“A STUDY OF HISTOPATHOLOGY FINDING OF CARBON PARTICLES

IN TERMINAL BRONCHIOLE / ALVEOLI IN CASES OF DEATH DUE

TO BURNS SUBJECTED TO AUTOPSY AT TIRUNELVELI MEDICAL

COLLEGE”

DISSERTATION

SUBMITTED TO TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,

CHENNAI

in partial fulfilment of

the requirements for the degree of

M.D. (FORENSIC MEDICINE)

BRANCH – XIV

Register No.201724103

TIRUNELVELI MEDICAL COLLEGE,

TIRUNELVELI- 627011

MAY 2020

CERTIFICATE

This is to certify that the dissertation entitled “A STUDY OF

HISTOPATHOLOGY FINDING OF CARBON PARTICLES IN

TERMINAL BRONCHIOLE / ALVEOLI IN CASES OF DEATH DUE TO

BURNS SUBJECTED TO AUTOPSY AT TIRUNELVELI MEDICAL

COLLEGE” is a record work done by Dr. C. SUNDERA MOORTHY, in the

Department of Forensic Medicine, Tirunelveli Medical College, Tirunelveli, during

his post graduate degree course period from 2017-2020.This work has not formed

the basis for previous award of any degree.

Dr. M. RAVICHANDRAN M.D.,

DEAN

Tirunelveli Medical College,

Tirunelveli - 627011.

CERTIFICATE

This is to certify that the work in this dissertation entitled “A STUDY OF

HISTOPATHOLOGY FINDING OF CARBON PARTICLES IN

TERMINAL BRONCHIOLE / ALVEOLI IN CASES OF DEATH DUE TO

BURNS SUBJECTED TO AUTOPSY AT TIRUNELVELI MEDICAL

COLLEGE”, has been carried out by Dr. C. SUNDERA MOORTHY a Post

Graduate under my supervision and guidance for his study leading to fulfillment of

the requirement for the award of M.D. Degree Branch – XIV Forensic Medicine

during the period of 2017 to 2020.

Head of the Department,

Department of Forensic Medicine,

Tirunelveli Medical College,

Tirunelveli.

DECLARATION

I, Dr. C. SUNDERA MOORTHY, solemnly declare that this dissertation

titled “A STUDY OF HISTOPATHOLOGY FINDING OF CARBON

PARTICLES IN TERMINAL BRONCHIOLE / ALVEOLI IN CASES OF

DEATH DUE TO BURNS SUBJECTED TO AUTOPSY AT TIRUNELVELI

MEDICAL COLLEGE” is a bonafide work done by me, under the expert

guidance and supervision of Dr.A.SELVAMURUGAN., MD., DNB., MNAMS.,

Professor and Head, Department of Forensic Medicine, Tirunelveli Medical

College, Tirunelveli. The dissertation is submitted to The Tamil Nadu Dr. M.G.R.

Medical University towards the partial fulfilment of requirements for the award of

M.D. Degree (Branch XIV) in Forensic Medicine.

Place: Tirunelveli Dr. C. SUNDERA MOORTHY,

Date: Postgraduate,

Register No: 201724103

Department of Forensic Medicine,

Tirunelveli Medical College

Tirunelveli-11.

ACKNOWLEDGEMENT

This dissertation is made possible with the combined effort of lot of

people. I take this opportunity to express my gratitude towards them.

I am grateful to the Dean, Dr. M. Ravichandran M.D., Tirunelveli

Medical College, Tirunelveli for permitting me to conduct this study.

I take this chance to express my deep sense of gratitude and humble

thanks to Dr. A. SELVAMURUGAN., MD., DNB., MNAMS., Professor and

Head, Department of Forensic Medicine, Tirunelveli Medical College, Tirunelveli

whose kindness, guidance and constant encouragement enabled me to complete

this dissertation.

My sincere thanks to Dr. M. Seethalakshmi, M.D., Associate Professor,

Department of Forensic Medicine, Tirunelveli Medical College, who helped me

offering most helpful suggestions throughout the study.

My sincere thanks to Dr. P. Prasanna, M.D., Assistant Professor,

Department of Forensic Medicine, Tirunelveli Medical College, who helped me

offering most helpful suggestions throughout the study.

I am grateful to all other Medical Officers, colleagues and staffs of the

Department of Forensic Medicine, Tirunelveli Medical College, Tirunelveli.

Most importantly, I thank the God Almighty for blessing me not only to

complete this study, but in all the endeavours of my life.

CERTIFICATE – II

This is to certify that this dissertation work titled “A STUDY OF

HISTOPATHOLOGY FINDING OF CARBON PARTICLES IN

TERMINAL BRONCHIOLE / ALVEOLI IN CASES OF DEATH DUE TO

BURNS SUBJECTED TO AUTOPSY AT TIRUNELVELI MEDICAL

COLLEGE” of the candidate Dr. C. SUNDERA MOORTHY, with registration

Number 201724103 for the award of M.D. Degree in the branch of FORENSIC

MEDICINE (XIV). I personally verified the urkund.com website for the purpose

of plagiarism Check. I found that the uploaded thesis file contains from

introduction to conclusion page and result shows 0 percentage of plagiarism in the

dissertation.

Guide & Supervisor sign with Seal.

CONTENTS

Sl.No Title Page No.

1. INTRODUCTION 1

2. AIM OF THE STUDY 13

3. REVIEW OF LITERATURE 14

4. MATERIALS AND METHODS 52

5. RESULTS 55

6. DISCUSSION 70

7. CONCLUSION 77

8. RECOMMENDATIONS 78

9. BIBILOGRAPHY

10. ANNEXURES

1

INTRODUCTION

Forensic medicine deals with application of medical

knowledge to explore solutions to cases of medico legal importance.

Autopsy is procedure consists of thorough examination of a corpse by

dissecting it to determine the cause of death.

Anatomical dissection is done to study the anatomical

structures of human body. It is done by anatomist and students for

academic purpose. This is done on donated bodies and on unclaimed

bodies. Pathological autopsy guides for detailed study of clinical course

and pathology of disease causing mortality. It is usually done with consent

from deceased relatives. Common purpose necessitating autopsy is to

decide the cause of unexpected death where the diagnosis could not be

made. In some cases pathological autopsies are done to confirm diagnosis

where it was doubtful.

Medico legal autopsy is conducted after receiving requisition from

the Investigating Officer. It is done in cases of unnatural deaths or in

deaths under unnatural circumstances. In such instances IO will hold the

inquest and send the deceased body for conducting post-mortem

examination. After conducting post mortem examination opinion

regarding cause of death, manner of death and time since death are given

2

to Investigating Officer for conducting his investigation for administration

of justice to the deceased person and his / her relatives

A registered medical practitioner only certifies death but if the person was

brought dead to a doctor, if the death was unnatural such as accident,

homicide or suicide, attack by animals, by machinery at work place,

anaesthetic death and suspicious death he converts that as MLC. In such

cases it’s the responsibility of the doctor to inform it to the nearby Police

Station and proceed as medico legal case and if IO requests, post-mortem

examination must be done.

According to Indian statistics self-destruction of their own life i.e. suicide

is nearly three times higher than homicide. India stands for about 17% of

overall suicides worldwide and holds one of the top countries with high

suicidal rates. Methods of committing suicide differs between

geographical regions, social factors, gender and cause availability. The

most common modes of suicide includes consuming poisons 33%

hanging-26%, self-immolation-9%. Among them self-immolation in

women are in higher proportion than men to commit suicide

The most interesting novels pace around the death of a person making

readers imagine of multiple ideas of guess to decide whether it is homicide

or suicide. There are not only winning stories where homicide are being

3

detected as suicides; with the reversal gaining much more enthusiasm for

readers, when the suicide is dramatized as homicide with some gain.

In case of unnatural deaths due to fire arm injury, hanging, stab injury due

to knife or any other sharp weapons or death due to poison, it is feasible

to come into conclusion whether it is antemortem or post-mortem by

detailed forensic evaluation. But in some cases of death due to burns it is

difficult to decide whether it is antemortem or post-mortem burns.

According to WHO burns are serious public health problem, more than

96% of fire related deaths occurs in developing and underdeveloped

countries. Millions of people are left by lifelong disfigurement and

disabilities due to burns sequela.

At the same time injuries due to burns and their outcome is a serious

public health problem in India. Thermal burns appear to be one of the

major public health and medico legal issue in India. Burns is a devastating

injury any person can sustain. According to “National Health Portal of

India”(The authentic health information by Ministry of Health and Family

Welfare) that there are about 70 lakhs people experience burns injuries

every year, around one lakh forty thousand deaths and two lakhs

forty thousand were affected by its sequel. The victims commit suicide

by burning for two common reasons like affective and financial

4

constraints. Though suicide is the most common cause of death of burns,

these burns death can also be accidental and homicidal.

In our Tirunelveli Medical College mortuary we receive more than 100

cases of death due to burns every year, an average of 8 cases per month.

The main medico legal issue regarding injury resulting from burns is how

the injury was caused and whether the injury was deliberate act or by

accident. Most burns are caused by deliberate act of self-immolation, only

few percentage are accidental.

“FIRE A BOON OR A CURSE”

Fire is the rapid oxidation of a material in exothermic chemical

process of combustion releasing heat, light and various reaction products.

Fire(Agni) is one among the five great elements in earth others are Earth

(Prithvi) Water(varuna) Sky(Akash) vayu(Air). The prehistoric man

considered fire as a destroyer, because the fire following natural sources

such as lightning storm ,natural wild fire, volcanic eruption e t c the fire

destroyed the plants and trees in the forest were he lived, forced him to

move to another place, he lacked the knowledge to control the fire. Then

he realised the benefits of fire. Fire gave him warmth which led to gather

people around it as a modern day campfire, used it as torch to evade dark.

He used fire to scare away animals. According to Hinduism Agni(fire) is

5

the Vedic fire God, guardian of southeast direction found in southeast

corners in temple. Fire is of cultural significance in Hinduism. Fire

according to Christianity is symbol of divinity, religious zeal and

martyrdom.

Modern man with science and technology with new equipment could

control use of fire. Systematically fire became a day today need. Inspite

of taking care and being much preventive there has been multiple

instances that fire has turned to be disastrous to mankind in day to day

life.

Inspite being a horrible thing to get burnt and the knowledge of

severity of pain what has motivated our people to follow this?

In ancient India, there was a practise called “Sati” in which a

widow herself immolate on her husband’s pyre and there existed a belief

that these women are directly honoured to heaven. Sati was banned by the

British in India by Bengal Sati Regulation in 1829. People in rural corners

are still believed to follow these practices. It is considered a honoured

death which erases all sins. Secondly it is a powerful equipment of

social protest much commoner among Tibetan monks against Chinese

Government; Buddhist monks against Vietnam Government; Let us not

6

forget when a Tunisian president was terminated his post holding

responsibility for a young chap’s self-immolation.

