Centre for Anatomy & Human Identication

Age Estimation in the Living in Matters Civil and Criminal

Anil Agrawal University of New Delhi, India.

Abstract
Estimation of age is one of the main tasks of a forensic practitioner, especially in third world countries, where many births take place in rural settings, without the benet of the expert supervision of a trained obstetrician. Such births are poorly recorded or more often not recorded at all in terms of exact dates. In many other cases, records are fraudulently falsied for gain, e.g. to get government jobs or pensions. Developed countries, where ordinarily the birth records are meticulously maintained, are not immune to this problem either. Estimation of age of living individuals may be needed here for refugees or other persons who arrive without acceptable identication papers. A wide variety of methods are used by the forensic clinician to assess the age of the individual in such cases. This paper discusses and evaluates the most common methods used. Keywords: Age estimation, deciduous teeth, odontological examination, ossication of bones, permanent teeth, radiological examination, successional teeth, third molar

Introduction
Estimation of age of an individual may become necessary in a number of cases. Virtually no age is immune from medicoelgal scrutiny. In the authors thirty years of practice, children as young as four years have been brought for medicolegal examination of age. The issue in question is whether the child has attained ve years of age or not. This is because according to Section 6 (a) of The Hindu Minority and Guardianship Act 1956, a minor who has not completed the age of 5 years shall ordinarily be in the custody of the mother, and a divorced mother often wants to keep the child in her custody. On the other end of the spectrum, people as old as 75 years of age (allegedly) have come for medicolegal opinion on age. Many of them allege that they are above 70 years of age in order to be
AXIS Vol.1, Issue 2 (Winter 2009)

able to qualify for some State Governments pension schemes for old people. Thus virtually no age is irrelevant from a medicolegal point of view. Ages of Medicolegal Importance An exhaustive list of various ages which are important from a medicolegal angle is available elsewhere (Aggrawal, 2000). The list in this paper gives only a glimpse of the amazing range of ages which a practicing medicolegist may be asked to opine upon. This list would presumably differ from country to country and even within the various states of the same country. It would be helpful for a medicolegist of a particular state or country to compile his or her list in accordance with their laws.
1

Medicolegal importance of 1 year of age 1. According to South Carolinas child passenger restraint law, children from birth to 1 year old, or who weigh less than 20 pounds, must be secured in a rear-facing child safety seat. Washington state also has a similar law. Similar laws exist in several other nations too. 2. In some countries, such as Canada, Italy, the United Kingdom and Australia, murder of a child less than one year of age by its own mother is not considered homicide. Instead, the mother is charged with a lesser offence of infanticide for which the punishment is reduced. This is because such murders could be due to post-partum depression, or babyblues [supposed to be due to the effects of lactation and other aspects of post-natal care]. Medicolegal importance of 2 years of age 1. According to the Code of Maryland, in certain cases of alimony, a determination of potential income may not be made for a parent who is caring for a child under the age of 2 years for whom the parents are jointly and severally responsible. Medicolegal importance of 3 years of age 1. According to the UK law, if a child under 3 years old is carried in the front seat of a car, an appropriate child restraint must be used (the adult seat belt is not sufcient). Children under 3 years old may not travel in the front unless they are in a child restraint. If carried in the rear seat, an appropriate child restraint must be used, if available. If an appropriate restraint is tted in the front of the car, but not the rear, children under 3 years old must sit in the front and use that restraint. Remember, one could move the restraint from the front to the rear if one wished. Rearward-facing seats are designed to be used in the rear as well as the front. One should always put a rearward-facing baby seat in the rear if a front passenger airbag is tted.

Medicolegal importance of 4 years of age 1. Under Pennsylvania law, children under 4 years of age are required to use a child restraint device. Nonuse is a primary offense. Children 4 to under 8 years of age are required to use a booster seat. Nonuse of this is a secondary offense. The ne is a sliding ne up to $100.00. Medicolegal importance of 5 years of age 1. According to Section 6 (a) of The Hindu Minority and Guardianship Act 1956, a minor who has not completed the age of 5 years shall ordinarily be in the custody of the mother. Medicolegal importance of 6 years of age 1. Under California law, automobile passengers under 6 years or lighter than 60 pounds must be securely fastened in a child safety seat. 2. According to section 154 of Crimes Act 1961 (New Zealand), everyone is liable to imprisonment for a term not exceeding 7 years who unlawfully abandons or exposes any child under the age of 6 years. Medicolegal importance of 7 years of age 1. According to Section 82 of the Indian Penal Code (I.P.C.), a child less than 7 years of age can not commit an offence. Medicolegal importance of 8 years of age 1. Under Pennsylvania law, Children under 4 years of age are required to use a child restraint device. Nonuse is a primary offense. Children 4 to under 8 years of age are required to use a booster seat, nonuse of this is a secondary offense. The ne is a sliding ne up to $100.00. Medicolegal importance of 9 years of age 1. According to the 1819 Factory Act of UK, no child under 9 could work in factories. Children from 9 to 16 were allowed to work
2

