penetrating wound of the abdomen, during pregnancy, not involving the uterus - (Dyer I, Barclay D: Accidental Trauma complicating pregnancy and delivery. Am. J. Obstet. Gynec. 1962; 83: 907) Only a man who has a pistol needs it. - An old saying My wife yes; My dog maybe; My gun never! - Bumper Sticker (Quoted in "Gunshot Wounds", 2nd Edition, by Vincent J. M. Di Maio, on page 1) There is nothing more exhilarating than to be shot at without result. - Winston Churchill (Quoted in "Gunshot Wounds", 2nd Edition, by Vincent J. M. Di Maio, on page 65) God created men equal. Sam Colt made 'em equal. - Anonymous (Quoted in "Gunshot Wounds", 2nd Edition, by Vincent J. M. Di Maio, on page 123) The U.S. Exports Coca Cola; Japan exports Sony; Russia exports Kalashnikovs. - Anonymous (Quoted in "Gunshot Wounds", 2nd Edition, by Vincent J. M. Di Maio, on page 167) Is there life after death? Trespass and find out. - Bumper Sticker (Quoted in "Gunshot Wounds", 2nd Edition, by Vincent J. M. Di Maio, on page 253) This property is protected by Smith & Wesson. - Bumper Sticker (Quoted in "Gunshot Wounds", 2nd Edition, by Vincent J. M. Di Maio, on page 253) It is always hazardous to conclude that a person could not have done some rational act after receiving gunshot wounds in vital organs. - LeMoyne Snyder in his book "Homicide Investigation", (Third Edition, May 1977) Published by Charles C. Thomas, Springfield, Illinois, USA, on page 139, in chapter 7 entitled "Homicide due to Gunshot Wounds" You will acquire a deep understanding of that ancient Christian moral principle, as applied to aimed fire,"It is better to give than to receive" - George Prosser, Black Politics, 1968 (quoted at the beginning of the book "Armed and Dangerous - A writer's guide to weapons" by Michael Newton, Writer's Digest Books, Ohio, 1990) There is nothing wrong with shooting, as long as the right people get shot. - "Dirty Harry" Callahan (quoted at the beginning of the book "Armed and Dangerous - A writer's guide to weapons" by Michael Newton, Writer's Digest Books, Ohio, 1990) Whatever happens, we have got, The Maxim gun and they have not. - A popular jingle quite popular with the imperialists in the late 19th and early 20th Century. (Quoted by Isaac Asimov in "Asimov's New Guide to Science", Penguin Books 1987, page 495) (N.B. In the 1860s the American Inventor Richard Gatling produced the first machine gun. This was improved upon in the 1880s by another American inventor Hiram Stevens Maxim in 1880s. These guns were respectively called the Gatling gun and the Maxim gun. The Gatling gun also gave rise to the slang gat for gun. These guns gave tremendous advantage to the Imperialists over Africans and Asians. The word "they" in the jingle refers to these Africans and Asians.) FORENSIC ENTOMOLOGY 'Who saw him die?' 'I', said the fly 'With my little eye, I saw him die.' - Anon., 'Who killed Cock Robin' (quoted by Zakaria Erzinçlioglu in his book "Maggots, Murder and Men - Memories and Reflections of a Forensic Entomologist" Harley Books, England 2000, on page 13) In the midst of all this decay, death calls in reinforcements. - Heather Pringle in her book "The Mummy Congress - Science, Obsession, and the Everlasting Dead", Theia, New York, 2001, page 39 FORENSIC MYTHOLOGY Descriptions of an abnormal fluidity of blood seen at autopsy in asphyxial deaths are part of forensic mythology and can be dismissed with little discussion. - Bernard Knight (Forensic Pathology, 2nd Edition, 1996, page 350) Persistent fluidity of the blood likely relates to inhibition of the coagulation process due to some unknown mechanism. - Michael S. Pollanen in his book "Forensic Diatomology and drowning", Elsevier, 1998 at page 26 (N.B. Quotes 1 and 2 are antethetical in nature - and both are from contemporary books - meaning thereby that this controversy is far from over. For other similar forensic controversies, see quotes on "Petechial haemorrhages" and "Hydrostatic Test") Descriptions and photographs of air segments in the cerebral veins are part of the mythology of forensic pathology, handed on uncritically from one book and one author to another. - Bernard Knight (Forensic Pathology, 2nd Edition, page 342 and 433) (N.B. Knight tells us through this pithy quote that air-embolism can not be, and should not, be diagnosed by seeing air bubbles in cortical veins, because there is simply no way, air bubbles could travel upstream!) FORENSIC ODONTOSTOMATOLOGY The jaws that bite, the claws that catch! - Through the Looking Glass (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 137, in Chapter 7 entitled "Odontology: its Forensic Applications") Dormouse to the expanding Alice : "I wish you wouldn't squeeze so" said the Dormouse who was sitting next to her. "I can hardly breathe." "I can't help it" said Alice very meekly, "I'm growing." "You've no right to grow here" said the Dormouse. "Don't talk nonsense," said Alice more boldly: "you know you're growing too."Yes, but I grow at a reasonable pace," said the Dormouse. "Not in that ridiculous fashion." - Cited in Lovat LS. The prosecution view of dental evidence. J Forensic Sci Soc. 1974 Jul;14(3):253-8. This quote – my favorite – is very cleverly cited by Lovat to show how sometimes science can grow at a much faster rate that associated law. In this very pertinent allegory, while Alice refers to the fast growing science of forensic odontostomatology, the Dormouse refers to “not so fast growing” law, which may have difficulties accepting dental evidence. FORENSIC OSTEOLOGY The skin and bones tell a story which the child is either too young or too frightened to tell. - Johnson, Cameron and Camps (Quoted in Bernard Knight's Forensic Pathology, 2nd Edition, page 458) It is difficult for me to evaluate how a single skull is classified as white, or Negro, or Mongoloid. - W.M.Krogman, in his "The Human Skeleton in Forensic Medicine" (1962), at page 195 As those who study them have come to learn, bones make good witnesses - although they speak softly, they never lie and they never forget. - Dr. Clyde Collins Snow, forensic anthropologist (Quoted in "The Bone Detectives" by Donna M. Jackson at the front page) FORENSIC PATHOLOGY AND FORENSIC PATHOLOGISTS Professor John Glaister II (1892-1971) He is the man who furnishes Perry Mason with so many authentic facts. - Erle Stanley Gardner on Professor John Glaister II (1892-1971), Professor of Forensic Medicine at Glasgow University, Scotland (Quoted in "The Bedside Book of Murder" by Richard & Molly Whittington-Egan, at page 171) Edward O. Heinrich (1881-1953) Just the mention of his name was enough to send shudders through opposing counsel. -Colin Evans on Edward O. Heinrich (1881-1953) in his book "The Casebook of Forensic Detection" John Wiley & Sons 1996, page 301 (N.B. Edward Oscar Heinrich was one of the most remarkable figures in the history of US Jurisprudence. Epithets commonly ascribed to him are "The American Sherlock Holmes" and "The Edison of Crime Detection") Henry C. Lee (1938-) How the hell did he know? - A defendant heard to whisper, after Lee had methodically walked the court through each step the killer took during the murders. (N.B. Lee used blood spatter and other other evidence to do this. This anecdote appears in "Cracking Cases" by Henry C. Lee with Thomas W. O'Neil, Prometheus books, 2002, page 9) Thomas T. Noguchi (1927- ) I love to enter the crime scene from the kitchen. - This is what Noguchi said, when interviewed in November 1986 by Douglas Stein. For full story please visit http://www.omnimag.com/index.html (Readers may want to know why. He follows up the above statement with this: People's minute-to-minute movements are registered here. I routinely open the refrigerator to get people's life-styles: the type of food they like, where they buy, how much they pay, how they wrap. In one homicide I investigated, the homeowner returned early, surprising the burglar, so the burglary ended in murder. But the burglar was hungry, so he had a bite to eat before leaving. We found distinct teeth marks in the cheese!") Sir Bernard Henry Spilsbury (1877-1947) ~ His Adulation He stood for forensic pathology as Hobbs stood for cricket or Dempsey for boxing or Capablanca for chess. - Edgar Lustgarten on Sir Bernard Henry Spilsbury (1877-1947), probably the greatest Forensic Pathologist, the English world has seen (Quoted in "The Bedside Book of Murder" by Richard & Molly Whittington-Egan, at page 164) He could achieve single-handed all the legal consequences of homicide - arrest, prosecution, conviction and final post-mortem - requiring only the brief assistance of the hangman. - Dr. Richard Gordon on Sir Bernard Henry Spilsbury (1877-1947) (Quoted in "The Bedside Book of Murder" by Richard & Molly Whittington-Egan, at page 164) A simple newspaper report of Sir Bernard's attendance at a mortuary or churchyard is enough to condemn an accused man to death, even before committal proceedings have begun. - Dr. Patrick Brontë, Spilsbury's bitter professional rival (this quote appears on page 25 in the article "Is Sir Bernard Spilsbury Dead?" in "Crime Investigation: Art or Science?", edited by Alistair R. Brownlie. Scottish Academic Press, Edinburgh 1984) ~ His Criticism When did you last examine a live patient Sir Bernard? - A young chirrupy young barrister to Sir Bernard Henry Spilsbury in the court room (Quoted in "The Bedside Book of Murder" by Richard & Molly Whittington-Egan, at page 164) Spilsbury's statements in the witness box were often based upon insufficient material, and a lack of clinical experience. - Professor Michael A. Green on page 24 in the article "Is Sir Bernard Spilsbury Dead?" in "Crime Investigation: Art or Science?", edited by Alistair R. Brownlie. Scottish Academic Press, Edinburgh 1984 When Sir Bernard speaks as a pathologist, I respect his opinion. When he gives a view on an obstetric matter, I hold him in contempt. - Alec Boune, the distinguished gynaecologist called by the defence in a case in which Spilsbury appeared from the other side (this quote appears on page 24 in the article "Is Sir Bernard Spilsbury Dead?" in "Crime Investigation: Art or Science?", edited by Alistair R. Brownlie. Scottish Academic Press, Edinburgh 1984) ~ His Conceit I have never claimed to be God - but merely his locum on his weekends off. - Bernard Spilsbury (this quote appears on page 25 in the article "Is Sir Bernard Spilsbury Dead?" in "Crime Investigation: Art or Science?", edited by Alistair R. Brownlie. Scottish Academic Press, Edinburgh 1984) Rudolph Virchow (1821-1902) Rudolph Ludwig Karl Virchow, where are you now that we need you? - Leon Eisenberg, 1984 (Quoted in "The Autopsy-Medical Practice and Public Policy" by Rolla B. Hill and Robert E. Anderson; Butterworths 1988, page 251) General The commonest causes of death amongst forensic pathologists are alcohol