In India, the higher prevalence of burns death is among females, who were

housewives, solely dependent on their spouse, is due to fact that fire has

cultural significance and easy availability of accelerants such as kerosene.

The most common method used by these victims is pour kerosene or any

other inflammable materials and light it up so it’s very difficult to

extinguish the fire because the clothes too catches fire, they pour the

accelerant usually over the head and upper part of the body. Which are

more vulnerable to cause death due to burns.

The most common reasons for death due to burns are domestic violence,

extramarital affairs, cruelty by in-laws, disappointment in love, widowed,

divorced or separated, poor academic performance, infertility or

impotence, outraging the modesty, psychiatry illness such as depression,

schizophrenia.

Most common place of occurrence of suicidal burns are at home because

of easy availability of kerosene at home. So this can be used as method to

conceal a murder as suicide and to murder someone by dousing kerosene

or petrol.

7

Homicidal burns is rare, but cases have been reported. Inflammables such

as petrol, Kerosene, hot metals and corrosives are used with criminal

intent. Among adult females burns are inflicted as punishment for

adultery. In children mechanical violence and a variety of thermal injuries

are inflicted as battering. Deliberate focal lesions of Cigarette burns and

burning of buttocks and other areas on hot plates and injuries may be of

different ages of healing.

Killing a person by dousing with inflammables is very difficult if the

victim is well conscious and alert, so the victim is made unconscious or

semiconscious by way of intoxicating or assault and then burned after

pouring inflammable substance on the body. In some cases the upper and

lower limbs are tied with rope, so that victim is unable to move, mouth is

gagged with clothes so that he\she will not shout. The yell and resistance

offered by victim would make the surrounding vigilant. Hence the victim

is immobilised by ropes or severely traumatised/intoxicated to succumb

to allow burning. There are also cases where the dead bodies are burnt to

conceal the trauma or evidences of homicides.

Dowry deaths also called as bride burning. Such cases are booked under

culpable homicide. Inflammables such as kerosene or petrol are

8

deliberately poured on a woman by her husband or her in-laws and lighted,

and such cases are booked under culpable homicide.

Though multiple legislations have been framed against dowry deaths, the

holes in justice guiding these culprits remains a challenge to those females

who raise up to file cases bravely leading to depression and suicide. In

India the firearms are rarely handled by females; they have difficulty in

going to shops to purchase toxic agents; gets accustomed to situations

before getting ready to hang. Owing to increased time of presence in

kitchen and easy availability of kerosene is one probable cause for higher

prevalence of burns death in females.

The accidental cause of burns death is common among mentally ill and

children and elderly people. We couldn’t forget the Ervadi mass

accidental death of mentally challenged persons.

Difficulty exists in deciding if the burns death is suicide or homicide. It is

not possible to say based on total body surface area burnt.

Burns caused by accidental fire occur both in house and at work place, in

the house due to electric short circuit, clothes such as shawl or thupatta

may catch fire accidentally. Letting out cooking gas, while lighting sacred

lamps or candles. Accidental burns have been reported while the person

was drugged or drunk or diseased in old age and children while playing

9

with fire or match stick. At work places from cottage industries to heavy

industry numerous accidental fires happen round the year.

The scene of crime the place where the burnt dead body was found tells

the crime scene investigator (who collects vital evidence) what might have

happened during the crime? A burnt body found at unusual place such as

open field, near highway, in forest range or in an abandoned place or

inside a charred vehicle and a burnt dead body is found inside a room

where a known or unknown person was present at the time of incident or

burnt body is found in unlocked room unlocked house from inside or if

there is no disturbance of the surroundings in a room or place such as the

furniture were not disturbed or there were no burnt flooring other than the

place where the body was found could raise suspicion to the investigating

police officer.

The “Cover Up” of crime by criminals to conceal the crime is a big

headache for the investigating Police team. In this Internet era like

planning to do a crime and evade from law enforcement authorities can

be browsed from mobile phone itself before committing a crime.

In such cases the investigating police officer fully depends on the forensic

expert’s opinion because a terminal state of a burnt corpse at the scene of

10

crime cannot reflect the manner of death that is whether the burns are

antemortem or post-mortem.

Whenever we receive a burned spot dead body in mortuary we have to

know the identity of the deceased because the body might have charred

beyond recognition. Identity can be made whether he is male or female.

Age can be established approximately by dental examination and sutural

closure of skull bone. Cause of death has to be evaluated i.e. Whether the

burns were real cause of death or not. Have to examine any if ligature

strangulation mark around the neck, about the status of hyoid bone. Any

stab injury or cut injury, scalp contusion, EDH,SDH, SAH, bullet entry or

exit wound or any other injuries other than burns

There are many signs to differentiate between antemortem and post

mortem burns. Some are common for both antemortem and post-mortem

burns such as pugilistic attitude or boxers attitude because it is due to

coagulation of muscle protein, dehydration and contracture of muscle due

to heat.

Heat rupture if the heat applied is more skin may contract and ruptures,

this is common to both antemortem and post-mortem burns. At the same

time a laceration of skin could also looks like that. Heat fractures are seen

on skull and long bones in cases of severely burned cases due to increased

11

intracranial pressure due to steam the skull may get fractured but this may

mimic an antemortem violence. Like the same way in other bones too.

The surest sign of antemortem burns are presence of soot particles in

trachea or lower respiratory tract and presence of high level of carbon

monoxide in blood. But mere absence of carboxy haemoglobin in the

blood does not rule out antemortem burns because the carbon monoxide

formed could be minimum if the place of occurrence is an open place or

if death was immediate.

Soot particles are produced by incomplete combustion or pyrolysis, soot

contains fine black particles mainly composed of carbon, which are

extremely tiny about 2.5 micrometre in size or about 1/30 of the size of

human hair. So such a small size particle which is formed during a fire

can passively enter to the upper respiratory tract. But only if there is active

breathing or increased respiration due to fear or anxiety or choking due to

smoke these carbon particles can deposit in the trachea and also enter up

to the lower respiratory tract such as terminal bronchiole. Many authors

says that presence of carbon particles in trachea and lower respiratory tract

up to the terminal bronchiole is said to be surest sign of antemortem burns.

However, absence of carbon particles in trachea does not rule out

antemortem burns because of (I)Occurrence of burns in open places

12

displaces soot particles due to airflow(II) hospitalisation with oxygen

therapy and other lifesaving procedure leads recirculation of air in the

upper respiratory tract which questions its effect as definitive sign.

Also, due consideration has to be given to rule out false positive

results where, presence of soot particles in upper respiratory tract can be

present in post-mortem burning of a corpse too that the soot particle may

enter up to larynx passively but it is difficult for the carbon particles to

enter into the lower respiratory tract such as terminal bronchioles until the

victim was breathing during the burns.

Hence I would like to look at the prevalence of soot particles in lower

respiratory tract i.e. the terminal bronchiole, where(a) replacement of soot

is not so easy as in upper respiratory tract due to post hospitalization

procedures;(b)false positive soot in upper respiratory tract due to passive

inhalation does not extent up to lower respiratory tract.

13

AIM OF THE STUDY

To determine the presence of the carbon particles in terminal

bronchioles by histopathological study in cases of burns death.

OBJECTIVES OF THE STUDY

My present work aims to find out the presence of carbon particles

in terminal bronchiole among one hundred cases of burns death subjected

to autopsy at mortuary of Department of Forensic Medicine and

Toxicology Tirunelveli Medical College.

14

REVIEW OF LITERATURE

NEED FOR AUTOPSY:

Asnaes .S et al conducted a study to determine the differentiation of

certification of death and its correlation with autopsy findings and

justified that a difference of 30 percent of death certification occurred

when autopsy was not conducted by Investigating Officer. He also

empathised the need of autopsy thereby ensuring extra security.(1)

The need of autopsy is not only meant for the medico legal purposes but

also for the study of course and presentation of varying diseases. There is

a high rate of discrepancy in antemortem diagnosis of a patient in

emergency department against the contradictory diagnosis in autopsy.

Thus regular autopsy of deaths in uncommon presentations should be

confirmed so as to guide us in not missing the serious diagnosis; where

the corrective antemortem diagnosis would have changed the treatment

protocol thereby saving the victim.(15)

Guidance are prevalent to comment that about fifty percent of autopsy

findings are those which are unsuspected before deaths. The study

focusses on the histopathological autopsy and its major contribution in

auditing the accuracy of clinical diagnosis at casualty, treatment protocol

and death certification.(16)

15

PREVALENCE OF FIRE DEATHS

WHO statistics in 2018 highlights that 180,000 burns death occur every

year. The predominant population were from low and middle class. The

majority victims were females and children.

American Burns Association data reveals 486,000 people per year receive

medical aid for burns and related injuries. Of which about 3240 deaths

occur out of fire and smoke inhalation at the distribution of 2855

residential fires,300 vehicle crash and 85 other sources.

“ONE FIRE DEATH OCCURS EVERY TWO HOURS AND

FOURTY TWO MINUTES

Indian statistics have also supportive evidence to show burns causing high

mortality and morbidity hindering the progress in society. Focus has to be

made on dowry related deaths in females which is highly prevailing in

northern parts of India.

Meera et al from her study of unnatural deaths in females concluded that

the most common cause of female death was attributed to road traffic

accidents in contrast to expected dowry related deaths in our Nation.

Shaha and Mohanthy et al conducted a retrospective study for a period of

five years among female burns death where about 50% of death were

16

homicidal with higher prevalence among illiterate ,housewives within five

years of marriage with dowry issues and most of these deaths were spot

death with majority within 24hrs of burns.(49)

A study by Tapse et al in North Karnataka shows that majority of mortality

is associated with forty percent of total body surface area with

burns.(51);However Palwikar conducted a study in Manipal were high

proportion of mortality was associated with sixty percent burns.

PATHOPHYSIOLOGY OF BURNS:

Bailey and Love (58)states that Burns cause damage in number of

different ways but by far the most common organ affected is the skin.

However burns can also damage the airway and lungs with life threatening

consequences. Airways injuries occur when the face and neck are burned.

Respiratory system injuries usually occur if a person is trapped in a

burning vehicle, house, car or aeroplane and is forced to inhale hot and

poisonous gas.

Physical burn injury to the airway above larynx:

a) Hot gases physically burn the nose, mouth, tongue ,palate and

larynx. Once burnt the linings of these structure will start to swell.

