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Describe corrosive injuries and the medicolegal aspects of acid attacks.

Forensic Medicine · 2nd Professional — Para-Clinical

Corrosives and Their Action

A corrosive is a substance that destroys tissue on contact by chemical action. acids act by coagulative necrosis, forming a firm eschar that limits penetration; alkalis act by liquefactive necrosis with saponification of fat, which allows them to penetrate deeper and continue acting for longer.

Corrosive	Colour of the eschar and features
Sulphuric acid (oil of vitriol)	The commonest in Indian acid attacks — cheap and freely available. The eschar is black or brownish-black; it is strongly dehydrating and chars organic material; clothing is charred and destroyed
Nitric acid (aqua fortis)	Yellow eschar — the xanthoproteic reaction with tissue protein; yellow fumes are given off
Hydrochloric acid (muriatic acid)	Greyish-white to brown eschar; less destructive than the others
Carbolic acid (phenol)	A greyish-white, corrugated, painless burn; distinctive smell; and the urine turns dark green or olive on standing — "carboluria"
Oxalic acid	Corrosive locally and a systemic poison, chelating calcium to produce hypocalcaemia, tetany and renal failure with oxalate crystals
Alkalis — caustic soda, caustic potash, ammonia, lime	The eschar is soft, soapy and slippery, greyish-white; penetration is deeper and continues for longer, so alkali injuries of the eye and oesophagus are more serious than acid ones

CLINICAL PEARL

Alkalis are more dangerous than acids, which is the reverse of what people assume. An acid coagulates the tissue and forms an eschar that limits its own penetration. An alkali liquefies the tissue and saponifies the fat, so it keeps burrowing deeper for as long as it remains. This is why alkali splashes to the eye and alkali ingestion carry a worse prognosis, and why irrigation must be far more prolonged.

Acid Attacks (vitriolage)

Acid attack is the deliberate throwing of a corrosive on a person, usually the face, with the intention of disfiguring rather than killing. In India it is directed overwhelmingly at women, most often by a rejected suitor or over a domestic or dowry dispute
The characteristic pattern — burns of the face, neck, upper chest and the front of the shoulders, with vertical streaks running downward as the liquid trickles under gravity, and satellite splash marks. The direction of the streaks indicates the posture of the victim when it was thrown, which may contradict or support an account
Consequences — loss of vision, often bilateral, from corneal destruction; destruction of the eyelids, nose and ears; gross contractures and disfigurement requiring many operations over years; airway compromise; and profound psychological and social consequences, since the injury is designed to be visible
Legal provisions — BNS 124 (formerly IPC 326A and 326B) creates specific offences of voluntarily causing grievous hurt by acid, punishable with a minimum of 10 years extending to life and fine payable to the victim to meet medical expenses, and of the attempt. Following Laxmi v Union of India (2013) the Supreme Court directed regulation of the retail sale of acid, and free treatment and compensation for victims — and a hospital may not refuse treatment
Suicidal and accidental corrosive injury — ingestion of a corrosive, accidental in children who drink from an unlabelled bottle, and suicidal in adults; producing burns of the lips, mouth, oesophagus and stomach, with the characteristic streaking down the chin and neck

Management and Applied Aspects

Irrigate immediately with copious running water for a prolonged period — at least 20 to 30 minutes, and far longer for alkali. This is the single most important intervention and every minute of delay increases the damage
Do not attempt chemical neutralisation; the reaction is exothermic and generates heat, adding a thermal burn to the chemical one. Water alone, in quantity, is correct
Do not induce emesis or pass a stomach tube after ingestion of a corrosive; the substance will burn the oesophagus a second time on the way up, and the tube may perforate the softened wall
Irrigate the eye at once and for longer, everting the lids and sweeping the fornices for particulate material; ocular alkali injury requires irrigation until the pH normalises
Record the direction of the streaks and photograph them; they indicate the posture of the victim and the direction from which the acid came, and this may be the point in dispute
Preserve the clothing and any residue for chemical identification of the acid, and swab the burnt area before irrigation where this is possible without delaying treatment
Treatment must be given free of charge and cannot be refused; and the case is medicolegal, requiring police intimation and a detailed injury report with the opinion on the nature of the injury
Acid injury to the face is grievous hurt on the ground of permanent disfiguration of the head or face, and separately under BNS 124 with a minimum sentence
Carbolic acid gives a painless burn and dark green urine; the combination is distinctive and the painlessness delays presentation

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