related! - Contributed by Dr. Gyan Fernando So why the dead body, the often smelly morgue, exhumation, lust and violence, the inconvenience of calls to derelict premises, dells in Epping Forest, ponds, prostitutes' bedrooms at odd hours; of sudden challenge, hard duels with lawyers, pompous old judges and obtuse juries? Why? - Professor Keith Simpson, asking himself the question "Why he chose Forensic Pathology despite being the best student in his medical career" (This interesting quote appears in his autobiography "Forty Years of Murder", Grafton Books 1978, at page 9) (N.B. Professor Keith Simpson follows it up with this answer: Well, few doctors can enjoy a more exciting life, such a challenge to be constantly on the qui vive, or should it be the qui meure?) As Stethoscope and BP Instruments are status symbols of a physician and Surgeon, so are Lens and Measuring tape to an Autopsy Surgeon. - Professor Heeresh Chandra (Quoted in his site) An operation during life is attended by pain and is for the benefit of the individuals. An operation after death is free from pain and is for the benefit of humanity. - Braouardel & Jasolin (Quoted by Professor Heeresh Chandra in his site) FORENSIC PHOTOGRAPHY A picture tells a thousand words. - An old adage (quoted in Chapter 9 of the book "Craniofacial Identification in Forensic Medicine". The chapter is on "Crime Scene Photography") A picture is worth a thousand words. However, few investigators may realize that 'a picture may also contain a thousand measurements'. - John H. Garstang, in chapter 6 entitled "Aircraft Explosive Sabotage Investigation" page 153, in the book "Forensic Investigation of Explosions" edited by Alexander Beveridge, Taylaor & Francis, 1998 (N.B. There is a veiled reference here to photogrammetry, a technique which is increasingly being used in forensic investigations now. Photogrammetry is the art, science and technology of obtaining reliable information about physical objects and the environment through processes of recording, measuring and interpreting photographic images and patterns of electromagnetic radiant energy and other phenomena.) A good photograph is tantamount to stopping the clock. - unknown (quoted on page 35 in Chapter 3 (fire investigation) of the book "Forensic Engineering" by Kenneth L. Carper (CRC Press 1998)) FORENSIC PSYCHIATRY ".. . the Tories have compelled me to do this. They follow and persecute me wherever I go and have entirely destroyed my peace of mind.. .," - Daniel M'Naughten 1843 (quoted in "Forensic pharmacology - Medicines, Mayhem, and Malpractice" by R.E. Ferner, Oxford University Press, 1996, page 66) (N.B. Daniel M'Naughten was a mentally disturbed person - a Scotsman from Glasgow. He had a delusion of persecution, that Tories were trying to kill him. In his time Sir Robert Peel was the Prime Minister of Britain - from December 1834 till March 1835, and then again from September 1841 till July 1846. On 20th January 1843, Daniel was seen loitering in Whitehall Gardens, and followed Mr. Edward Drummond, the private secretary of Sir Robert Peel, from Sir Robert Peel's house till a street in Charing Cross, where he shot him. He believed that Mr. Edward Drummond was the Prime Minister himself. Mr. Drummond lingered, in great pain, until January 25th, when he died. M'Naughten was brought to trial on 3rd March, 1843 at the Old Bailey before Chief Justice Tindal, and two other Queen's bench judges, Williams and Coleridge. It was at this historic trial that the famous "insanity defense" emerged, known to this day as the "M'Naughten rule".) -- We do not believe that anyone could be insane who wanted to murder a Conservative Prime Minister. - A young Queen Victoria (1840-1901) referring to Daniel M'Naughten (see above for details). The quote appears in "If A Man Be Mad - A scientist testifies against the insanity defense" by David T. Lykken. Lykken, who is a professor of psychiatry and psychology at the University of Minnesota, says that this was an immortal quip by Queen Victoria, not otherwise known for her wit. When you speak to God it's called praying; but when God speaks to you it's called schizophrenia. - A West German observer comment on the psychiatric evidence given during the Yorkshire Ripper's Trial (quoted in "Science Against Crime", Published by Marshall Cavendish, 1982, on page 175) (N. B. A brief note may be appropriate here. The Yorkshire Ripper or Peter Sutcliffe killed 13 women in Leeds and adjoining areas between October 1975 and November 1980. At his trial, which began May 1981, he said he had heard the voice of God instructing him to kill.) -- Such terms as 'mental disease and mental defect' give expert pyshiatric witnesses a blank check. - Justice Kaufman criticizing the Durham test (N. B. A brief note might well be in order here. In Durham vs. United States, 1954, Justice David L. Bazelon abandoned the M'Naghten criteria, and used a new criterion known as the Durham test, which was perpetually in criticism. It was finally overturned by Justice Bazelon himself in 1972 in United States vs. Brawner. The Durham rule stated that "an accused is not criminally responsible if his unlawful act was the product of mental disease or defect".) -- The psychiatrists spun sticky webs of pseudoscientific jargon, and in those webs the concept of justice, like a moth, fluttered feebly and was trapped. - A prominent columinst, after the 1982 verdict of a District of Columbia jury, which found John W. Hinckley, Jr., the would-be assassin of President Ronald Reagan, not guilty by reason of insanity (quoted in Kaplan and Sadock's Synopsis of Psychiatry - Behavioral Sciences/Clinical Psychiatry, eighth edition 1998, by Harold I. Kaplan, M.D. and Benjamin J. Sadock, M.D. Page 1316) Had M'Naghten been tried under M'Naghten's rules in any American court, there would have been a battle of the "experts" and M'Naghten would surely have been found legally sane and would have been found guilty as charged. - Matthew Brody, M.D., Acting Chief, Psychiatry, Brooklyn Jewish Hospital and Medical Center, testifying in 1965, before a joint legislative commission of the penal law and criminal code. This commission recommended some alteration of the M'Naghten Rule. This quote is reproduced by Matthew Brody himself in his paper entitled "Trial of Daniel M'Naghten" published in March 1982 issue of "New York State Journal of Medicine". This quote appears on page 381 A man might say that he picked a pocket from some uncontrollable impulse, and in that case the law would have an uncontrollable impulse to punish him for it. - Baron Alderson, the presiding judge deciding on the fate of Robert Pate, who went on trial in 1850 for the high misdemeanor of striking Queen Victoria with his walking stick. Pate's counsel had claimed irresistible impulse as a defence. The quote appears in "If A Man Be Mad - A scientist testifies against the insanity defense" by David T. Lykken. FORENSIC RADIOLOGY Now we see through a glass darkly. -I Corinthians 13 (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 149, in Chapter 8 entitled "Radiology and its forensic application") FORENSIC SCIENCE AND FORENSIC MEDICINE Forensic Science is the link between the criminal and the crime. - Ken Goddard, Wildlife Forensics, (quoted in Natur (German) Nov. 1990) Forensic Science can be defined as the application of the laws of nature to the laws of man. - Michael J. Camp, (quoted by P. ChandraSekharan in "Indian Journal of Forensic Sciences" Vol 5, April 1991, No. 2, p. 37) Forensic Science is used to predict not the future but the past. - Henry C. Lee (Reproduced in "Forensic Radiology" by B.G. Brogdon, at page 279) (N.B. The book goes on to say,"Nowhere in Forensic Radiology is Dr. Lee's provocative aphorism less applicable than in the field of abuse. Here lies the opportunity to go beyond the limits of the necropsy 'where death delights to help the living'.") Legal medicine has been described as the key to the past, the explanation to the present, and, in some measure, as a signpost to the future. - Professor J. Malcolm Cameron, in his Presidential address to the British Academy of Forensic Sciences, also published in "Medicine, Science and the Law" (1980), Vol 20, No. 1, in the paper entitled "The Medico-legal Expert - Past, Present and Future" page 3 There is only one path to the mastery of Forensic Medicine, and that is an extensive practical experience. - Harvey LittleJohn She's cold Her blood is settled and her joints are stiff, Life and these lips have long been separated, Death lies on her like an untimely frost, Upon the sweetest flower of all the field - William Shakespeare Most sudden deaths are of cardiac origin. - Fortunatus Fidelis (1598) It will never be possible to eliminate all chance of error or misjudgement, but the Forensic Science Service strives to do the greatest good for the greatest number, for the greatest part of time. - Professor Michael Green, University of Sheffield (quoted in "The Modern Sherlock Holmes- An Introduction to Forensic Science Today" by Judy Williams, at page 12) The science of Forensic Medicine turns the clock back. It relivens the dead. - R.D. Rikhari (Editor "Invention Intelligence". Sent on July 14, 2000. His original quote was "Your profession turns the clock back. It relivens the dead") Forensic medicine is like an illegitimate child of health and home departments. We belong to both, but none belong to us. We offer our services to both, we are answerable to both, but we receive nothing from either. I feel that it is high time that our paternity be ascertained and we be adopted by our rightful parentage. - Professor L. Fimate, President of the Indian Academy of Forensic Medicine (IAFM), in his inaugural speech on the occasion of XXII Annual Conference of The Indian Academy Of Forensic Medicine, Jaipur, India, 5 - 7 January 2001 Many people ask me why I chose Forensic Medicine as a career, and I tell them that it is because a forensic man gets the honor of being called when the top doctors have failed! - Anil Aggrawal, Professor of Forensic Medicine, Maulana Azad Medical College, New Delhi-110002, India There is no such thing as 'forensic science'; instead it is a collection of scientific techniques and principles that are begged and borrowed from 'real' sciences such as chemistry, biology, physics, medicine and mathematics. - A general saying by some experts (cited in the Introduction to "Encyclopedia of Forensic Sciences" edited by Jay A. Siegel, Pekka J. Saukko and Geoffrey C. Knupfer. 2000 Academic Press.) The 'sciences' of fingerprints, firearms and toolmarks and questioned documents are the only real forensic sciences; all the rest of it is on loan from the classical hard sciences. - Another general saying (cited in the Introduction of "Encyclopedia of Forensic Sciences" edited by Jay A. Siegel, Pekka J. Saukko and Geoffrey C. Knupfer. 