After a few hours they start to interfere with the larynx and may

17

completely block the airway if action is not taken to secure on

airway.

b) Inhaled hot gases can cause supraglottic airways burns and

laryngeal oedema.

Steam can cause subglottic burns and loss of respiratory epithelium.

c) Inhaled smoke particles can cause chemical alveolitis and

respiratory failure. Inhaled poisons such as carbon monoxide can

cause metabolic poisoning. Full thickness burns to chest can cause

mechanical blockage to rib movement.

Physical burn injury to the airway below the larynx:

1) Rare injury

2) Heat exchange mechanism in the supraglottic airway are usually

enabled safely to absorb the heat from hot air. However steam has

a large latent heat of evaporation and cause thermal damage to

lower airway.

3) The respiratory epithelium rapidly swells and detaches from the

bronchial tree. This creates casts which can block the main upper

airway.

18

Inhalation Injury

A. Caused by the minute particles within thick smoke inhaled which

because of their small size are not filtered by the upper airway but

are carried down to the moist lining causing an intense reaction in

the alveoli.

B. Chemical pneumonitis cause oedema within alveolar sac and

decreasing gas exchange over the ensuing 24 hours

C. Leads to bacterial pneumonia. Its presence or absence has a very

significant effect on the mortality of any burn patient.

Knights Forensic Pathology (59) states that, Heat Injury in Mammalian

tissue can survive only with a relatively narrow range of temperature

approximately 20-44 centigrade. When external heat is applied the extent

of damage depends upon.

The applied temperature.

Ability of the body surface to conduct away the excess heat.

The temperature for which heat is applied.

The temperature\ time relationship is important for it is sometimes

forgotten that relatively low temperature even as little as 44 centigrade,

can cause damage if sustained long enough.

19

The degree of thermal damage were investigated by Moritz and Henriques

who found that the lowest temperature that would cause damage was 44

centigrade though it required no fewer than 5 hours before a burn

appeared. Only 3 seconds are needed if the object was at 60 centigrade.

Apurba Nandy textbook (64) says Age of burn injury in case of superficial

burns are there will be erythema. Blister is formed within 2-3 hours. The

erythema around a blister or deep injury usually goes away by second day.

Pus formation occurs by 3rd day. Slough formation in next one or two

days, the slough is shredded off by end of first week. Burn injury

involving skin and deeper tissue heal by two weeks.

CLASSIFICATION OF BURNS:

Parikhs Textbook (60) says that burns may be classified into three types

1. Epidermal burns

2. Dermo-epidermal burns

3. Deep burns

20

Type Degree Depth Characteristics

Epidermal First and

second

Epidermis

Superficial

Painful

Redness

Mild swelling

Blisters

Singeing of hair

No scar on recovery

Dermo

epidermal

Third and

fourth

Dermis

Papillary

region

Pain +/-

Blisters

White feathery skin

Severe swelling

COAGULATIVE NECROSIS

GROSS DISFIGUREMENT

PAIN AND SHOCK

Deep Fifth and

sixth

Dermis

Reticular

region

Hypodermis

(subcutaneous

tissue)

Charred skin

Painless due to nerve

destruction

Eschar

GROSS DISFIGUREMENT

21

Textbook by Anil Agrawal (61) says that Effects of Burns depends on

A. Surface area:

I) “Rule of Nine” According to this rule all areas in multiples of

nines as follows, Head and neck 9%, Right upper limb 9%, left

upper limb 9%, front of chest 9%, back of chest 9%, front of

abdomen 9%, back of abdomen 9%, front of left lower limb

9%,back of left lower limb 9%, front of right lower limb 9%, back

of right lower limb 9% and genitals 1%

WALLACE RULE OF NINE IN ADULTS

22

Wallace rule of nine is not applicable for infants because of decreased

body surface area of infants. So we use the rule of nine in paediatrics. This

does not hold good for child which increased variation in total body

surface area. For every year after one year of age subtract one percent

from head and add 0.5% to lower limb. By the time the child reaches ten

years of age the child equates to adult rule.

III).Rule of palm used in isolated and scattered burns palmar surface equal

to 1% of his own body surface. commonly used when the total burns

surface area is less than 10%

23

B. The degree of heat: Higher the heat more severe the damage it

causes.

C. The duration of exposure: Higher the duration more severe the

damage is.

D. Age: Children and old age are more vulnerable.

E. Sex: Females are more susceptible.

F. Site of burns: Burns of sites such as head and neck, face, trunk and

anterior abdominal wall are more dangerous.

PUNISHMENTS IN BURNS INJURY

Textbook of Forensic Medicine by Krishan Vij(62) says that Nature of

burns injury in the absence of death: If death has not occurred due to burns

it will come under “Simple or Grievous hurt”. If the burns are not

extensive it will be a simple hurt. At the same time it will be a grievous

24

hurt if it results in disfigurement of face or permanent privation of sight

or permanent impairment of powers of any member joint etc. Lastly it may

come under last clause i.e. if the individual has suffered shock so as to

endanger or if he or she has severe body pain or bedridden and incapable

of doing daily routines for 20 days.

P.C. Dikshit text book says that Dowry prohibition act 1961 was amended

in 1983 1984 and 1986. According to “Section 3” of dowry prohibition

act as amended in 1986 states taking dowry is an offence “Section 4”

implies demanding dowry is an offence. A new prescribing punishment

for dowry deaths. S176 Cr.P.C: Magistrate inquiry shall be conducted in

dowry deaths cases. Post-mortem will be conducted by a team of doctors,

where the period of marriage is within seven years. (69).

Forensic Medicine and Toxicology by P.C. Ignatius says that S.304B IPC

: where death of a woman is caused by any burns or bodily injury or

otherwise than under normal circumstances within 7 years of marriage and

it is shown that soon before her death she was subjected to cruelty or

harassment by her husband or any relative of her husband, or in

connection with demand of dowry, such deaths are called dowry deaths.

Whoever commits dowry deaths, shall be punished with a term not less

than 7 years but may extend to life.

25

S.498 A: Whoever being husband or relative of the husband of the woman,

subject the woman to cruelty, shall be punished with 3 years imprisonment

and fine.

S.306 IPC : Deals with abetment of suicide. Whoever abets the

commission of suicide, shall be punished with imprisonment of a term

which may extent to 10 years and also liable to fine(70).

LEADING CAUSES OF BURNS DEATH:

Forensic Medicine and Toxicology by Gautam Biswas (63)states that

Causes of death in burns cases: Burns individuals develop a host of

complications one or two contributes to death. Sepsis is the leading cause

of death as a complication of burns.

Immediate cause:

1. Primary or neurogenic shock due to pain or fright.

2. Asphyxia: suffocation due to inhalation of toxic gases such as

carbon dioxide, carbon monoxide or cyanide

3. Heat or smoke can lead to laryngospasm, respiratory arrest or vagal

reflex which causes cardiac arrest which can lead to sudden death.

26

Delayed causes

1. Hypovolemic shock: More than half of the death occurs due to

secondary shock within 24-48hrs, usually the burns causes fluid

and protein loss which in turn leads to decrease in cardiac output

and multi system organ failure.

2. Acute edema of glottis occur due to inhalation of smoke or hot

gases with or without pulmonary edema, Respiratory failure

(inhalation injury pneumonia or ARDS).

3. Toxiaemia due to toxic substances inhaled death may occur in 3-4

days.

4. Sepsis: Most important cause of death occurring more than 4-5 days

or longer. Septicaemia can be caused by wound infection,

pneumonia, UTI following prolonged catheterisation.

5. Infective complication: Bronchitis, bronchopneumonia, enteritis,

may cause delayed death.

Remote Cause

1. Complications of anorexia, hematemesis, respiratory

complications.

2. Suppurative discharge from infected burns areas which lasts for

weeks or months can result in diseases of vital organs and death.

27

3. Gangrene, tetanus, anaemia, oedema, of all dependent parts and

jaundice.

Robbins and Cotran Pathologic basis (65)states that “Particulate Matter”

also known as soot is particularly important in case of morbidity and

mortality related to pulmonary inflammation and secondary

cardiovascular effects. Particulates are emitted by coal and oil fired power

plants by industrial process. Burning these fuels and by diesel exhaust.

Although particles have not been well characterised chemically or

physically fine or ultrafine particles less than 10 micrometre in diameter

are the most harmful. They are readily inhaled into the alveoli where they

are phagocytosed by macrophages and neutrophils. Which respond by

releasing number of inflammatory mediators. In contrast particles that are

greater than 10 micrometre in diameter are of less consequence because

they are generally removed in the nose or trapped by “mucociliary

epithelium” of the airways.

SUICIDE VS HOMICIDE BURNS

Anil Aggrawal Textbook states that the characteristic Post-mortem

appearances includes

28

External Appearance

A. Clothes such as cotton fabrics burn faster than wool; victim may

get very severe burns if wearing cotton fabrics. At the same time

nylon and polyester melt and stick to the skin may produce severe

burn.

Examination of clothes-clothes should be removed, preserved in

plastic bags or at air tight bottles and sent for examination for the

presence of inflammable material.

B. Stature and Weight of the body

The stature and weight are markedly reduced due to

Body is made of organic matter so consumed as fuel

Loss of tissue fluid

Fracture of bones

Pulverization of intervertebral discs

So the stature may be less by several centimetres and there may be severe

weight loss up to 60%

C. Position of the body

Usually present at the site of burning, sometime the corpse was

precariously balanced at the edge of the bed, stool or chair, flexion

of the limbs may cause tumbling of the dead body on the floor.

29

D. Facial Features

i. Face

Face is swollen and distorted

In case of severe burns, soft tissue of the face may get

completely burnt exposing the skull.

Facial features may get changed due to contraction.

ii. Eyes

In most of the cases the eyes are closed, and the shrunken eye

lids can be opened completely.

Cataract can be seen as a result of coagulation of proteins in

the lens.

iii. Nose and Mouth

May show froth due to pulmonary oedema

iv. Tongue

Burnt protruding outside

v. Forehead “Crows Feet”

These are areas without soot deposits or burns on the

forehead, angles of the eyes this is mainly due to non-

penetration of the smoke in to the base of forehead wrinkles

which form due to pain. So presence of crow’s feet may

indicate antemortem burns.

30

vi. Neck

Unsooted creases may be found on neck and groin too.

Such unsooted creases may mimic as a ligature mark also

called as pseudo ligature mark.

E. Pugilistic Attitude

Also called as boxing attitude, fencing attitude, defence

attitude

It is the characteristic attitude adopted by the body after

severe burns.

It is similar to that of boxers during fight.

Main features are due to contracture of muscles

Head slightly extended.

Arms held out in front of the body flexed at elbows

and wrists.

Fingers hooked like claws.