AXIS Vol.1, Issue 2 (Winter 2009)

a maximum of 72 hours per week with one and a half hours a day for meals. This age was however later reduced to 8 years by the 1844 Graham`s Factory Act. Medicolegal importance of 10 years of age 1. According to Section 369 of I.P.C., to constitute a crime of kidnapping or abducting a child with the intention of taking dishonestly any moveable property from its person, the age of such child should be below 10 years. 2. Under the 1842 Mines and Colleries Act all women and children under 10 were banned from working underground. 3. According to Indian Customs rules, free allowance for tourists of Indian origin is Rs. 25,000.00 per passenger, including two liters of whisky/wine and 200 cigarettes. However this free allowance is lower for passengers less than 10 years of age (g 1).

Medicolegal importance of 12 years of age 1. According to Section 83 of I.P.C., the crime committed by a child between 7-12 years of age is not an offence, if he hasnt attained sufcient maturity of understanding. The judge often decides this issue. 2. According to Section 89 of I.P.C, a child below 12 years can not give valid consent to suffer any harm which may occur from an act done in good faith and for its benet (as a general physical examination by a doctor) 3. According to Section 90 of I.P.C, a child below 12 years cannot give consent, as is intended by any section of I.P.C. 4. Under the Indian Oaths Amendment Act 1939, the unsworn evidence of a child below 12 years of age is admissible if the court thinks he does not understand the nature of an oath. 5. Under the Bombay Shops and Establishments Act 1948, no child who has not completed 12 years shall be employed in these establishments. 6. According to Section 317 of I.P.C, exposure or abandonment of a child less than 12 years of age by parents or person having care of it, may lead to punishment for 7 years and/or ne. 7. According to Section 376 of I.P.C, if a man rapes his own wife and her age is less than 12 years, he will get punishment as if he raped any other girl (the sentence is not less than 7 years, and may extend to life). But if he raped his wife who was above 12 years of age, but below 15 years, he would get a lesser sentence of only 2 years. This clause may appear paradoxical as the minimum legal age for marriage in India is 18 years for girls. But despite this law, many marriages of young girls go on in India, and section 376 caters to such cases. 8. Under the Children and Young Persons Act 1933 & 1952 of UK, it is an offence for a person over 16 years to have a child under 12 years in a room with an unguarded re.

Figure 1: Government of India arrival card,

which all overseas tourists arriving in India, and Indians returning back to India have to complete AXIS Vol.1, Issue 2 (Winter 2009)

9. According to section 16 of Indian Arms Rules 1962, any person below the age of sixteen years but not below the age of twelve years may be allowed to use a rearm for the purpose of training in the use of such re-arm in the immediate presence, or under the direct supervision and guidance of an adult instructor or the licensee. Provided that no person below the age of sixteen years shall be allowed carry a rearm requiring a license, in a public place, except in the immediate presence and supervision of the person who is lawfully entitled to carry such rearm. 10. Sixteen marks the time at which collection of full fares in all modes of transport in India and in several other countries begins. 11. A pediatrician traditionally looks after a child only up to 12 years of age. Medicolegal importance of 13 years of age 1. According to Section 375 of I.P.C, sexual intercourse with ones own wife, even with her consent, is rape if she was below 13 years (This provision is for the state of Manipur only by a local amendment. For the rest of the country this age is 15 years) 2. Sections 5 to 8 of The Sexual Offences Act 2003 of UK, deal with rape and other offences against children under the age of 13 years. (i). Under section 5, a person commits an offence if (a) he intentionally penetrates the vagina, anus or mouth of another person with his penis, and (b) the other person is under 13. A person guilty of an offence under this section is liable, on conviction on indictment, to imprisonment for life. (ii). Under section 6, a person commits an offence if (a) he intentionally penetrates the vagina or anus of another person with a part of his body or anything else, (b) the penetration is sexual, and (c) the other person is under 13. A person guilty of an offence under this section is liable, on conviction on indictment, to imprisonment for life.
AXIS Vol.1, Issue 2 (Winter 2009)