2000 Academic Press.) It has always been a source of amazement to me, how a subject as inherently fascinating as Forensic Medicine, can be presented in a dull and uninteresting manner as is the case with some of the existing books on the subject. - Dr. V.V.Pillay, in the preface of the book "MKR Krishnan's Handbook of Forensic Medicine and Toxicology", Paras Publishing, 12th Edition, 2001 FORENSIC SCIENTISTS Francis Galton (Feb 16, 1822 - Jan 17, 1911) ~ General Francis Galton's arrival on Henry Fauld's stage was like the antihero's entrance in a tragically ending play. - Colin Beavan, in "Fingerprints - The origins of crime detection and the murder case that launched forensic science", Hyperion, New York, 2001, page 94 ~ His Criticism He was notorious for using his status against those with fewer advantages. - Colin Beavan, in "Fingerprints - The origins of crime detection and the murder case that launched forensic science", Hyperion, New York, 2001, page 94 Those who dared to oppose him learned that he was, by all accounts, that dangerous breed of dog who bites before even bothering to growl. - Colin Beavan, in "Fingerprints - The origins of crime detection and the murder case that launched forensic science", Hyperion, New York, 2001, page 94 GENERAL Satyameva Jayate (Truth alone triumphs) - An Old Sanskrit saying, very popular in India, often written on plaques in Judges’ rooms If you can't prove it, don't claim it. - Bernard Knight, (Quoted in Bernard Knight's “Forensic Pathology”, 2nd Edition, Preface) I keep six honest serving men (They taught me all I knew); Their names are What and Why and When And How and Where and Who - Rudyard Kipling (1865-1936) Indian born British writer, in “Just so stories” (Cited in “Recent Advances in Forensic Pathology” edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 216, in Chapter 13 entitled "Medico-Legal aspects of Exotic Diseases") (N.B. The author at the end of this chapter stresses on Population explosion and advises the doctors to think in terms of global medicine. On page 221, he modifies Kipling’s quote like this: ..She keeps ten million serving men, Who get no rest at all! She sends ‘em abroad on her own affairs, From the second she opens her eyes- One million Hows, two million Wheres, And seven million Whys!) Truth is incontrovertible Panic may resent it Ignorance may deride it Malice may distort it But here it is. - Winston Churchill In a sense, the victim shapes and moulds the criminal. - Hans von Hentig "Excellent," I cried. "Elementary", said he. - Arthur Conan Doyle (1859-1930): ("The Memoirs of Sherlock Holmes" (1894) 'The Crooked Man'. The oft quoted "Elementary, my dear Watson" is not found in any book by Conan Doyle) Seldom say never- seldom say always! - Forensic Proverb (Quoted in Bernard Knight's “Forensic Pathology”, 2nd Edition, at the Title page) In God we trust......All others are suspects - (Contributed by Signal45@aol.com who picked this quote from a homicide investigators school in Southern Louisiana) In Forensic Medicine, eye the most, hand the next and tongue the least. - (From the frontpage of a forensic medicine practical notebook prescribed for undergraduate students at the Department of Froensic Medicine, Al-Ameen Medical College, Bijapur, India) Well now; there’s a remedy for everything except death. - Sancho Panza in Don Quixote by Miguel de Cervantes (1547-1615) (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 30) He that digeth a pit shall fall into it. - Ecclesiastes 8 (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 269) The problem isn’t with what we don’t know. The problem is with what we do know that isn’t so. - Will Rogers. (Quoted at the beginning of the article “Shaken Baby Syndrome and Death of Matthew Eappen” by John Plunkett, M.D., in The American Journal of Forensic Medicine and Pathology”, Vol 20, Number 1, March 1999 at page 17) You do the work in the daytime and cry at night! - Clyde Snow (1928- ), forensic anthropologist, on his philosophy of life I guess you can say law enforcement officials have come a long way since the days of Sherlock Holmes and his magnifying glass. - Northumberland County District Attorney Robert Sacavage, at the conclusion of the Robert Auker murder trial (Quoted in “Hard Evidence” By David Fisher at page 381) Dead Men tell tales! - The title of Juergen Thorwald’s book (Published by Thames and Hudson, London, 1965) Dead Men tell no tales! - LeMoyne Snyder in his book “Homicide Investigation”, (Third Edition, May 1977) Published by Charles C. Thomas, Springfield, Illinois, USA, on page 376, in chapter 20 entitled “Popular Fallacies in Homicide Investigation” (N.B. This interesting quote, although outwardly appearing as an antithesis to the quote preceding it, must be read in the proper context. Snyder follows up this interesting quote with the following qualifying remark: “How much they tell may be in direct proportion to the care, diligence and conscientious effort that the investigators and the laboratory technicians apply to the investigation. Sometimes the dead man actually becomes eloquent. As the science of homicide investigation advances, dead men will tell more and more.”) Dead Men do tell tales! - The title of William R. Maple’s (1937-1997), book (published by Doubleday, New York, 1994) (N.B. Quite appropriately, this quote sets the matter right once again, by reiterating the earlier quote! Thus the wheel seems to have turned one full circle.) Take nothing for granted because things are not always what they seem. - LeMoyne Snyder in his book “Homicide Investigation”, (Third Edition, May 1977) Published by Charles C. Thomas, Springfield, Illinois, USA, on page 141, in chapter 7 entitled “Homicide due to Gunshot Wounds” A medicolegist must avoid talking too much, talking too soon and talking to the wrong persons. - Anonymous Fools and Wise men are equally harmless. Dangerous are those who are half foolish and half wise, and only see half of everything.. - General saying (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 8, in Chapter 2 entitled “Thanatology”) A Corpus Delicti is not a corpse. - Title of chapter 6 (at page 177) in Herbert Leon Macdonell's book “The Evidence never lies", published by Dell Publishing, 1984 Life is like an autopsy -- one piece at a time. - Anonymous (I found the above interesting quote as an attachment from an E-mail I received from clemency@innocent.com ) One can not expect a quality investigation if the technical consultant is given inadequate time for preparation and analysis. - Genck 1987 (Quoted in “Tire Imprint Evidence” by Peter McDonald, 1989 Elsevier, page 185) The truth - the whole truth - and nothing but the truth. - General saying (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 1, in Chapter 1 entitled “General advances in Forensic Medicine”) HAIR The drug test is moving from the bathroom to the barber shop. - U.S. News and World Report (Quoted by Heather Pringle in her book “The Mummy Congress - Science, Obsession, and the Everlasting Dead”, Theia, New York, 2001, page 86) (N.B. A two-inch-long strand can tell almost five months of personal drug history, as almost all drugs of abuse find their way into hair. Urine test on the other hand can tell only a few days’ drug history. Hence it is much more useful to take samples from the barber’s shop (hair) than from bathroom (urine), especially for employers to screen applicants.) HANGING, JUDICIAL They hanged ‘em; I execute ‘em. - William Marwood (N.B. Marwood was the famous Lincolnshire executioner from 1875 till 1883. Before Marwood’s time, executioners simply allowed the victims to suspend from a rope till they asphyxiated slowly over a period of several minutes. For the first time in history Marwood introduced a long drop, breaking victim’s neck, killing him instantaneously, thus lessening his agony. (This quote appears in “The Book of Victorian Heroes” by Adam Hart-Davis and Paul Bader, Sutton Publishing 2001, at page 96) Question: “If pa killed ma, who’d kill pa?” Answer:”Marwood”. - a famous jingle about Marwood in his time. (From “The Book of Victorian Heroes” by Adam Hart-Davis and Paul Bader, Sutton Publishing2001, page 95) HYDROSTATIC TEST Hydrostatic test smatters of black magic and is a complete waste of time. - Bernard Knight (Forensic Pathology, 2nd Edition 1996, page 442-3) Whatever its fallacies it was a welcome substitute for the torture which had preceded it in questions of alleged infanticide. - Professor J. Malcolm Cameron, in his Presidential address to the British Academy of Forensic Sciences, also published in "Medicine, Science and the Law" (1980), Vol 20, No. 1, in the paper entitled "The Medico-legal Expert - Past, Present and Future" page 5 IDENTIFICATION To write the history of identification is to write the history of criminology - Edmond Locard (1877-1966), French Criminologist INFANTICIDE Breathing is living; the onset of respiration is the beginning of life. - J. Barcroft The best way of seeking proof of respiration is to look at, to feel and to listen to the lungs. - Bernard Knight (Forensic Pathology, 2nd Edition, page 442-3) (For related quotes, see also "Hydrostatic Test") INJURIES Antistius, the physian examined the dead body of Julius Caesar after he was murdered, and opined that only one of the twenty three wounds present on his body was mortal, namely that which had penetrated his chest between the first and second ribs. - (The first ever autopsy recorded in history, 44 B.C.) Meanwhile, I will keep on treating the injuries, not the weapon. - D. Lindsey (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 86) Come, thick night,… that my keen knife see not the wound it makes. - Macbeth, Shakespeare (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 97) INQUEST At an inquest, regard nothing as unimportant. A difference of a hair will be the difference of a thousand li. - Hsi Yuan Lu ("Instructions to Coroners" published in China in A.D. 1248) (N.B. Li is a Chinese Linear measure equivalent to about one third of a mile.) As a hunter traces the lair of a wounded deer by the drops of blood, even so the king shall discover on which side the right lies by inferences from the facts. - Manu Dharma Shastra (Ancient Hindu Law book written by Manu) Having searched the dead body, we find not any blows, or wounds, or any other bodily hurt. We find that bodily weakness caused by long fasting and weariness, by going to and fro, with the extreme cold of the season were the causes of his death. - First record of an inquest from the Colony of New Plymouth, New England, 1635 We must have the courage to know the causes of death. - Ramsey Clark, 1972 (Quoted in "The Autopsy-Medical Practice and Public Policy" by Rolla B. Hill and Robert E. Anderson; Butterworths 1988, page 107) There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance - that principle is contempt prior to investigation. - Herbert Spencer (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 192) There is no such thing as a “born investigator”. - (Quoted in “Computer Evidence: A Forensic Investigations Handbook” by Edward Wilding, page 33, on the first page of chapter 3 entitled “A guide to Investigative methods”) INVESTIGATION OF CRIME Just as life depends on the equal functioning of the tripod of life i.e., heart, lung and brain, so also a successful investigation of crime depends on equal functioning of forensic medicine, forensic science and police investigation. - Professor L. Fimate, President of the Indian Academy of Forensic Medicine (IAFM), in his inaugural speech on the occasion of XXII Annual Conference of The Indian Academy Of Forensic Medicine, Jaipur, India, 5 - 7 January 2001 "I think we have a murderer on board". - Wireless message sent by Captain Henry Kendal of SS Montrose, to London, informing Walter Dew, Chief Inspector of the CID, Scotland Yard, London, that Dr. Crippen, who was suspected of having murdered his wife Cora Crippen, could be on board.) (N.B. A short note on this interesting quote would be in order. Dr. Crippen was an American who lived in London, where he murdered his wife at their house at 39 Hilldrop Crescent, Camden Town with an excessive dose of Hyoscine. He bought about 17 grains of hyoscine on 17 January 1910, and killed his wife in the early hours of 1 February. Shortly afterwards, along with his lover Ethel le Neve, he took the ship SS Montrose from Antwerp and tried to flee to Canada. However Captain Henry Kendal recognized him on board and sent the above message back to London. Dew boarded a faster ship and confronted the pair on the morning of 31 July 1910 (as the ship lay off the mouth of the St Lawrence river) with the words,” Good morning, Dr. Crippen” (which is yet another good quote!). Dr. Crippen was tried at the Old Bailey on 18 October, found guilty and hanged at Pentonville on 23 November 1910. This quote is important because Crippen was the first murderer to be caught using the newly discovered wireless technology. Marconi had received the Nobel Prize for wireless telegraphy only the previous year. The first UK demonstration of wireless telegraphy was in 1896, and when in 1996, wireless telegraphy completed 100 years, British Telecom celebrated the occasion by issuing six special BT phone cards. Number 3 of these cards celebrated Crippen’s arrest by showing Crippen’s photograph on the front, and the wireless message on the back. Surprisingly British Telecom got the date of this message wrong. According to the card, the message was sent in 1911, while actually it was 1910. In fact Crippen never lived to see the year 1911. Click below to see the front and back of this phone card.) Currently there are no entries under this heading. Readers' contributions are welcome. Currently there are no entries under this heading. Readers' contributions are welcome. LAW AND FORENSICS No man is above the law and no man is below it. - Theodore Roosevelt MASS DISASTERS With the exception of the more dramatic murders, the activity which focuses most public attention on the work of forensic pathologists is the mass disaster. - Bernard Knight (Forensic Pathology, 2nd Edition, page 43) The (Mass Disaster) plans are clinically oriented, but often completely ignore provision for the dead. - Bernard Knight (Forensic Pathology, 2nd Edition, page 43) MICROSCOPY Microscopes of hextra power. - Pickwick Papers (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 178, in Chapter 10 entitled “Microbiology and Parasitology”) MURDER Thou shalt not kill. - Old Testament, Exodus 20:13 Clarissa: Oh dear, I never realized what a terrible lot of explaining one has to do in a murder! - Agatha Christie (Spider's Web, 1956) ) Murder is a serious business. - Francis Iles 1893-1970, in “Malice Aforethought (1931) Other sins only speak; murder shrieks out. - Anne Hocking, British mystery writer (Death Loves a Shining Mark, 1943) For murder though it has no tongue, Will speak with the most miraculous organ. - William Shakespeare (Hamlet) Up the close and down the stair, But and ben with Burke and Hare, Burke's the butcher, Hare's the thief, Knox the boy that buys the beef. - A song commemorating murders by William Burke and William Hare in 1820's, who allegedly killed as many as 32 persons, to supply their bodies for dissection to the anatomist Dr. Robert Knox of Edinburgh. This song is still sung on macabre occasions in England today (quoted in "Almanac of World Crime" by Jay Robert Nash at page 271) Lizzie Borden took an axe, And gave her mother forty whacks, When she saw what she had done, She gave her father forty-one. - A song sung about Lizzie Borden, who allegedly killed her parents (father and step mother) at Fall River, Massachusetts on 4 August 1892, but was acquitted by the jury in June 1893 (quoted in "Almanac of World Crime" by Jay Robert Nash at page 194) You have borne up under all, Lizzie Borden, With a mighty show of gall, Lizze Borden, But because your nerve is stout, Does not prove beyond a doubt, That you knocked the old folks out, Lizzie Borden. - Another song sung about Lizzie Borden, this one giving her benefit of doubt: composed by A.L. Bixby (quoted in "Almanac of World Crime" by Jay Robert Nash at page 194) You can’t chop your poppa up in Massachusetts, Not even if it’s planned as a surprise No you can’t chop your poppa up in Massachusetts You know how neighbours love to criticize. - Yet another song sung about Lizzie Borden:. Composed by Michael Brown in “Lizzie Borden” (1952) Sometimes Playmates get killed. - Paul Snider (1980) to his friend shortly before killing his wife Dorothy Stratten, who had been Playboy’s Playmate of August 1979 (quoted in “Murder - Whereabouts” by J.H.H. Gaute and Robin Odell, page 82) NARCOTICS If you are smoking ganja, you first watch the curls of smoke. In other moment, you feel yourself crouched together in the bowl of your pipe smoked by yourself at the other end. - M. Baudelaire Cocaine isn't habit forming. I should know- I have been taking it for years. - Tallulah Bankhead (1903-1968), US stage and screen actress Thou hast the keys of Paradise, Oh, just, subtle and mighty Opium! - Thomas De Quincey (1785-1859): English essayist and critic "H" is for heaven: "H" is for hell: "H" is for heroin. In the life of the addict, these three meanings of "H" seem inextricably intertwined. - Isador Chein, 1964 (Reproduced in "Historical Medical Classics involving new drugs, by John C. Krantz, Jr. Ph.D. on page 121) That is the nectar, you call it a gum. Ah! The lean tree whence such gold oozings come. - R. Browning (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 204, in Chapter 12 entitled "Drugs of Dependence") NEGATIVE AUTOPSY A higher rate of negative conclusions will originate from older and more experienced pathologists than from juniors. - Bernard Knight (Forensic Pathology, 2nd Edition, page 47) (N.B. Knight follows up this “ paradoxical quote” with this interesting statement: The younger pathologist is often uneasy about failing to provide a cause of death, feeling that it reflects upon his ability, whereas the more grizzled doctor, enjoying the security of tenure and equality with - or even seniority over - his clinical and legal colleagues, is less inhibited in his admissions of ignorance when the cause of death remains obscure. I have a different opinion - and experience - though ( I am bald, not grizzled however). Frequently when I fail to find a cause of death, with my students standing over my head, I feel very embarrassed, and tend to offer a cause of death, knowing it to be wrong. On the contrary a younger pathologist - certainly in my hospital - is very comfortable - even happy - in facing an obscure death. Because he has the facility of rushing to his senior colleagues and asking for their opinion. An added pleasure for him might be the possible confusion causing to the senior in the process! Readers' opinions on this subject are welcome. Currently there are no entries under this heading. Readers' contributions are welcome. PETECHIAL HEMORRHAGES La seule présence… de extravasations sanguines disséminées… suffit pour démontrer… que la suffication est bien, en réalité la cause de la morte. - Ambroise Tardieu, 1855 (The full citation of the paper in which he made this assertion is: Tardieu A. Ann Hyg Pub et de med Legale (series II) 1855;(6):371-82. This paper is quoted in the paper “Petechial Hemorrhages - A review of Pathogenesis” by Frederick A. Jaffe. American Journal of Forensic Medicine and Pathology 15(3):203-207, 1994) Petechiae arise at the capillary level. - Frederick A. Jaffe, Forensic Pathology Branch, Toronto, Ontario, Canada (in his paper entitled “Petechial Hemorrhages - A review of Pathogenesis”. American Journal of Forensic Medicine and Pathology 15(3):203-207, 1994. This quote appears on page 204, column 2, top line) A common error is to attribute the petechiae to the rupture of capillaries, whereas they actually emanate from small venules - capillary bleeding would be invisible to the naked eye. - Bernard Knight (Forensic Pathology, 2nd Edition, 1996, page 348) (N.B. Note the contradiction between quotes 2 and 3 - both from contemporary books and journals. This is another important forensic controversy that is far from over. For other similar forensic controversies, see quotes on "Forensic Mythology" and "Hydrostatic Test". Interestingly, Bernard Knight, writing under the pseudonym of Bernard Picton in his book "Murder, Suicide or Accident - The Forensic Pathologist at Work", (Robert Hale & Company, London, 1971), has this to say on page 102: "The lining of the smallest blood vessels - the capillaries - is very sensitive to both increased pressure and oxygen lack. When these become deranged, the capillaries become fragile and burst at many points, causing small haemorrhages into the tissues, called 'petechiae'." One would tend to believe that while Knight changed his view between 1971 and 1996, others stuck to the traditional view.) PHILOSOPHICAL Sometimes life is like an autopsy - gutted & emptied. An autopsy reveals the cause of death; whereas, being gutted & emptied can reveal a new beginning in life. - Found as an attachment to the E-mail received from e. catherine on Fri, 22 Sep 2000 PHYSICAL EVIDENCE Physical evidence can not be intimidated. It does not forget. It sits there and waits to be detected, preserved, evaluated, and explained. - Herbert Leon Macdonell (Quoted at the opening page in his book “The Evidence never lies”) Physical evidence does not get excited, like people do. - Herbert Leon Macdonell (Quoted at the opening page in his book “The Evidence never lies”) Wherever he steps, whatever he touches, whatever he leaves even unconsciously, will serve as silent