Legs flexed at hips and knees.

Body showing opisthotonus due to contraction of Para

spinal muscles

31

Delayed decomposition because intense heat produce

heat fixation of tissues and inactivating autolytic

enzymes.

Interpretation of pugilistic attitude

It occurs irrespective of whether the victim was alive

or dead at the time of burning.

So pugilistic attitude cannot be taken as sign of

antemortem burns.

F. Burnt areas

Usually have a patchy distribution and vary in size and shape

Patterned burns may take size and shape of ornaments worn

or clothing worn.

Areas of redness, blistering or charring depending upon the

depth of the burns.

There may be blackening over some areas due to soot

deposition

Absence of burns – burns may be absent at gums, armpit,

hand and feet

G. Heat rupture

Heat tears or heat ruptures are produced as a result of

splitting of soft parts.

32

In case the skin got completely burnt, muscle may show

rupture.

Heat rupture occurs both in antemortem as well as in post-

mortem burns.

H. Hair

Singed and burnt.

If the burns is of lesser degree ends of hairs may be bulbous

or clubbed

Colour of hair may reveal the temperature reached. Grey hair

becomes brassy blonde at 250⁰ Fahrenheit. Brown hair

become slightly reddish when exposed to 400⁰ Fahrenheit.

Internal Appearance

1. Heat hematoma

Heat hematoma is the collection of blood in the extradural space

due to excessive heat. Salient Features are following:

Heat hematoma occurs only when there is charring of the

skull.

Grossly appears honeycomb like because of air bubbles

inside.

It is light chocolate in colour

33

Thickness 1.5mm to 1.5cm and volume up to 120 ml.

Trait Heat Hematoma Extradural Hematoma

Cause Intense Heat Blunt trauma to head

Location

Parietotemporal. Along

Superior sagittal sinus

At the site of trauma

(Coup injury)

Distribution

Diffuse Localised

Mechanism

Expansion of blood in

diploe or rupture of

Dural sinuses

Rupture of middle

meningeal artery

Appearance

Honeycomb

appearance soft and

friable

No honeycomb is seen,

more rubbery, reddish

purple in colour

Skull

and CNS

Post mortem fracture as

heat fracture. No CNS

injury

Shows antemortem

fractures. CNS injury

present

34

2. Heat Fracture

They are post mortem fractures produced by

excessive heat.

Bones are burnt, becomes grey white colour.

3. Air Passage

The mucosa of whole air passage from nasal

mucosa till terminal bronchioles is congested

and oedematous.

Aspirated soot particles (carbon particles)

may be present on surface of nose, mouth,

larynx, trachea and bronchi.

Presence of soot (carbon) particles on

histopathological examination is a very

strong sign of antemotem burns.

Amount of soot depends on time duration of

survival in smoke, type of combustible

object,

4. Blood

Haemoconcentration

Cherry red colour due to COHb

35

COHb levels usually more than 10% in some

cases it may reach up to 70-80%

Absence of COHb due to: Adequate supply

of oxygen, wind which may drive away CO

laden air, inhalation of super heated air

which lead to constriction of air passage so

death occurs due to suffocation.

Difference between Antemortem and Postmortem Burns

Feature Antemortem burn Postmortem burn

1.Line of redness Present Absent

2.Blister Contain leukocytes Contain no leucocytes

3.Vital reaction Cellular infiltration Absent

4.Enzyme Peripheral zone shows

increased enzyme

reaction.

Peripheral zone does

not show increase in

enzyme.

5.Colour of blood Cherry red due to

COHb

No cherry red colour

6.Soot particles Present in trachea and

bronchi

Absent

36

According to study conducted by Fanton et al and Tilket et al and Malicier

et al, the criminal deaths were superceding the suicidal causes of burns

death. About 31 percent of deaths on autopsy study showed criminality;

among which majority gains in covering up homicidal death but the

incidence of criminal burns as direct cause of homicide was rare (i.e)some

means of hurt by weapon and hit by weapon to dampen the exertion made

to escape before setting fire. This highlights the necessity of performing

imaging studies to rule out bony injuries and toxicological analysis in

burnt deaths.(2)

Crime scene to Court The essentials of Forensic science(67) states that At

the Crime Scene. Fire investigator will take needed precautions when he

dealing with the burned body to avoid compromising any forensic

evidence. If the body is extensively burnt then other non-accidental

evidence or signs may get concealed. However if unusually we find a large

amount of blood around the fire victim it’s a ground for suspicion as

thermal injuries will not lead to blood loss. After a fatal fire it is generally

desirable that victim is removed as soon as possible to a mortuary where

examination can be done. The investigator will record the condition and

position of the body before it is moved to mortuary and he will supervise

the whole process so that any vital fire related evidence is not lost.

Personal effects that might aid in the identification of the victim retrieved

37

at this time. When the body is lifted, the presence or absence of fire debris

or smoke staining under the dead body gives some insight in to the stage

of the fire at the time of collapse. If a clean contact area is present between

the victim and surface it indicates that the victim was prone prior to, or at

an early stage, of fire. At the same time presence of fire debris or smoke

deposits trapped between the contact surfaces indicates the victim was

upright and mobile after fire has started. If the deceased has accidentally

ignited the clothing then the garments trapped beneath the body may show

signs of burning, and in cases of self-immolation these burnt materials

may also retain the only traces of flammable liquid to survive the ensuing

fire.

Shkrum and Johnson et al made a detailed Canadian study on self

immolation deaths by fire; they revealed certain characteristics of self

immolation by fire that it was common among males. Their study states

much of those people had selected common places and very few choose

to commit in remote areas. The evident soot in airway and increase in

carboxy haemoglobin concentrations helped in guidance that the victims

were not only alive but have also died of inhalation of smoke and

poisoning by carbon monoxide.(3)

38

Gupta and Srivatsa et al who conducted Indian study on fatal burns death.

As per this study about 10.79 percent of medico legal case attributes for

burns death. Majority of them were females and the most predominant

cause was the issues due to dowry. About half was considered accidental

and fifty percent deaths contributed to criminal deaths of medico legal

importance.(4)

Leth P,Hart-Madsen et al conducted a Danishian study which revealed

there was no gender difference in cases of self incineration.Most cases

were identical and studies had showed that press release of a case was

guidance for the following cases. Majority of victims were suffering from

mental illness and had preceding multiple failed suicide attempts. Their

studies had made a significance in contradicting the presence of high

levels of carboxy haemoglobin to be the major cause of sudden death.

Though most of these deaths were at the scene of crime only a minority

had lethal levels of carboxy haemoglobin.(5)

A study of mode of death and clinico pathological profile of burns death

by Sharma BR, Singh VP showed that on comparing the proportion of

homicide and suicides among antemortem burns death; the homicides

holds to be double the proportion of suicides next only to accidental cause

of death.(6)

39

Aggarwal and Chandra were conflicting the above study showing suicide

to supervene the homicidal death at about ten percent variation. Even in

this study the accidental burns were the major cause of burns death as like

the previous study.(7)

Tumer AR et al and co were the first to conduct a study which focussed

on to post-mortem burning to cover up the homicidal action. The presence

of corpses in unfamiliar location and absent vitality signs are common

features of post-mortem burning following homicide.(9)

Gaur and his colleagues disclosed the necessity of physical evidence in

cases of burns death even in presence of vitality at death and confirmation

of suicide as mode of death when dowry burning are being forced to be

attempted. This study has guided the investigation by forensic experts

where on the basis of the physical evidence collected at the scene of crime

aided in conviction of the accused.(11)

Every year in India the fifteen percent of murders constitute female

deaths; of which the majority contribution is the dowry deaths of married

women within seven years of marriage. The most prevalent method is fire

deaths. These incidents are usually reported as stove explosions

(i.e)accidental burst. However the presence of paraffin or kerosene over

40

the clothes and hair reveals the evident deliberate burning. There needs a

keen eye to look for other injuries unrelated to burning.(12)

Complex suicide is a terminology where two or more modes of suicide is

combined ensuring the death, and avoiding the chances of survival. there

was a study of two cases where the shot individual made sure that their

corpses were burnt following the ballistic injury.(24) This mode of suicide

shows high rates of successful attempt indicating the severity of

willingness to terminate their life.

So far no distinct demarcation has been made to differentiate between

accidental or homicidal or suicidal burns death.

This focusses the need of detailed study of manner of death.(26).

In India the kerosene was found to be the most common inflammable

substance used for ignition owing to the easy availability and low cost.

According to study conducted by Hosseini et al(27) who autopsied 167

cases; about seventy seven percent had used oil and gasoline. Another

study by Chawla revealed four percent of his cases smells kerosene(28).

SEARCH FOR VITALITY SIGNS

Gary’s Anatomy(53) says that The trachea is a tube formed of cartilage

and fibro muscular membrane lined internally by mucosa. The

41

anterolateral portion is made up of incomplete rings of cartilage and the

posterior aspect by a flat muscular wall. It is 10- 11 cm long and descends

from the larynx from the fifth cervical vertebra to upper border of fifth

thoracic vertebra where it divides in to right and left principal bronchi.

Cunningham’s Manual of Practical Anatomy(54) states that A principal

bronchus passes inferiolaterally from the termination of trachea to the

hilum of the each lung. The bronchi divide in a tree like fashion within

the lungs. Thus each branch supplies a clearly defined sector of the lung.

Each principal bronchus divides in to secondary lobar bronchi(two on the

left, three on the right) to the lobes of the lung. Each lobar bronchus

divides in to tertiary branches. These segmental bronchi supply sectors

known as broncho pulmonary segments within each lobe of the lungs.

Each of these broncho pulmonary segments is pyramidal shape with its

apex towards the root of the lung and its space at the pleural surface.

Manipal manual of clinical anatomy(55) states that Bronchial tree, the

trachea divides into right and left principal bronchi at the root of the lung.

Each principal bronchus again divides in to secondary (or lobar bronchi).

One for each lung (3on right lung and 2 on left lung). Each secondary

bronchus subdivides into tertiary or segmental bronchi in each lung. The

42

tertiary bronchi divides repeatedly to form terminal bronchiole and further

divides in to respiratory bronchioles.

Histology a textbook by Michael H. Ross Wojcieb Pawlina (56) states that

pulmonary acini are smaller units of structure that make up the lobules.

Each acinus consists of a terminal bronchiole and the respiratory

bronchioles and alveoli that it aerates. The smallest functional unit of

pulmonary structure is the respiratory bronchiolar unit. It consists of a

single respiratory bronchiole and the alveoli that it supplies.

Bronchioles are air conducting ducts that measure 1mm or less in

diameter. The larger bronchioles represent branches of segmental bronchi.

These ducts branch repeatedly giving rise to smaller terminal bronchioles

that also branch. The terminal bronchioles finally give rise to respiratory

bronchioles.

Guyton and Hall Textbook of Medical Physiology (57) states that the

trachea branches out in to two main bronchi that connect each lobe. The

lobar bronchi further branch out into segmental bronchi and into smaller

bronchioles until they reach the terminal bronchioles which are the

smallest airway without any alveoli attached. All these airways do not

participate in any gas exchange and are referred to as “conducting zone”.

43

The terminal bronchioles are further divided in to respiratory bronchioles.

Those bronchioles differ from the terminal bronchioles because they have

alveoli occasionally attached to their walls. The respiratory bronchioles

lead to the alveolar ducts and finally to the alveoli. This region where

alveoli are present and where gas exchange takes place is called

respiratory zone.

The post-mortem findings of external examination is not useful due to

gross distortion of the body due to extensive charring and muscle

contraction. Hence the need of extensive internal structural organisation

in burns patients has to be evaluated in detail. The focus was made on the

respiratory architecture and post-mortem findings were suggestive of

oedema of entire airway with trachea showing varying degree of

ulcerations and mucosal damage. There were findings to establish the

disruptions to the terminal bronchioles showing thick mucosal

plugging.(13)

Robbins and Catron pathologic basics of diseases vol I page 409 (65)

states that carbon soot particles of size less than 10 micrometres are highly

harmful. these particles readily enter the alveoli where it gets

phagocytosed by macrophages and neutrophils thereby initiating acute

inflammatory mediators in contrast to those particles greater than 10

44

microns which usually get trapped by the mucociliary action of the upper

airways.

KNIGHTS Forensic Pathology (66) states that ,The inhalation of carbon

monoxide, victims in a fire usually breathe in carbon particles present in

the sooty smoke. This is again more pronounced in a building fire than a

vehicle fire, though there are many exceptions. The combustion of

wooden doors, roofs, furniture, and the fabric of furnishings and carpets

produces large amount of dense black smoke. Every forensic expert

attending the scene of a house fire is aware of the thick layer of soot than

clings to every surface and may hang in fronds from the ceilings. So such

material which are suspended in the air finds its way into the

respiratory passages of the victims too. So as a marker of antemortem

inhalation it is almost as useful as carbon monoxide. Soot particles may

enter the open mouth of a corpse, stain the tongue and pharynx and may

even passively reach the glottis. No significant amount can enter the

trachea after death, however so carbon particles in lower respiratory

tract is ascertain indicator of breathing during the fire. Histological

demonstration of soot in the more peripheral bronchi, out as far as terminal

bronchioles is absolute proof of such respiratory function. The carbon is

usually mixed with mucus adherent to the tracheal and bronchi walls

because of heat irritation of the mucosa. Often there is swallowed soot and

45

mucus in the stomach and again this is the evidence of life during smoky

phase of fire. Thermal damage to the air passage and lungs from the direct

effect of hot gases. At autopsy the tongue, pharynx and especially glottis

may be scorched, lesser degrees causing a greyish yellow blanching of

mucosa. The interior of larynx, trachea and main bronchi may be

thickened or reddened and inflamed, if the temperature is too low actually

to burn the lining. Heat effects on the pharynx and epiglottis can occur

post mortem through the open mouth. The lungs usually respond to the

heat damage by marked pulmonary edema, though this is often present in

fire victims even when the inhalation of hot gas has been insufficient to

cause visible damage to the bronchial tree.

Parikhs Textbook (60) says that…., The following two are considered as

surest antemortem sign of death due to burns

Particles of soot in respiratory passage, oesophagus and stomach

Cherry red colour of blood due to presence of carbon monoxide

Principle and practice of FM by B.Umadethan II edition page 244-45(71)

states that the presence of carbon soot distal to the larynx is enough to

prove that the person was alive at the time of conflagration. Presence of

carbon soot in the bronchioles and alveoli is the sure sign that the victim

was alive during the burns.

46

Forensic Medicine a study in Trauma and Environmental Hazards

Volume I states that differentiating features of Antemortem Vs

Postmortem burns death are …, In severe fire accidents either in

buildings or vehicles, the final state of the body often will not reflect the

condition at the time of death because many deaths would have occurred

before any heat reaches the body, death being caused by the smoke

inhalation. It may be difficult or impossible for the forensic experts to

determine the extent of ante-mortem damage if the ensuing fire later

reaches the body and causes post-mortem burning. The exposed skin

surface may be reddened in both ante-mortem and post-mortem burns.

Blisters can form post-mortem, but are pale yellow unless on scorched

skin. There is rarely a red base or erythematous areola, though this sign

cannot be depended upon absolutely. The contained fluid is thin and clear.

However many 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. The blister formed in life is said to contain more

protein and chlorides, but no absolute figures are offered and the authors

have yet to meet a pathologist who does this as a routine. Most authentic

of all in burns deaths are the presence of carbon monoxide in the

circulating blood and carbon particles in the air apassages and lungs.

These both signs are considered to be specific signs of antemortem

47

burns. The extradural heat haematoma may be investigated in a different

way to determine its time of origin. If it is a true traumatic lesion produced

before the fire began, it should not contain carboxyhaemoglobin at all. A

spurious heat haematoma is formed from blood which contain

carboxyhaemoglobin if the victim has inhaled this gas during the fire. It

is well known that not all persons alive during a fire accumulate

carboxyhaemoglobin in their blood. If there is carboxyhaemoglobin

absorption, then the heat haematoma will also have the same.

The role of multi detector computed tomography in aiding the autopsy of

burns death is controversial. Though the MDCT could help in exposing

the internal thermal tissue changes like cortical fractures, bone and organ

destruction, thermal epidural haematoma and thermal amputation; this is

of limited value to differentiate the vitality of the deceased at the time of

burns.(14)

The need of imaging studies has to be a part of routine autopsy to avoid

missing cover up homicides and keen suspicion on bony defects and the

necessity to differentiate it from heat fractures is critical.

However the significant signs of antemortem burns are the soot in

respiratory passage and the carboxyhaemoglobin elevation.

48

Bohnert M, Werner CR, Pollak S. et al conducted a study in the institute

of forensic medicine in Germany from 1996 to 2002 evaluating 88 cases

of burnt deaths where the most common vitality parameter was not

attaining the criteria in 23 percent of cases. They have established the

query in lack of vitality features in peracute deaths.(18)

According to a mass smoke exposure study there was high rates of burns

injury in eighty three percent of study population; among which sixty six

percent was severe enough to cause death: However there was difficulty

in establishing whether these deaths where antemortem or post-mortem.

Soot deposits in respiratory passage was seen in ninety one percent of

study community. The presence of elevated carbonmonoxide levels were

seen in fifty two percent of study group.(22)

Gill JR et al made a review of mass death due to smoke inhalation in

Happy Land Social Fire Club, the carbon soot particle was present in

respiratory tract of all victims however though carboxyhaemoglobin

concentration was high there wasn’t proportionate high cyanide

pathologising the cause of death.

Burnt wives are hot topics in India; here is a study by Kumar and his co-

workers (29) who studied the various features of vitality of burnt corpses

at time of ignition. carbon soot particles was found in 20 percent as

49

compared to glottis edema in two percent of victims. According to his

study generalised congestion was noted in 94.66%; generalised pallor in

5.34%; cherry red colour of blood in 16.67%; pleural effusion in 18.67%;

ascitic fluid in 2%; pleural effusion with ascitic fluid in 15.33%.

The another study by Kumar et al (30) supported the previous findings

and he made few correlations to decide the mode of death. Generalised

congestion was found in both suicidal and homicidal antemortem burns

(100%).the cherry red coloured blood was higher in homicidal victims

(44.44%) when compared to suicidal (30.76%) burns death. the carbon

soot particles in respiratory passages was found in higher proportion in

homicide and suicidal cases. Though there exists the sure sign of vitality,

it is misleading that it can be washed out after hospitalization procedures

nor the victim had insufficient time to inhalation of carbon soot particles.

Gross morphological findings of lungs and its correlation with the

histopathological changes is must.(32)

Respiratory cause of death in burns patients is one of the common causes

of death.(33)

There has been evidences that the carbon soot particles can also be in

burning after deaths. So mere presence of soot particles is not the surest

50

sign of vitality. Also the absence of soot particles in cases with elevated

carboxy haemoglobin levels is not contributory.(34)

False positive results of carbon soot particles in trachea can acquire due

to neck dissection at charred regions.(41)

Anthracosis is a condition in which there is deposition of carbon particles

in respiratory passage which is more common among smoker which could

also be a false positive guide in confirming the vitality of burnt deaths at

the time of fire setting.

The expected histopathological changes detecting the vitality of

individual is disturbed in cases of peracute deaths of burnt deaths.(40)

In the study conducted by Misra(41), the carbon soot particles were seen

only in five cases out of eighty eight total cases. The soot particles in

trachea was seen in 19% of cases in Mazumdar A and Patowary A

literature(45); Das K.C (42) found soot particles in trachea in 18.05% of

cases; Nath D(46) found carbon soot in respiratory passage in 34% cases.

The variations in presence of soot particles suggests the treatment details

and burns in open spaces could alter the decision of vitality if it is

considered the single confirmatory evidence.

Owing to soot particles in trachea is not so reliable sign of antemortem

burns death, as it has been constantly washed out due to early hospital

51

therapy and death in open spaces we here would try to establish the

correlation between carbon soot particles in terminal bronchiole and

manner of death.

52

MATERIALS AND METHODS

Burns cases are selected from the bodies received for autopsy during the

period of study. My study compromises of one hundred cases with history

given by the police.

Since the samples were taken as usual procedure of medico legal

examination of dead body consent is not necessary for the study.

RISKS (if any)

No risk to the subject or the deceased.

No risk of mutilation of body.

No risk to the examiner.

INSTITUTIONAL ETHICAL COMMITTEE CLEARENCE

Obtained before collecting samples.

PLACE OF STUDY

1. Mortuary hall and research lab of Department of Forensic medicine,

Tirunelveli Medical college, Tirunelveli

2. Department of Pathology, Tirunelveli Medical College, Tirunelveli

53

METHODOLOGY

One hundred cases of suspected death due to burns bought for medico

legal autopsy at mortuary of our department are selected. Lungs is

dissected as per standard textbooks procedure and examined a bit of lungs

is sent to pathology department for histopathological findings of carbon

particles, results are compiled according to positive finding.

OUTCOME AND BENEFITS.

If all antemortem burns cases have positive histopathological findings

of presence of carbon particles in terminal bronchiole. It can be taken as

“Carbon particles must be present in terminal bronchiole in all cases of

antemortem burns cases”. Presence of carbon particles in terminal

bronchiole is ”The specific sign of antemortem burns”.