witness against him. Not only his fingerprints or his footprints, but his hair, the fibers from his clothes, the glass he breaks, the tool marks he leaves, the paint he scratches, the blood or semen he deposits or collects - all of these and more bear mute witness against him. This is evidence that does not forget. It is not confused by the excitement of the moment. It is not absent because human witnesses are. It cannot perjure itself. It cannot be wholly absent. Only its interpretation can err. Only human failure to find it, study and understand it, can diminish its value. - Crime Investigation, second edition, Paul L. Kirk (deceased), edited by John I. Thornton (1974), p. 2. (Quoted also in “Footwear Impression Evidence” by William J. Bodziak, at page 1) In the course of a trial, defense and prosecuting attorneys may lie, witnesses may lie, the defendant may certainly lie. Even the judge may lie. Only the evidence never lies! - Herbert Leon Macdonell (Quoted at the opening page in his book “The Evidence never lies”) Absence of Evidence is not the same as Evidence of Absence. - Howard Frumkin, M.D. Emory University School of Public Health, Chairmain, Dept: of Environmental & Occupational Health (Quoted in Jornal of Forensic Sciences, March 2000 at page 510) POISON, DEFINITION OF Poison is any substance, which introduced into the system, either directly or by absorption, produces violent, morbid or fatal changes, or which destroys living tissue with which it comes in contact. - Watkins v. National Elec. Products Corp., C.C.A. Pa., 165, F. 2d 980, 982 Poison: Any substance which, when relatively small amounts are ingested, inhaled, or absorbed, or applied to, injected to, or developed within the body, has chemical action that may cause damage to structure or disturbance of function producing symptomology, illness or death. - Stedman’s Medical Dictionary, 26th Edition, Williams & Wilkins, Baltimore MD, 1995 Poison: Any substance which, when ingested, inhaled or absorbed, or when applied to, injected into, or developed within the body, in relatively small amounts, by its chemical action may cause damage to structure or disturbance of function. - The Sloane-Dorland Annotated Medical-Legal Dictionary, West Publishing Company, New York, NY, 1987 Poison is any substance in relatively small quantities that can cause death or illness in living organisms by chemical action. The qualification “by chemical action”, is necessary because it rules out such effects as those produced by a small quantity of lead entering the body at high velocity. - Scientific American (N. B. It may be interesting to note that the usual fatal dose of a lead salt such as lead acetate is considered to be about 20 g. A lead bullet weighing 20 g can also kill a person, but in that case, the death would not be by chemical action, and thus lead in the second case, would not be supposed to kill as a poison!) POISONS AND TOXINS All substances are poisons. There is none, which is not. The right dose differentiates a poison and a remedy. - Paracelsus (1495-1541), Swiss physician and Chemist (N. B. There are several versions of this quote, which differ. This is understandable as this quote has been translated in English from a different language. The real quote in the original language is given in “Handbook of Pesticide Toxicology, Vol. 1 (Principles), page xxvii, 2nd Edition, Edited by Robert I. Krieger, (Academic Press, 2001)”. The quote -in German- goes like this, “Alle Ding sind Gift und nichts ohn Gift; alein die Dosis macht das ein Ding kein Gift ist”. Krieger in his Foreword goes on to say, “With the exception of E=mc2, perhaps no other single statement has wielded such force in establishing the popular notoriety and the professional stature of an individual in the history of science as the words just quoted”. This in itself appears a very fine quote to me!). Other similar quotes attributed to him are- What is there that is not poison. All things are poison and nothing (is) without poison. Solely the dose determines that a thing is not a poison.) --- Even nectar is poison if taken in excess. - Hindu Proverb (Quoted in “Encyclopedia of Clinical Toxicology” by Irving S. Rossoff, 2002, “The Parthenon Publishing Group”, a CRC Press Company, page vi) Give me a decent bottle of poison and I’ll construct the perfect Crime. - Agatha Christie (Quoted in “Dame Agatha’s poisonous pharmacopoeia”. The Pharmaceutical Journal. Dec 23 & 30, 1978, Page 573) Alcohol, Hashish, Prussic acid, strychnine are all weak dilutions; the surest poison is time. - Ralph Waldo Emerson (1803-1882): American poet, essayist, philosopher The gnat that sings his summer song Poison gets from slander's tongue, The poison of the snake and newt Is the seat of envy's foot. The poison of the honey bee Is the artist's jealousy. - Blake, (Auguries of Innocence) There is no such thing as a safe drug - only safe doses. - C. Pippenger There are no safe drugs, only safe ways of using them. - Voltaire (quoted in “Introduction to Toxicology” 2nd Edition by J. A. Timbrell, 1995, Taylor & Francis Ltd, at page 61) The dose is the difference between the victim and the patient. - M. Gerald Plants are the most overrated poisons of childhood. - N.C. Fraser in “ Accidental poisoning deaths in British children 1958-77”. Br Med J 1980; 280: 1595-1598 (In a survey of deaths due to accidental poisoning in British children, out of 598 registered deaths over 20 years, Fraser found that only three were attributable to the ingestion of plant poisons!) Having sniffed the dead man’s lips, I detected a slightly sour smell, and I came to the conclusion that he had poison forced upon him. - Sherlock Holmes, in Sir Arthur Conan Doyle’s “A Study in Scarlet” (Quoted in “Hard Evidence” By David Fisher at page 23) Poisons and medicines are oftentimes the same substance given with different intents. - Peter Mere Latham Passion (poison) often makes fools of clever men; sometimes even makes clever men of fools. - La Rochefoucauld I maintain that though you would often in the fifteenth century have heard the snobbish Roman say, in a would-be-off-hand tone, “I am dining with the Borgias tonight”, no Roman was ever able to say, “I dined last night with the Borgias.” - “And Even Now”, Max Beerbohm When you consider what a chance women have to poison their husbands, it’s a wonder there isn’t more of it done. - Kim Hubbard Most signs and symptoms associated with natural disease can be produced by some poison, and practically every sign and symptom observed in poisoning can be mimicked by those associated with natural diseases. - L. Adelson Poison is a chemical bomb. - John Harris Trestrail III, on page 30 of his book “Criminal Poisoning”, Humana Press, 2000 If you poison us, do we not die? - The Merchant of Venice. III.i.69 (quoted on the front page in “Curare -Its history and usage” by K. Bryn Thomas, Pitman Medical Publishing Co. Ltd. London, 1964. I found this book while leisurely scanning the S.M.S. Medical College library at Jaipur on 14 June 2001, when I had gone there as a post-graduate examiner) Poison is a silent weapon. - John Harris Trestrail III, on page 31 of his book “Criminal Poisoning”, Humana Press, 2000 Revolted by the odious crime of homicide, the chemist’s aim is to perfect the means of establishing proof of poisoning so that the heinous crime will be brought to light and proved to the magistrate who must punish the criminal. - “Traite de Poison”, M.J.B. Orfila (1814) MARTHA: “Well, dear, for a gallon of elderberry wine, I take one teaspoonful of arsenic, and add a half a teaspoonful of strychnine, and then just a pinch of cyanide. - “Arsenic and Old Lace” by Joseph Kasserling, New York Pocket Books, New York, NY, 1944 (quoted by John Harris Trestrail III in his book “Criminal Poisoning” on page 93. Also by Serita Deborah Stevens and Anne Klarner in their book “Deadly Doses - A writer’s guide to poisons”, Writer’s Digest Books, Ohio, 1990 on page 10) If all those buried in our cemeteries who were poisoned could raise their hand, we would probably be shocked by the numbers! - John Harris Trestrail III, in this book “Criminal Poisoning” on page 99 And yonder soft phial, the exquisite blue Sure to taste sweetly - is that poison too? - R. Browning (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 191, in Chapter 11 entitled "Forensic Chemistry") It would be nice if someday, like Star Trek’s Dr. McCoy, we could pass a “Tricorder” over the body in question and thereby scan for over a million different chemical entities. - John Harris Trestrail III, in this book “Criminal Poisoning” on page 71, stressing the fact that when an analytical result for toxicology comes negative, it does not necessarily mean that the specimen was free of all chemical substances. It only means that none of the substances tested for were present in detectable quantities. Every death with no visible signs of trauma must be considered a poisoning until the facts prove otherwise. - John Harris Trestrail III, in this book “Criminal Poisoning” on page 99 Doctors put drugs of which they know little, into our bodies of which they know less, to cure diseases of which they know nothing at all. - Voltaire (quoted in “Introduction to Toxicology” 2nd Edition by J. A. Timbrell, 1995, Taylor & Francis Ltd, at page 61) POISONS (INDIVIDUAL) ACETAMINOPHEN APAP - induced heart injury? May be yes, may be no. Next question? - Title of a paper by Martin J. Smilkstein in Clinical Toxicology, 34(2), 155-156 (1996) I have just taken Tylenol, will I die? - A frantic call made by several Americans in September - October 1982 to poison centres, following unfortunate deaths of 7 people, who took Tylenol Capsules, which all turned out to be laced with cyanide. Such a panic spread among the Americans that many reported that their toothpaste smelt oddly or their antacids tasted strangely. Many pharmacists described this reaction as “Tylenol Syndrome”. (Taken from “Dunea G. Death over the Counter. British Medical Journal, Vol, 286, 15 January 1983, pages 211-212”. This incident is also reported in “Forensic Pharmacology - Medicines, Mayhem, and Malpractice” by R.E. Ferner, Oxford University Press, 1996, at page 15) ARSENIC Arsenic was a popular homicidal poison; women purchased it with the ostensible excuse of destroying rats. The rat in this context was usually the husband! - Anonymous The history of arsenic poisoning is, at the same time, the history of murder by means of poisoning. - Leschke (quoted in “The Power of Poison” by John Glaister, Chritopher Johnson, London, 1954, page 78) ACONITE Aconite is useful to hunters for destroying tigers and elephants, useful to the rich for putting troublesome relatives out of the way, and useful to jealous husbands for destroying faithless wives. - saying common among Lepchas of Sikkim, India CHLOROFORM Now she's acquitted, she should tell us in the interests of science how she did it! - Sir James Piaget, a distinguished Victorian surgeon, exhorting Adelaide Bartlett, when she was acquitted, to tell how she killed her husband by giving him chloroform (quoted in "Murder - What dunit" by J.H.H. Gaute & Robin Odell, at page 93) DATURA Datura makes you hot as a hare, blind as a bat, dry as a bone, red as a beet and mad as a hen. - H.G. Morton And some of them ate plentifully of it, the effect of which was a very pleasant Comedy; for they turned natural Fools upon it for several Days. One would blow a Feather in the Air; another would dart straws at it with much fury; and another stark naked was sitting up in a Corner, like a Monkey grinning and making Mows at them; a Fourth would fondly kiss and paw his Companions, and sneer in their Faces with a Countenance more antik than any in a Dutch Droll. - Robert Beverly, describing the condition of some soldiers who accidentally ate Datura stramonium (Jimson weed) leaves in their salad. This description appears in the book “History and Present State of Virginia”, Book 2 (1705 A.D.), p 24 (N.B. This is one of the most widely quoted quotes on Datura stramonium by medical and lay authorities alike. It has appeared in (i) JAMA 1939; 112:2500-2 in a paper by JD Hughes and JA Clark Jr. (ii) Editorial, Lancet 1948;i:649-50 (iii) Clinical Toxicology by CJ Polson, MA Green, MR Lee, 3rd Edition, page 393 (iv)The Medical Detectives by Berton Roueché, Washington Square Press 1980, page 184) DDT I hate Bosco, It's full of DDT. Mommy put it in my milk to try to poison me. But I fooled Mommy, I put some in her tea. Now there's no more Mommy to try to poison me. - Children's rhyme (Quoted in "The New England Journal of Medicine" Volume 330:1095, April 14, 1994, Number 15, (in the Review of the book "The Poisonous Pen of Agatha Christie" By Michael C. Gerald. 275 pp. Austin, Tex., University of Texas Press, 1993. $32.50. ISBN 0-292-76535-5). Review by Orah S. Platt, M.D. and Richard Platt, M.D.,Children's Hospital Medical Center, Boston, MA 02215. Available on the net at http://content.nejm.org/cgi/content/full/330/15/1095) HELLEBORE Besides, hellebore is rank poison to us, but given to goats and quails makes them fat. - Lucretius: “De Rerum Natura” Book 4, lines 640-641, Translated by W.H.D. Rouse (This quote appears in “Handbook of Pesticide Toxicology, Vol. 1 (Principles), page 109, 2nd Edition, Edited by Robert I. Krieger, (Academic Press, 2001)” HYOSCINE ‘.. .Upon my secure hour thy uncle stole, With juice of cursed hebenon in a vial, And in the porches of mine ears did pour The leprous distilment.. .’ - Hamlet, Act 1, Scene 5 (Quoted in “The Encyclopedia of Forensic Science” by Brian Lane, Headline 1992, at page 375 MERCURY Mercury is ‘the hottest, the coldest, a true healer, a wicked murderer, a precious medicine, and a deadly poison, a friend that can flatter and lie’. - Woodall J. (1639), The Surgeon’s Mate or Military & Domestic Surgery, London, p256 (quoted from Cassarett and Doull’s Toxicology. Also quoted in “Introduction to Toxicology” 2nd Edition by J. A. Timbrell, 1995, Taylor & Francis Ltd, at page 118) MUSHROOMS There are old Mushroom Hunters and Bold Mushroom Hunters, but no Old Bold Mushroom Hunters. - Anonymous Had nature any outcast face? Could she a son condemn? Had nature an Iscariot That mushroom - it is him - Emily Dickinson (Quoted in “Wilderness Medicine”, 4th edition, by Paul S. Auerbach, Mosby, 2001; chapter 49 entitled “Mushroom Toxicity” by Sandra Schneider and Mark Donnelly, page 1141) PHOSPHORUS Keep any cakes and sandwiches over, for the funeral. - Mrs. Mary Elizabeth Wilson of Durham, who poisoned her two husbands with phophorus, jokingly at her wedding feast in 1958 (Quoted in “The Bedside Book of Murder” by Richard & Molly Whittington-Egan, at page 81) STRYCHNINE We’ll murder them all amid laughter and merriment, Except for a few we’ll take home to experiment. My pulse will be quickenin’ with each drop of strychnine we feed to a pigeon. (It just takes a smidgin!) To poison a pigeon in the park. - Tom Lehrer (1928- ): in “Poisoning Pigeons in the Park” (1953) TOADS (POISONOUS) Toad, that under cold stone, Days and nights went thirty-one, Swelter’d venom sleeping got, - Shakespeare alluding to the evil reputation of the toad in Macbeth (Reproduced from “Poisons and Poisoners” by C.J.S. Thompson, page 103) POLICE AND POLICING The more technical knowledge a police officer possesses, the greater the probability of securing not only a criminal arrest but also a guilty verdict from the jury. - Howell 1988 (Quoted in “Tire Imprint Evidence” by Peter McDonald, 1989 Elsevier, page 189) The police are the public and the public are the police. - Sir Robert Peel (Quoted in “Criminal Investigation - Basic Perspectives” by Paul B. Weston, Charles Lushbaugh and Kenneth M. Wells, eighth edition, 2000, Prentice Hall, page 396) You become a cop so you can watch the parade from the front. Detective is even better because you don’t have to be in uniform to watch the parade. - Detective Captain Frank Bolz (quoted in “Cop Talk” by E.W.Count, Pocket Books, 1994. The quote appears at the beginning of the book) POST MORTEM CHANGES PUTREFACTION The process of putrefaction is simple in its complexity and complex in its simplicity, resting upon the variables operating in a particular case. - Dr. Krishan Vij, Professor and Head, Department of Forensic Medicine, Government Medical College, Chandigarh, India, in his book “Textbook of Forensic Medicine - Principles and Practice”, B.I. Churchill Livingstone, 2001, page 186 QUESTIONED DOCUMENTS It is a compliment to monetary stability when currency is forged. - Jay Levinson in his book “Questioned Documents - A Lawyer’s Handbook”, Academic Press 2001, page 165 It is competent for a judge and jury to compare the handwriting of a disputed document. - A Canadian Court in 1918, in the case Rohoel v. Darwish, 1 WWR 627; 13 Altn LR 180 (Quoted by Jay Levinson in his book “Questioned Documents - A Lawyer’s Handbook”, Academic Press 2001, page 1) No matter how extensive his background may be, no document examiner can know all the answers to all the questions. - Jay Levinson in his book “Questioned Documents - A Lawyer’s Handbook”, Academic Press 2001, page 24 “Handwriting” is not hand writing. - Ron N. Morris in his book “Forensic Handwriting Identification: Fundamental concepts and principles”, Academic Press 2000, page 1 (N.B. To those who find this interesting little quote confounding, the following lines from the same page may be quoted. Morris follows up this quote with this: There are a substantial number of people who are not able to use their hand so they write with their foot, mouth etc. Writing is actually a brain function and the hand, foot, mouth etc are merely the devices which carry out brain orders.) ROAD SIDE VEHICULAR ACCIDENTS There are only two classes of pedestrians these days - the quick and the dead. - Lord Dewar (1864-1930) (Quoted in “The Pathology of Trauma” 2nd Edition, Edited by J.K.Mason, page 17) Drive slowly, reach safely, And not race with the devil, To reach the tomb prematurely. - S.C. Mestri (Professor and Head, Dept. of Forensic Medicine, KIMS, Hubli-580022, India), in “Preventive and safety measures to be adopted in road traffic accidents”, Journal of Karnataka Medicolegal Society; 9(2): December 2000, pages 28-30 (this quote appears on page 30) I wasn’t the driver. - Statement often made by occupants of an automobile which has been involved in a fatal collision. (cited on page 24 of “Encyclopedia of Forensic Sciences” edited by Jay A. Siegel, Pekka J. Saukko and Geoffrey C. Knupfer. 2000 Academic Press.) SCENE OF CRIME “Lestrade showed us the exact spot at which the body had been found, and indeed, so moist was the ground, that I could plainly see the traces which had been left by the fall of the stricken man. To Holmes, as I could see by his eager face and peering eyes, very many other things were to be read upon the trampled grass.” - Dr. Watson, the companion of the Legendary Sherlock Holmes in “The Boscombe Valley Mystery” by Arthur Conan Doyle Scenes as well as suspects often conceal the truth. - Jon J. Nordby, forensic science investigative consultant, in his book “Dead Reckoning - The Art of Forensic Detection”, CRC Press 2000, on page 23 SERIAL KILLERS They are the waste product of our frustrated, bored, over-stressed Western industrialized society. - Sean Mactire in his book “Malicious Intent-A writer’s guide to how murderers, robbers, rapists and other criminals think”. Writer’s Digest Books, Cincinnati, Ohio, 1995. This quote appears in on page 67, in 5th chapter entitled “Serial Murder”) SEXUAL OFFENCES No man shall have sexual intercourse with any woman against her will. - Charaka Samhita (Book of Medicine written in the 4rth Century B.C. by the Ancient Hindu writer Charaka) In no state can a man be accused of raping his wife. How can any man steal what already belongs to him? - Susan Griffin, American Poet (Ramparts, September 1971) … marriage [is] in modern times regarded as a partnership of equals and no longer one in which the wife [is] the subservient chattel of the husband. - Lord Keith in Regina v R. 23 October 1991 (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 138) Rape is the only crime in which the victim becomes the accused and, in reality, it is she who must prove her good reputation, her mental soundness, and her impeccable propriety. - Freda Adler, American Educator (Sisters in Crime, 1975) Insertion or thrust of male organ between the thighs kept tight amounts to penetration sufficient to constitute rape. - In the Indian case of State v Gobindan, 1969 Cr LJ 818 Rape is an accusation easily to be made and hard to be proved and yet harder to be defended by the party concerned though never so innocent. - Khelleher v Queen, 1974 (131) Commonwealth Law Reporter 534 The act of actus reus is complete with penetration and emission is not essential or relevant. - Queen v Marsden, 1821 QBD 149 If his bones in general, and his shoulders are strongly made, if his gait and voice are vigorous, by these tokens may a potent man be known; and one impotent by the opposite characteristics. - Narada Smriti (Ancient Hindu text) There is no difference between being raped and being bit on the ankle by a rattlesnake except that people ask if your skirt was short and why you were out alone anyhow. - (Mary Piercy, excerpt from 'Rape Poem': Reproduced in "Clinical Approaches to sex offenders and their victims" edited by Clive R. Hollin and Kevin Howells, at page 261 The worst myth that has to be busted is that rape and sex crimes are about sex. They are only about power and anger. - Sean Mactire in his book “Malicious Intent-A writer’s guide to how murderers, robbers, rapists and other criminals think”. Writer’s Digest