SAMPLE SIZE

One hundred cases of death due to thermal burns.

INCLUSION CRITERIA

Bodies subjected to autopsy of death due to thermal burns.

EXCLUSION CRITERIA

1. Death due to other causes.

2. Other causes burns such as scalds, flash burns e t c

54

3. Decomposed body

DURATION OF THE STUDY

One and half year.

TECHNIQUE

The lung was removed along with the trachea, it is examined grossly

and then dissected to see if any soot particles are present and then the main

bronchus was dissected and a bit of lungs at lower segment was resected

and put inside a labelled glass container containing formaldehyde

solution. The information such as Department name, Name and age of the

deceased, post-mortem number, crime number and police station name

and specimen were labelled. The container was sent to Department of

Pathology for histopathology examination.

55

RESULTS

The study sample of 100 cases was evaluated and various comparative

data have been furnished.

Table I.

AGE MALE FEMALE TOTAL

Less than 20 00 08 08

21-30 05 16 21

31-40 14 26 40

41-50 06 03 09

51-60 03 01 04

Above 61 06 12 18

TOTAL 34 66 100

According to the age the following details are observed among the 100

cases. 8% are below 20 years old and among them all are females. About

21% fall under the age group of 21-30 years old, five males and sixteen

females. Around 40% fall under the age group of 31-40 years old, fourteen

males and twenty six females. About 9% fall under the age group of 41-

50 years old, six males and three females. About 4% fall under the age

group of 51-60 years old, three males and one female. About 18% fall

56

under the age group above 60 years of age, six males and twelve females.

Females are more vulnerable from above table. Majority of my study

sample were females showing the higher prevalence of females among

burns death which is similar to many studies and statistics data. The late

reproductive age group of 31-40 yrs shows high rates of burns deaths.

TABLE II: PLACE OF OCCURRENCE OF BURNS CASES.

Open space Closed Space TOTAL

Home 06 87 93

Work Place 01 01 02

Other area 05 00 05

Total 12 88 100

From the above data the burns cases occurred mainly at home. Out of 100,

93 of burns injury happened at home, two cases occurred at work place

and five cases occurred from other area (except home and work place).

57

According to the data 88% of the burns occurred in closed space and 12%

of the burns death occurred in open spaces.

12%

88%

PLACE OF OCCURENCE

OPEN SPACE

CLOSED SPACE

HOME, 93

WORKPLACE, 2

REMOTE AREA, 5

HOME

WORKPLACE

REMOTE AREA

0 20 40 60 80 100

PLACE OF OCCURENCE

58

TABLE III: MANNER OF DEATH.

The manner of death for the 100 cases taken for study 79% are Suicide

and 21% are accident and nil homicide cases.

0

10

20

30

40

50

60

SUICIDE HOMICIDE ACCIDENT

MANNER OF DEATH

MALE FEMALE

Manner of death Male Female Total cases %

Suicide 27 52 79 79

Accident 07 14 21 21

Homicide 00 00 0 0

Total 34 66 100 100

59

TABLE IV CARBON PARTICLE PRESENT IN TERMINAL

BRONCHIOLE VS SOOT IN TRACHEA

CARBON

PARTICLE

PRESENT IN

TERMINAL

BRONCHIOLE

SOOT PARTICLES

PRESENT IN

TRACHEA

SOOT PARTICLES

ABSENT IN

TRACHEA

43 20 23

According to this table Total No of Carbon Particle Present in Terminal

Bronchiole 43 cases, Out of which Soot particles present in Tarchea 20

cases, Soot Particles Absent In Trachea 23 cases.

TABLE V CARBON PARTICLE ABSENT IN TERMINAL

BRONCHIOLE VS SOOT IN TRACHEA

CARBON

PARTICLE

ABSENT IN

TERMINAL

BRONCHIOLE

SOOT PARTICLES

PRESENT IN

TRACHEA

SOOT PARTICLES

ABSENT IN

TRACHEA

57 8 49

According to this table Total No of Carbon Particle Absent In Terminal

Bronchiole 57 cases, Out of which Soot particles present in Tarchea 8

cases, Soot Particles Absent In Trachea 49 cases.

60

TABLE VI PRESENCE OF CARBON PARTICLES IN DIFFERENT

AGE GROUPS

AGE IN YRS MALE FEMALE TOTAL

<20 YRS 0 2 2

21-30YRS 3 7 10

31-40 YRS 7 8 15

41-50 YRS 3 1 4

51-60 YRS 0 0 0

>60 YRS 5 7 12

TOTAL 18 25 43

According to the above data Presence of carbon particles in different age

groups total no of cases <20 yrs 2 cases, among them 2 female cases, Age

group21-30 yrs 10 cases, 3 male and 7 female cases, Among the age group

31-40 yrs total 15 cases, 7 male and 8 female cases, Among the age group

41-50 yrs total 4 cases, 3 male case and 1 female case, Among the age

group >60 yrs total no of cases 12, 5 male and 7 female cases.

61

TABLE VII ABSENCE OF CARBON PARTICLES IN DIFFERENT

AGE GROUPS

AGE IN YRS MALE FEMALE TOTAL

<20 YRS 0 6 6

21-30YRS 2 9 11

31-40 YRS 7 18 25

41-50 YRS 3 2 5

51-60 YRS 3 1 4

>60 YRS 1 5 6

TOTAL 16 41 57

According to the above data Absent of carbon particles in different age

groups total no of cases <20 yrs 6 cases among them 6 female cases, Age

group 21-30 yrs 11 cases, 2 male and 9 female cases, Among the age

group 31-40 yrs total 25 cases, 7 male and 18 female cases, Among the

age group 41-50 yrs total 5 cases 3 male case, 2 female cases, Among the

age group 51-60yrs total 4 cases, 3 male case and 1 female case, Among

the age group of >60 yrs total no of cases 6, 1 male and 5 female cases.

62

The prevalence of carbon soot particles in lower

respiratory tract is proportionately higher in age group of above 60(66%)

followed by age group of 21-30 yrs(50%)

0

10

20

30

40

50

60

70

MALE FEMALE

GENDER COMPARISION OF CARBON PARTICLES IN BRONCHIOLES.

SOOT PRESENT SOOT ABSENT

0

5

10

15

20

25

30

35

40

45

0-20 YRS 21-30 YRS 31-40 YRS 41-50 YRS 51-60 YRS >60 YRS

AGE GROUP COMPARISION OF CARBON PARTICLES IN BRONCHIOLES

SOOT PRESENT SOOT ABSENT

63

TABLE VIII CARBON PARTICLE PRESENT IN TERMINAL

BRONCHIOLE VS PLACE OF OCCURENCE

CARBON

PARTICLE

PRESENT IN

TERMINAL

BRONCHIOLE

OPEN SPACE CLOSED SPACE

43 6 37

TABLE IX CARBON PARTICLE ABSENT IN TERMINAL

BRONCHIOLE VS PLACE OF OCCURENCE

CARBON

PARTICLE

ABSENT IN

TERMINAL

BRONCHIOLE

OPEN SPACE CLOSED SPACE

57 6 51

64

On comparing the relation between place of occurrence and the presence

of carbon soot particles

According to above graph out of forty three cases of carbon particles

present in alveoli, thirty seven cases of death has occurred in closed space

and six cases, death has occurred in open space. So majority of carbon

particles inhaled up to terminal bronchiole has occurred in closed space.

0 10 20 30 40 50 60 70 80 90 100

OPEN SPACE

CLOSED SPACE

COMPARISION OF PLACE OF DEATH AND CARBON PARTICLES IN BRONCHIOLES.

CARBON PARTICLE POSITIVE CARBON PARTICLE NEGATIVE

65

TABLE X CORRELATION BETWEEN CARBON SOOT PARTICLE

IN RESPIRATORY TRACT AND MANNER OF DEATH

Presence of soot particle No. of cases

Antemortem burns

Accidental

Homicide

Suicide

6

00

37

Post-mortem burns 00

According to above data out of 79 cases of suicide, 37 cases had carbon

particles present in alveoli. Out of 21 cases of accidental burns death, 6

cases had carbon particles present in alveoli.

0

20

40

60

80

100

SUICIDE HOMICIDE ACCIDENT

COMPARISON OF MANNER OF DEATH AND PRESENCE OF SOOT PARTICLES IN BRONCHIOLES.

SOOT PRESENT SOOT ABSENT

66

TABLE XI CORRELATION BETWEEN CARBON PARTICLES AND

TIME SINCE INCIDENCE OF BURNS

TIME

SINCE

INCIDENCE

OF BURNS

CARBON PARTICLES

PRESENT

CARBON PARTICLES

ABSENT

OPEN

SPACE

(%)

CLOSE

SPACE

(%)

OPEN

SPACE

(%)

CLOSE

SPACE

(%)

SPOT DEAD 9 33.33 66.66 5 20 80

ONE DAY 21 9.52 91.47 17 5.88 94.11

TWO DAYS 6 16.66 83.33 5 - 100

THREE

DAYS

7 - 100 9 11.11 88.88

MORE

THAN

THREE

DAYS

0 - 100 21 14.28 85.71

Analysis of the 43 cases which has presence of carbon particles

in relation with time since the incidence of burns reveals that among them

9 cases died on the spot, 21 cases died on 1st day of hospitalisation, 6 cases

died on 2nd day of hospitalisation, 7 cases died on 3rd day of hospitalisation

and no positive cases after 3rd day of hospitalisation. Among the 57 cases

which shows negative for carbon particles 5 cases died on the spot, 17

cases died on the 1st day of hospitalisation, 5 cases died on 2nd day of

hospitalisation, 9 cases died on 3rd day of hospitalisation, 21 cases died

after 3 days of hospitalisation.

67

0 5 10 15 20 25

SPOT DEAD

ONE DAY

TWO DAYS

THREE DAYS

MORE THAN THREE DAYS

CORRELATION BETWEEN CARBON PARTICLES AND TIME SINCE INCIDENCE OF BURNS

CARBON PARTICLES ABSENT CARBON PARTICLES PRESENT

68

Soot Particles in Trachea in case of Death due to Burns

Soot with tracheobronchial secretions in a case of death due to burns.

69

Photo Micrograph showing absence of carbon particles in Lungs

Inflammatory infiltrates in the interstitium composed predominantly of

lymphocytes and few neutrophils.

Photo Micrograph Showing Carbon Particles in Terminal Bronchiole.

Carbon particles in the interstitium and also with pulmonary alveolar

exudates.