Books, Cincinnati, Ohio, 1995. This quote appears in on page 94, in 7th chapter entitled “Sexual predators”) Not enough people understand what rape is, and, until they do.. .., not enough will be done to stop it. - rape victim (quoted in “Men Who Rape” by N. Groth 1979, Plenum p.87, also quoted in “A Natural History of Rape” by Randy Thornhill and Craig T. Palmer, 2000, MIT Press, on page 1) SUDDEN DEATH The fact that an AV or SA node, or the bundle of His or its branches shows fibrosis or some other lesion, does not necessarily mean that this played any part in the death. - Bernard Knight (Forensic Pathology, 2nd Edition, page 498) SUDDEN INFANT DEATH SYNDROME (SIDS) ..there has developed a “maxim in Forensic pathology: one unexplained infant death in a family is SIDS. Two is very suspicious. Three is homicide.” This is dangerous and scientifically shaky dogma. - (Cyril H. Wecht, MD, JD , Coroner of Allegheny County , Pittsburgh, in JAMA Jan 7, 1996, Vol. 279, No. 1, page 85) (N.B. A little background above the above quote may be appreciated. This above maxim developed following Van Der Sluys case in 1986, Tinning case in 1987 and Wanda Hoyt case in 1995, each of which involved three dead infants. Wanda Hoyt was convicted of murder in 1995) Elevated T3 levels in SIDS can be considered as a post-mortem artifact. - J.I.Coe (in “Postmortem chemistry update. Emphasis on Forensic Application". Am. J. Forensic Med Pathol, 1993, 14, 91-117; cited in “de Letter EA, Piette MHA, Lambert WE, De Leenheer AP. Medico-Legal Implications of Hidden Thyroid Dysfunction: A study of two cases. Med. Sci. Law (2000)Vol. 40, No. 3, Pp 251-257, on page 255) SIDS is perhaps the greatest single medical mystery confronting scientists. - (Cyril H. Wecht, MD, JD , Coroner of Allegheny County , Pittsburgh, in JAMA Jan 7, 1996, Vol. 279, No. 1, page 86) SUICIDE If one wants to get away with murder, one has to jolly well keep one’s wits about one. It’s the same way with suicide. - Starr Faithful (1931) (quoted in “Murder - Whereabouts” by J.H.H. Gaute and Robin Odell, page 78) Every homicide is also unconsciously a suicide and every suicide in a sense a psychological homicide. - Stephen Nordlicht, MD, Clinical Associate Professor in Psychiatry, Cornell University Medical College, in his paper entitled “Medical Deterrents” published in Bull. N.Y.Acad. Med. Vol. 62, No. 5, June 1986. This quote appears on page 584 TERRORISM “Terrorism” means the use of violence for political ends, and includes any use of violence for the purpose of putting the public or any section of the public in fear. - Prevention of Terrorism (Temporary Provisions) Act 1989, s.20(1) (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 71) THROMBOSIS, DEEP VEIN Deep vein thrombosis is a hazard of long air flights. - Bernard Knight (Forensic Pathology, 2nd Edition, page 507) TIME SINCE DEATH Estimating the time of death is one of the most difficult and inaccurate techniques in forensic pathology. - Milton Helpern in his book “Autopsy - The Memoirs of Milton Helpern, the World’s greatest medical detective”, published by St. Martin’s Press, New York, 1977, on page 116 The time of death is sometimes extremely important. It is a question almost invariably asked by police officers, sometimes with a touching faith in the accuracy of the estimate. Determining the time of death is extremely difficult, and accuracy is impossible. - Bernard Knight, Legal Aspects of Medical Practice, 4th edition, 1987, Churchill Livingstone, Edinburgh page 115 I will be the first to admit that if any physical or even mental disturbance occurs soon after the food is swallowed, the whole digestive process can be drastically altered. - Milton Helpern in his book “Autopsy - The Memoirs of Milton Helpern, the World’s greatest medical detective”, published by St. Martin’s Press, New York, 1977, on page 118 Considering the variables which influence the rate of body heat loss, the best one can say about the reliability of algor mortis as a post mortem clock is that it permits a rough approximation of the time of death. Errors in over-estimating and under-estimating the post mortem interval based on body cooling are common, even in the face of considerable experience by those making the estimate. Body temperature as an indicator of the post mortem interval should be correlated with all other phenomenon and observations utilised in establishing the time of death. - Adelson, The Pathology of Homicide, 1974, Thomas, Springfield, Illinois, page 164 To offer an unreasonably accurate time of death is worse than providing such a wide range on times that the police derive no help from it. - Bernard Knight in “The Estimation of the Time Since Death in the Early Postmortem Period”, Edward Arnold, 1995, page 2 A medical witness who attempts to determine the time of death from temperature estimation in minutes or fractions of hours is exposing himself to a severe challenge to his expertise which may well amount to near ridicule, thus denegrating the rest of his evidence. - Polson, Gee and Knight, The Essentials of Forensic Medicine, 4th edition, 1985, Pergamon Press, Oxford, page 12 It is often the least experienced medical witness who tends to offer the most accurate estimate of time since death. - Bernard Knight in “The Estimation of the Time Since Death in the Early Postmortem Period”, Edward Arnold, 1995, page 2 Livor mortis, rigor mortis and algor mortis … provide, at best, “postmortem windows”. - Stephen J. Cina, Charleston County Medical Examiner’s Office, Charleston, SC 29425, USA (Quoted by him in his paper “Flow Cytometric Evaluation of DNA Degradation: A predictor of Postmortem Interval?”. American Journal of Forensic Medicine and Pathology 15(4):300-302, 1994) The opinion of any doctor who offers a single time of death, instead of a range, must be viewed with suspicion. - Bernard Knight in “The Estimation of the Time Since Death in the Early Postmortem Period”, Edward Arnold, 1995, page 2 No problem in forensic medicine has been investigated as thoroughly as that of determining the time of death on the basis of post mortem findings. Apart from its obvious legal importance, its solution has been so elusive as to provide a constant intellectual challenge to workers in many sciences. In spite of the great effort and ingenuity expended, the results have been meagre - Jaffe, A Guide to Pathological Evidence : For Lawyers and Police Officers, 2nd edition, 1983, Carswell Criminal Law Series, Carswell Ltd., Toronto, page 33 Repeated experience teaches the investigator to be wary of relying on any single observation for estimating the time of death (or "duration of the post mortem interval"), and he wisely avoids making dogmatic statements based on an isolated observation. - Adelson, The Pathology of Homicide, 1974, Thomas, Springfield, Illinois, page 151 Formerly, it was a hallowed "rule of thumb" that the rectal temperature dropped at an average of 1.5oF per hour, rather faster during the first few hours. This method was a guarantee of inaccuracy, but little has been found to replace it. - Bernard Knight, Legal Aspects of Medical Practice, 4th edition, 1987, Churchill Livingstone, Edinburgh, page 119-120 Some difference of opinion exists over the use of a thermometer at the scene of a suspicious death. Considerable caution must be employed when considering the taking of a rectal temperature with the body in situ. If there is any possibility at all of some sexual interference, whether homosexual or heterosexual, no intereference with the clothing or perineum must be made until all forensic examinations have been completed. Certainly, no instrument should be inserted into the rectum before trace evidence has been sought. - Polson, Gee and Knight, The Essentials of Forensic Medicine, 4th edition, 1985, Pergamon Press, Oxford, page 9-10 The timing of the sequence of events concerned in the dissolution of the body cannot be done with accuracy and one must be cautious never to pronounce too readily that the decomposed state of the body is inconsistent with the time interval alleged. - Camps, Lucas, Robinson, Gradwohl's Legal Medicine, 3rd edition, 1976, John Wright & Sons, Bristol, page 91 TIRE IMPRINT EVIDENCE I am familiar with forty-two different impressions left by tyres. - Sherlock Holmes to Dr. Watson in “The Adventure of the Priory School” 1901 A motor vehicle is used in 75 percent of all the major crimes reported today. - Given, Nehrich and Shields 1977 (Quoted in “Tire Imprint Evidence” by Peter McDonald, 1989 Elsevier, page 37) The ultimate goal of the tire track investigation is the identification of the vehicle producing the track. - Given, Nehrich and Shields 1977 (Quoted in “Tire Imprint Evidence” by Peter McDonald, 1989 Elsevier, page 67) Tire “Footprints” help solve Homicide cases (Title of article in Law and Order 1981) - Quoted in “Tire Imprint Evidence” by Peter McDonald, 1989 Elsevier, page 111 TONGUES OF SLIP “They told me you could help me, Dr. Zak… the people at the Funny Society.. .er.. . I mean the Forensic Society". - A patient (Henry Nash) over phone to forensic entomologist Zakaria Erzinçlioglu (quoted by Zakaria Erzinçlioglu in his biographical book “Maggots, Murder and Men - Memories and Reflections of a Forensic Entomologist” Harley Books, England 2000, on page 138) TRACE EVIDENCE Every contact leaves a trace. - Edmond Locard (1877-1966), Pioneering French Criminologist (This is often touted as the “Locard’s Exchange Principle”. Although nothing is wrong in this statement, the true principle goes like this: “The dust and debris that cover our clothing and bodies are the mute witnesses, sure and faithful, of all our movements and all our encounters.” It is quoted on page 299 of “Encyclopedia of Forensic Sciences” edited by Jay A. Siegel, Pekka J. Saukko and Geoffrey C. Knupfer. 