70

DISCUSSION

The presence of carbon particles in terminal bronchiole is

one of the surest sign of death due to burns i.e. the person was actively

breathing while the fire has started. This study was conducted with

hundred cases of death due to burns subjected for autopsy at Department

of Forensic Medicine and Toxicology Tirunelveli Medical College, to

detect the presence of carbon particles at terminal bronchiole or alveoli.

The trachea was inspected for any soot particles and then a bit of lung at

lower segment was resected and sent to Department of Pathology for

histopathological examination.

Study done by Dr. Chandra Shekhar Prasad et al in Profile of

Burn Injuries among autopsies conducted in Dept. of FM & T, Ranchi

states that male with female ratio is 1: 1.51 but in this study females

constitute 66% and males 34% which is more than the previous study.

Age group distribution reveals maximum number of cases fall

under 31-40 years of age group which is 40% of the total 100 cases.

Among them 26 where female and 14 where male. Least number fall

under less than 20 years of age group which is 8%.

71

Age wise analysis were made based on the presence of carbon

particles in terminal bronchiole which shows that 4.65% belongs to less

than 20 years of age group, 23.25% belongs to 21-30 years of age group,

34.88% belongs to 31-40 years of age group, 9.30% belongs to 41-50

years of age group, no positive in 51-60 years of age group and 27.90%

belongs to more than 60 years of age group.

Age wise analysis were made based on the absence of carbon

particles in terminal bronchiole which shows that 10.52% belongs to less

than 20 years of age group, 19.29% belongs to 21-30 years of age group,

43.85% belongs to 31-40 years of age group, 8.77% belongs to 41-50

years of age group, 7.01% belongs to 51-60 years of age group and

10.52% belongs to more than 60 years of age group.

Analysis of place of occurrence of the study samples reveals 93% of cases

of death due to burns has occurred in home, 2% at their work place and

5% at other areas like agricultural fields, deserted buildings, etc.,

Out of 100 cases studied 88 of burns death has occurred at closed

space and 12 at open spaces. Among the 88 closed space occurrence cases,

37 cases were detected positive for the presence of carbon particles in

terminal bronchiole which constitutes 42.04% and 51 cases doesn’t show

the presence of carbon particles in terminal bronchiole which constitutes

72

57.96%. Among the open space occurrence cases, 6 cases showed the

presence of carbon particles in terminal bronchiole which constitutes 50%

and the same number was negative for carbon particles in terminal

bronchiole.

Analysis of the 43 cases which has presence of carbon particles

in relation with time since the incidence of burns reveals that among them

9 cases died on the spot, 21 cases died on 1st day of hospitalisation, 6 cases

died on 2nd day of hospitalisation, 7 cases died on 3rd day of hospitalisation

and no positive cases after 3rd day of hospitalisation. Among the 57 cases

which shows negative for carbon particles 5 cases died on the spot, 17

cases died on the 1st day of hospitalisation, 5 cases died on 2nd day of

hospitalisation, 9 cases died on 3rd day of hospitalisation, 21 cases died

after 3 days of hospitalisation. According to Robbins and Cotran

Pathologic basis of disease. Carbon particles of size more than 10

micrometre may not enter in to lower respiratory tract, it may get trapped

by mucociliary epithelium, if the particles are less than 10 micrometre and

if there is active breathing during the fire these particles may travel up to

the lower respiratory tract that is terminal bronchiole. Carbon particles

less than 10 micrometre are phagocytosed by macrophages and

neutrophils due to inflammatory response, which is immediately after the

73

incidence of burns and after three days of incidence of burns the activity

of phagocytosis is increased showing the absence of carbon particles.

Among the study sample 14 cases are spot dead cases. Among

them, 9 cases (64.29%) shows positive for carbon particles in terminal

bronchiole and alveoli and 5 cases (37.7%) shows negative. Out of 9

positive cases 6 cases are closed space occurrence cases (66.67%) and 3

cases are open space occurrence cases (33.33%). Out of 5 negative cases,

4 cases belong to closed space (80%) and 1 case belongs to open space

(20%).

Among the study sample 38 cases are died on first day of

hospitalization. Among them, 21 cases (55.26%) shows positive for

carbon particles in terminal bronchiole and alveoli and 17 cases (44.73%)

shows negative. Out of 21 positive cases 19 cases are closed space

occurrence cases (90.47%) and 2 cases are open space occurrence cases

(9.53%). Out of 17 negative cases, 16 cases belong to closed space

(94.11%) and 1 case belongs to open space (5.89%).

Among the study sample 11 cases are died on second day of

hospitalization. Among them, 6 cases (54.54%) shows positive for carbon

particles in terminal bronchiole and alveoli and 5 cases (45.45%) shows

negative. Out of 6 positive cases 5 cases are closed space occurrence cases

74

(83.33%) and 1 case is open space occurrence cases (16.66%). Out of 5

negative cases, 5 cases belong to closed space (100%) and no case belongs

to open space.

Among the study sample 16 cases are died on third day of

hospitalization. Among them, 7 cases (43.75%) shows positive for carbon

particles in terminal bronchiole and alveoli and 9 cases (56.25%) shows

negative. Out of 7 positive cases 7 cases are closed space occurrence cases

(100%) and no cases are open space occurrence cases. Out of 9 negative

cases, 8 cases belong to closed space (88.88%) and 1 case belongs to open

space (11.11%).

Among the study sample 21 cases are died on after third day of

hospitalization. Among them, no cases show positive for carbon particles

in terminal bronchiole and alveoli and 21 cases (100%) shows negative.

Out of 21 negative cases, 18 cases belong to closed space (85.71%) and 3

case belongs to open space (14.29%).

In 14 spot dead cases, 10 cases are closed space occurrences cases.

Among them 6 cases show positive for carbon particle (60%) and 4 cases

shows negative for carbon particles (40%). Among 4 open space

occurrences cases, 3 cases show positive for carbon particle (75%) and 1

case show negative for carbon particles (25%).

75

In 38 cases who are died on first day of hospitalization, 35 cases are

closed space occurrences cases. Among them 19 cases show positive for

carbon particle (54.28%) and 16 cases shows negative for carbon particles

(45.72%). Among 3 open space occurrences cases, 2 cases show positive

for carbon particle (66.67%) and 1 case show negative for carbon particles

(33.33%).

In 11 cases who are died on second day of hospitalization, 10 cases

are closed space occurrences cases. Among them 5 cases show positive

for carbon particle (50%) and 5 cases shows negative for carbon particles

(50%). Among 1 open space occurrences cases, 1 case show positive for

carbon particle (100%) and no case show negative for carbon particles.

In 16 cases who are died on third day of hospitalization, 15 cases

are closed space occurrences cases. Among them 7 cases show positive

for carbon particle (46.67%) and 8 cases shows negative for carbon

particles (53.43%). Among 1 open space occurrences cases, no case

shows positive for carbon particle and 1 case show negative for carbon

particles (100%).

In 21 cases who are died on more than three day of hospitalization,

18 cases are closed space occurrences cases. No cases show positive for

carbon particle and 18 cases shows negative for carbon particles (100%).

76

Among 3 open space occurrences cases, no case shows positive for carbon

particle and 3 case show negative for carbon particles (100%).

By analysing the 100 study cases for the presence of carbon

particles in trachea and terminal bronchiole, 28 of them had carbon

particles in trachea 72 of them are negative for this finding, 43 of them

shows presence of carbon particles in the terminal bronchioles and 57 of

them were negative for this findings. Of the 43 cases positive for presence

for carbon particles in terminal bronchiole or alveoli, 20 of them were also

positive for soot particles in trachea and 23 of them were negative for the

same. Also, among the 57 cases which shows absence of carbon particles

in terminal bronchiole or alveoli, eight of them had positive for carbon

particles in trachea and 49 of them shows negative for the same.

77

CONCLUSION

In text books and articles it is mentioned that presence of carbon particles

in terminal bronchiole and alveoli is an absolute proof of life at the time

of burns. Present study reveals that, out of 100 cases, 21 cases died after

3 days of incidence which shows negative for carbon particles in terminal

bronchiole and alveoli due to phagocytosis. Among the remaining 79

cases, only 43 cases (54%) showed presence of carbon particles in

terminal bronchiole and alveoli. Even though presence of carbon particle

in terminal bronchiole and alveoli is mentioned as an absolute proof of

life at the time of burns this study shows that its absence does not exclude

antemortem burns.

78

RECOMMENDATION

It is recommended that, this study has to be conducted in large

sample size and in varied places. The study may be conducted by

comparing with post-mortem burns cases.

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DA

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1 11/19 03.01.2019 MANISEKAR 52 M 1 YES YES REMOTE YES YES ABSENT