2000 Academic Press.) For a long time he remained there, turning over the leaves and dried sticks, gathering what seemed to me to be dust into an envelop and examining with his lens not only the ground, but even the bark of the tree as far as he could reach. - Dr. Watson recalling the actions of Sherlock Holmes in “The Boscombe Valley Mystery” If evidence has been properly gathered and preserved, a mistake in interpretation may always be corrected. If the facts required for a correct interpretation are not preserved, the mistake is irreversible. - Alan R. Moritz, MD (Quoted in "The Pathology of Trauma" 2nd Edition, Edited by J.K.Mason, page 227) What is not looked for will not be found! - William J. Bodziak in his book “Footwear Impression Evidence” at page 2 The best evidence in the world will not stand up in court if the jurors have doubts about its integrity. - Los Angeles Times (Quoted in “Criminal Investigation - Basic Perspectives” by Paul B. Weston, Charles Lushbaugh and Kenneth M. Wells, eighth edition, 2000, Prentice Hall, page 6) Trace evidence is one of the most valuable, misunderstood, misused and underutilised forms of physical evidence. - Peter R. De Forest in his chapter "What is trace evidence" in the book "Forensic Examination of Glass and Paint" edited by Brian Caddy, Taylor & Francis, 2001, page 23 Currently there are no entries under this heading. Readers' contributions are welcome. Currently there are no entries under this heading. Readers' contributions are welcome. WITTICISMS Well folks, you’ll soon see a baked Appel. - George Appel, as he was being strapped into the electric chair in 1952 (Quoted in “Witticisms of 7 condemned criminals” on page 87 in “The Book of Lists #3” by Amy Wallace, David Wallechinsky and Irving Wallace) Nothing will happen until I get there. - Guy Clark (1832) on the way to gallows to the sheriff, when he asked him to speed up the pace (Quoted in “Witticisms of 7 condemned criminals” on page 87 in “The Book of Lists #3” by Amy Wallace, David Wallechinsky and Irving Wallace) You work in forensics and you don't know what FUBAR means???? - Contributed by James (Jamie) Crippin , Colorado Bureau of Inv., 3416 N Elizabeth St., Pueblo, CO 81008. Phone: 719-542-1133 (N.B. Anyone, who wants to know more about this interesting quote, or wants to know what FUBAR means, may want to get with touch with Mr. Crippin himself. He can be contacted by clicking on his name) When in doubt, think dirty. You’ll be right ninety percent of the time. - An old pathologist to Dr. William R. Maples (N.B. Dr. William R. Maples gives this quote in his book “Dead Men do tell tales” at page 11. Dr. Maples goes on to say, that it was good advice and that he put it to good use on many occasions.) Better save that. We'll need it for the autopsy. - A surgeons’ conversation overheard during a life saving surgery - sent by Dr. Vivek Jain, MD (Skin & VD) Forensic medicine in most of the countries is some kind of an unwanted Cinderella. - Dr. Peter Kovac, Institute of Forensic Medicine, Comenius University, Bratislava, Sasinkova 4, 81103 Slovakia (In an informal E-mail sent to this webmaster on 23 November 2000) To treat is human, to dissect divine. - This is the answer I frequently give to people who ask me why I left a lucrative career in medicine (way back in 1979) to take up forensic pathology Those who can, dissect; those who can’t, dissent. - Another perfectly valid answer to the same question, although I don’t remember having said this to anyone WOUNDS INCISED Incise the abdomen and conceal the jewel. - An old Chinese Proverb (Quoted in “Forensic Science”, 2(1973) 191-199 at page 191) PENETRATING Makes such a wound the knife is lost in it. - Shelley (Cited in "Recent Advances in Forensic Pathology" edited by Francis E. Camps, J.& A. Churchill Ltd., 1969, on page 101, in Chapter 6 entitled "The interpretation of wounds (Penetrating)") Currently there are no entries under this heading. Readers' contributions are welcome. Currently there are no entries under this heading. Readers' contributions are welcome. Currently there are no entries under this heading. Readers' contributions are welcome. Know a forensic quote which does not appear here? Well why not share it with us, and add to this growing pool of forensic quotes. Your contribution would appear with due credit to you. For submitting your quote, mail me. Contact

Main Page > Vol-26 No- 2 > Book 1 (you are here) LinkedIn X (Twitter) Facebook Copy link Share Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26 Number 2 (July - December 2025) Book Review (Technical Section) Basic Sciences as applied to Forensic Medicine and Toxicology By Anil Aggrawal Basic Sciences as applied to Forensic Medicine and Toxicology, 1st Edition, Publication date: 2025, by Anil Aggrawal , Paperback, Publisher: Arya Publishing Company, ISBN 9789360590864, Language: English, Pages: XVIII + 301. Price: ₹ 1310. A forensic masterclass in basic sciences for postgraduates. The current book by the Author is an attempt- novel and unique, in the sense that the effort is inspired by the Indian post-graduate curriculum designed by the erstwhile Medical Council of India (known as National Medical Commission now) for M.D. course in the discipline of Forensic Medicine, more specifically the Paper-I of the Theory examination. The import of the title “Basic Sciences as Applied to Forensic Medicine and Toxicology” is very wide in scope and pertains to all the relevant anatomy, biochemical and physiologic principles, etc which is the basis of understanding the morbid anatomy and application of those to better understand the core Forensic Pathology. The book is an attempt to provide a one stop solution to the postgraduates in the discipline who earlier had to scroll through voluminous texts of Anatomy, Physiology, Biochemistry, etc to derive examination oriented content for better presentation in the examinations. Although the relevant basic sciences applicable to particular topics of interest in Forensic Medicine have already been provided by the Author in his earlier books viz. Textbook of Forensic Medicine & Toxicology, Injuries- Forensic and Medico Legal Aspects and Clinical and Forensic Toxicology, the present book goes several leaps ahead to explain most commonly asked topics from the entire ream of basic sciences which are some of the emerging domains e.g. stem cells, immunohistochemistry and molecular pathology- to name a few. Yet, the book remains connected to the very soul of Forensic Medicine, Traumatology and Toxicology by referring back to prior cited texts and thus avoiding repetition and maintaining chronology stimulating the reader and allowing for both horizontal and vertical integration, which is also the essence of Competency Based Medical Education Curriculum. The text is amply studded with memory aids and some of the handmade diagrams by the Author- one of particular note is memory aid designed for remembering cranial nerves on Page No 18, which makes the anatomical orientation of the various cranial nerves with respect to each other as well as vastly simplifies the topographic anatomy. Not to suffice, the text contains numerous demonstration videos which are a rarity in the existing literature and help the reader in grasping the basic concept e.g. experimental demonstration of the law of Laplace given on page no 51, which helps in conceptual understanding of the abstract terminologies. General Pathology given in Chapter 4 is a welcome inclusion as it helps in understanding the basic pathologic principles which are the basis for understanding and interpreting Forensic Pathology. A clear differentiation between Septicemia, sepsis and septic shock, based on updated scientific criteria is heartening to see on Page no’s 96 and 97. Another exciting feature of the book is the innumerable case studies which make the topics both entertaining to read and further act as reminders how one particular development has a legal bearing or implication. Chapter 6 discusses general pharmacological principles which have importance in the field of clinical and forensic toxicology. Questionnaire towards the end of each topic are though provoking e.g. anti-neoplastic drug for homicide brings one to an old case of murder by means of Lomustine, which is a drug employed for brain tumor treatment but the aplastic anemia and multi-organ failure which are the consequence of it’s overdose resemble natural death. This is significant for even clinicians/ emergency physicians who treat a significant number of accidental drug over-dosages to be mindful of the drug history- both prescriptions as well as Over-the-counter (OTC). The chapter on “Radiology as Applied to Forensic Medicine and Toxicology” is very thoughtfully designed considering the advent of Virtual Autopsy at AIIMS in 2021 by the Government of India after the Virtopsy project under Prof Richard Dirnhofer of the Institute of Forensic Medicine, University of Bern, Switzerland. The radiographs important from the point of view of a forensic practitioner have been given along with comparative diagrammatic representation for simplification purposes. Readers shall be in a better position to interpret the basic postmortem radiographic findings if and when needed. National Board of Examinations (NBE) has been asking one question every year in Paper I of Forensic Medicine DNB Theory Examination based upon biostatistics accounting for 10 marks. The inclusion of statistics as applied to Forensic Medicine and Toxicology in Chapter 8 of the book is a welcome step to strengthen the students with the most essential and desired topics e.g. Null Hypothesis, P-value, Z score, etc. which could be asked. The next chapter on Research Methodology is educative for the thesis going and any researcher to understand the various study designs and how to calculate the sample size for a proposed research study. Types of citations and referencing systems have also been elaborated upon and the various indexing systems have been deliberated upon. This is very much needed for a novice researcher as imprecise understanding of these may create impediments in the growth and advancement of the latter. The last few chapters focus on infrastructural requirements related to setting up of a Museum and Analytical Toxicological Laboratory in the Department of Forensic Medicine and Toxicology. Basic chemistry has been given at the end to simplify the understanding of subtlety and nuances of Forensic Toxicology. Few sample questions have been provided in the appendix which could further be enhanced through the addition of previous year questions from various universities. Tentative thesis/ research topics given in the appendix give important food for thought to the examinees and the research oriented ones. Overall the book is a novel and fresh initiative in an unexplored genre/ theme which will bode well to the lot to whom it is intended to cover- postgraduates in Forensic Medicine & Toxicology and the faculty. - Dr. Varun Modgil He is currently working as Assistant Professor at Dayanand Medical College & Hospital, Ludhiana, Punjab. He was Senior Resident at Postgraduate Medical Education & Research (PGIMER), Chandigarh. He deposed as an expert witness at various courts in Punjab, Haryana and Chandigarh. He has completed his D.N.B. in Forensic Medicine and also published articles in various National & International journals and also delivered guest lectures in National Conferences on Forensic Medicine. He can be contacted at dr_varun_modgil@dmch.edu ,

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Discover diverse career opportunities in forensic science and medicine. Dr. Anil Aggrawal’s expert guide offers insights, resources, and advice for students, graduates, and professionals pursuing a future in forensics. Under Development.

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