2 103/19 18.01.2019 MANI 38 M 3 YES YES HOME NO ABSENT

3 107/18 19.01.2018 PECHIAMMAL 37 F 4 YES YES HOME YES YES NO ABSENT

4 108/19 19.01.2019 SEETHA 65 F - - NO YES REMOTE YES NO ABSENT

5 1106/18 24.07.2018 MUMTHAJ 36 F 4 YES YES HOME NO ABSENT

6 113/18 20.01.2018 ESAKKI THEVAR 75 M 1 YES YES HOME YES YES NO ABSENT

7 1142/18 01.08.2018 SANKARAN 50 M 1 - YES YES HOME YES NO ABSENT

8 1144/18 02.08.2018 THANGAMMAL 41 F NO YES REMOTE YES YES NO ABSENT

9 1172/18 11.08.2018 VIMALA 22 F 12 YES YES HOME YES NO ABSENT

10 124/18 22.01.2018 THANGARAJ 26 M - 14 YES YES HOME YES YES NO ABSENT

11 1263/18 28.08.2018 RAMASAMY 68 M - - NO YES HOME YES YES NO ABSENT

12 1280/18 01.09.2018 MAHALAKSHMI 19 F NO YES HOME YES NO ABSENT

13 1283/18 01.09.2018 KALAISELVI 36 F 3 - YES YES HOME YES NO ABSENT

14 1364/18 16.09.2018 RAJESHWARI 36 F - 2 YES YES HOME YES YES NO ABSENT

15 1380/19 20.08.2019 MURUGAN 57 M 2 YES YES HOME YES NO ABSENT

16 1388/18 19.09.2018 SUMATHI 33 F 4 YES YES HOME YES NO ABSENT

17 1401/18 23.09.2018 SAUNTHALA 33 F 4 YES YES HOME YES NO ABSENT

18 149/18 27.01.2018 SYED IBRAHIM 31 M 3 - YES YES HOME YES NO ABSENT

19 1556/17 13.12.2017 NAWAB 76 M NO YES HOME YES NO ABSENT

20 1580/18 30.10.2018 SUDALAIVADIVU 37 F 1 YES YES HOME YES YES NO ABSENT

21 160/19 28.01.2019 PERUMAL 65 M - - NO YES REMOTE YES NO ABSENT

22 1604/18 03.11.2018 SHUNMUGAM 37 M - 5 YES YES HOME YES NO ABSENT

23 162/18 29.01.2018 GUNASEELAN 21 M - - NO YES HOME YES YES NO ABSENT

24 1629/18 06.11.2018 ANAND 34 M 6 YES YES HOME YES YES ABSENT

25 1665/118 12.11.2018 REVATHI 42 F 3 - YES YES HOME YES YES ABSENT

26 1674/18 14.11.2018 MARIACHANDRA 25 F - 16 YES YES HOME YES NO ABSENT

27 168/18 31.01.2018 RATHINA RAJ KUMAR 42 M 7 YES YES HOME YES NO ABSENT

28 171/19 30.01.2019 SHANTHI 35 F NO YES HOME YES YES NO ABSENT

29 1758/18 03.12.2018 PETCHIAMMAL 85 F - 6 YES YES HOME YES NO ABSENT

CARBON

PARTICLES IN

TERMINAL

BRONCHI

SEX

PERIOD

OF

SURVIVA

L

TREATME

NT

S.N

O

PM No DATE NAME OF DECEASED

AG

E

PLACE OF OCCURRENCENATURE OF

DEATH

SOOT

PARTICLES

IN

TRACHEA

OP

EN S

PA

CE

CLO

SED

SPA

CE

DA

YS

HO

UR

S

YES NO

SUIC

IDE

HO

MIC

IDE

AC

CID

ENT

YES NO

PR

ESEN

T

AB

SEN

T

CARBON

PARTICLES IN

TERMINAL

BRONCHI

SEX

PERIOD

OF

SURVIVA

L

TREATME

NT

S.N

O

PM No DATE NAME OF DECEASED

AG

E

PLACE OF OCCURRENCENATURE OF

DEATH

SOOT

PARTICLES

IN

TRACHEA

OP

EN S

PA

CE

CLO

SED

SPA

CE

30 1793/18 08.12.2018 SEETHA 48 F 3 YES YES HOME YES NO ABSENT

31 184/19 01.02.2019 PRATHAP 26 M 3 YES YES HOME YES YES ABSENT

32 1841/18 20.12.2018 BEER MOHAMAD 34 M 5 YES YES HOME YES NO ABSENT

33 1848/18 21.12.2018 INDIRA 35 F 6 YES YES HOME YES NO ABSENT

34 1851/18 22.12.2018 MUPPIDATHI 80 F 4 YES YES HOME NO ABSENT

35 1854/18 22.12.2018 ARUMUGAM 75 F 3 - YES YES HOME NO ABSENT

36 187/19 01.02.2019 SUBUPRIYA 23 F 6 YES YES HOME YES NO ABSENT

37 200/18 06.02.2018 ESTHER 75 F 4 YES YES HOME NO ABSENT

38 213/18 09.02.2018 MONIRAJ 35 M 2 - YES YES HOME YES NO ABSENT

39 231/18 12.02.2018 SHANTHI 32 F 1 YES YES HOME YES YES YES ABSENT

40 240/18 14.02.2018 VELAMMAL 38 F - - NO YES HOME YES NO ABSENT

41 257/18 17.02.2018 GEETHA 21 F 6 YES YES HOME NO ABSENT

42 264/19 16.02.2019 MUTHUSELVI 19 F 5 YES YES HOME YES NO ABSENT

43 273/19 18.02.2019 MUTHULAKSHMI 26 F 6 YES YES HOME YES NO ABSENT

44 282/18 25.02.2018 KRISHNAN 42 M 3 YES YES HOME YES YES NO ABSENT

45 284/18 26.02.2018 ELANGOVAN 47 M - 7 YES YES HOME YES YES ABSENT

46 293/18 27.02.2018 PANDISELVI 19 F 5 YES YES HOME NO ABSENT

47 300/19 23.02.2019 PERIYASAMY 40 M - 6 YES YES WORK NO ABSENT

48 304/18 01.03.2018 JANCY JEBASELVI 27 F 3 - YES YES HOME YES NO ABSENT

49 310/19 25.02.2019 RAHEEMA 40 F 3 YES YES HOME NO ABSENT

50 312/19 25.02.2019 MURUGAN 35 M 2 YES YES HOME YES NO ABSENT

51 315/18 03.03.2018 SNEHA 20 F 3 YES YES HOME YES YES ABSENT

52 326/18 06.03.2018 REGINA 37 F 2 - YES YES HOME YES NO ABSENT

53 331/18 07.03.2018 SERMAKANI 25 F 5 YES YES HOME YES NO ABSENT

54 337/18 08.03.2019 MALINI 19 F - 6 YES YES HOME YES NO ABSENT

55 355/18 11.03.2018 GOMATHIAMMAL 69 F 12 YES YES HOME YES YES ABSENT

56 376/18 17.03.2018 LEELA 40 F 6 YES YES HOME YES NO ABSENT

57 38/19 01.01.2019 ESKKIAMMAL 19 F 12 YES YES HOME YES NO ABSENT

58 381/18 18.03.2018 MALATHI 70 F 2 YES YES HOME YES YES YES

DA

YS

HO

UR

S

YES NO

SUIC

IDE

HO

MIC

IDE

AC

CID

ENT

YES NO

PR

ESEN

T

AB

SEN

T

CARBON

PARTICLES IN

TERMINAL

BRONCHI

SEX

PERIOD

OF

SURVIVA

L

TREATME

NT

S.N

O

PM No DATE NAME OF DECEASED

AG

E

PLACE OF OCCURRENCENATURE OF

DEATH

SOOT

PARTICLES

IN

TRACHEA

OP

EN S

PA

CE

CLO

SED

SPA

CE

59 388/18 21.03.2018 MANJU 33 F - - NO YES HOME YES NO YES

60 396/18 27.03.2018 SUMATHI 37 F 2 - YES YES HOME YES NO YES

61 407/19 16.03.2019 RAMAIAH 80 M 3 - YES YES HOME YES YES

62 430/19 19.03.2019 NAGARAJAN 36 M 2 - YES YES HOME YES YES YES

63 457/18 02.04.2018 KOUSALYA 17 F 3 YES YES HOME YES YES YES

64 457/19 23.03.2019 MURUGAMMAL 32 F - 1 YES YES HOME YES NO YES

65 46/18 09.01.2018 MARIYASELVI 39 F 4 YES HOME YES NO YES

66 490/19 30.03.2019 PREMI JENIFER 20 F 2 YES YES HOME YES NO YES

67 511/18 13.04.2018 KARTHIKA 30 F 1 - YES YES HOME YES YES NO YES

68 515/19 04.04.2019 SATHYA 25 F 7 YES YES HOME YES YES YES

69 540/19 09.04.2019 MALAMURUGAN @ RAMESH34 M - - NO YES HOME YES NO YES

70 573/18 25-04-2018 AATHIYAMMAL 35 F 12 YES YES HOME YES NO YES

71 573/19 16.04.2019 SUGANYA 27 F - 6 YES YES HOME YES YES YES

72 600/18 29.04.2018 NEELAKANDAN 32 F 6 YES YES HOME YES YES YES

73 602/18 29.04.2018 VELLASAMY 33 M 6 YES YES HOME YES YES YES

74 613/18 02.04.2018 VELLAMMAL 25 F 1 - YES YES HOME YES NO YES

75 62/19 11.01.2019 MANIMEKALAI 24 F 3 YES YES HOME YES NO YES

76 627/19 23.04.2019 ANANTHAMMAL 64 F - 9 YES YES HOME YES YES YES

77 628/18 03.05.2018 ARULDEVI 22 F - 2 YES YES HOME YES YES YES

78 629/18 04.05.2018 KAVITHA 33 F 2 YES YES HOME NO YES

79 640/19 25.04.2019 RUKMANI 29 F 4 YES YES HOME YES YES

80 649/18 07.05.2018 RAJAN 35 M 4 YES YES HOME YES NO YES

81 661/19 29.04.2019 SEETHALAKSHMI 36 F NO YES HOME YES NO YES

82 677/19 30.04.2019 MUTHAMMAL 79 F - - NO YES HOME YES YES

83 72/19 13.01.2019 INDIRA 24 F 1 YES YES HOME YES NO YES

84 723/19 07.05.2019 SUBBAIAH 66 M 1 - YES YES HOME YES NO YES

85 73/18 14.01.2018 MAARISELVAM 35 F 3 YES YES HOME YES YES

86 739/18 23.05.2018 SARASWATHI 28 F 2 YES YES HOME YES YES NO YES

87 741/19 09.05.2019 SIVAGAMIAMMAL 80 F - - NO YES REMOTE YES YES YES

DA

YS

HO

UR

S

YES NO

SUIC

IDE

HO

MIC

IDE

AC

CID

ENT

YES NO

PR

ESEN

T

AB

SEN

T

CARBON

PARTICLES IN

TERMINAL

BRONCHI

SEX

PERIOD

OF

SURVIVA

L

TREATME

NT

S.N

O

PM No DATE NAME OF DECEASED

AG

E

PLACE OF OCCURRENCENATURE OF

DEATH

SOOT

PARTICLES

IN

TRACHEA

OP

EN S

PA

CE

CLO

SED

SPA

CE

88 75/19 14.01.2019 KANNAN 42 M 3 YES YES HOME YES YES YES

89 753/18 26.05.2018 JEYA 54 F 1 YES YES HOME YES YES

90 759\18 27.5.2018 VADIVU 79 F 4 YES YES HOME YES YES NO YES

91 768/18 28.05.2018 NIRMALADEVI 27 F - 1 YES YES HOME YES YES NO YES

92 774/18 29.05.2018 GOMATHI 70 F - 1 YES YES HOME YES NO YES

93 775/18 30.05.2018 PARVATHI 23 F 3 YES YES HOME YES NO YES

94 787/18 01.06.2018 GANESAN 31 M 3 - YES YES HOME YES YES YES

95 792/19 17.05.2019 KANAGARAI 46 M 2 - YES YES HOME NO YES

96 800/19 20.05.2019 KAMARAJ 58 M 5 YES YES WORK NO YES

97 803/18 05.06.2018 MUTHUPANDIAAN 25 M - 1/4 YES YES HOME YES YES YES YES

98 825/18 08.06.2018 AYYAPPAN 38 M 3 YES YES HOME YES YES YES

99 853/18 12.06.2018 ANNARATHINAM 33 F 8 YES YES HOME YES YES YES

100 958/18 28.06.2018 JOTHI 33 F 2 - YES YES HOME YES YES NO YES