(iii). Under section 7, a person commits an offence if (a) he intentionally touches another person, (b) the touching is sexual, and (c) the other person is under 13. A person guilty of an offence under this section is liable (a) on summary conviction, to imprisonment for a term not exceeding 6 months or a ne not exceeding the statutory maximum or both and (b) on conviction on indictment, to imprisonment for a term not exceeding 14 years. (iv). Under section 8, a person commits an offence if (a) he intentionally causes or incites another person (B) to engage in an activity, (b) the activity is sexual, and (c) B is under 13. A person guilty of an offence under this section, if the activity caused or incited involved (a) penetration of Bs anus or vagina, (b) penetration of Bs mouth with a persons penis, (c) penetration of a persons anus or vagina with a part of Bs body or by B with anything else, or (d) penetration of a persons mouth with Bs penis, is liable, on conviction on indictment, to imprisonment for life. In all other cases, the guilty person under this section is liable (a) on summary conviction, to imprisonment for a term not exceeding 6 months or to a ne not exceeding the statutory maximum or both and (b) on conviction on indictment, to imprisonment for a term not exceeding 14 years. 3. According to section 42, Title 14 of Louisiana Code, Aggravated rape is a rape committed upon a person sixty-ve years of age or older or where the anal, oral, or vaginal sexual intercourse is deemed to be without lawful consent of the victim because it is committed under any one or more of the following circumstances: (i). When the victim resists the act to the utmost, but whose resistance is overcome by force. (ii). When the victim is prevented from resisting the act by threats of great and immediate bodily harm, accompanied by apparent power of execution.

(iii). When the victim is prevented from resisting the act because the offender is armed with a dangerous weapon. (iv). When the victim is under the age of thirteen years. Lack of knowledge of the victims age shall not be a defense. (v). When two or more offenders participated in the act. (vi). When the victim is prevented from resisting the act because the victim suffers from a physical or mental inrmity preventing such resistance. 4. Section 320 of the Criminal Code of Western Australia, denes sexual offences against children under the age of 13. It states: 320. Child under 13: Sexual offences against (i). In this section child means a child under the age of 13 years. (ii). A person who sexually penetrates a child is guilty of a crime and is liable to imprisonment for 20 years. (iii). A person who procures, incites, or encourages a child to engage in sexual behavior is guilty of a crime and is liable to imprisonment for 20 years. (iv). A person who indecently deals with a child is guilty of a crime and is liable to imprisonment for 10 years. (v). A person who procures, incites, or encourages a child to do an indecent act is guilty of a crime and is liable to imprisonment for 10 years. (vi). A person who indecently records a child is guilty of a crime and is liable to imprisonment for 10 years. Medicolegal importance of 14 years of age 1. Under the law of England, a boy 14 year of age can not commit rape (In India no such age has explicitly been mentioned under the law pertaining to rape, but sections 82 and 83 of IPC serve as guidelines. According to these sections a boy below 7 years can not commit any crime, which implicitly includes
AXIS Vol.1, Issue 2 (Winter 2009)

rape. If the age of the boy were between 7-12 years, then the judge would decide if his action amounts to an offence or not.) 2. According to Article 24 of The Indian Constitution, a child below 14 years shall not be employed to work in any factory or mine or engaged in other hazardous employment (same provisions are reproduced in Section 67 of The Indian Factories Act 1948) 3. According to Section 23 of the United Provinces Excise Act, a licensed vendor is not allowed to employ children under the age of 14 years, in the premises in which foreign liquor or country spirit is consumed by the public. 4. Under section 375 of the I.P.C. (local amendment by Manipur Government), sexual intercourse with or without consent is rape if the age of the woman is less than 14 years (This provision is for the state of Manipur only by a local amendment. For the rest of the country this age is 16 years). 5. According to Section 15 of The Juvenile Justice (Care and Protection of Children) Act 2000 (India), where a Board is satised on inquiry that a juvenile has committed an offence, then, notwithstanding anything to the contrary contained in any other law for the time being in force, the Board may, if it thinks so t order the parent of the juvenile or the juvenile himself to pay a ne, if he is over fourteen years of age and earns money. Medicolegal importance of 15 years of age 1. According to Indian Factories Act 1948, a child above 15 years and below 18 years is an adolescent. A Child is a person who hasnt completed 15 years. Young Person is either a child or adolescent. 2. According to Section 375 of I.P.C, sexual intercourse with ones own wife, even with her consent, is rape if she was below 15 years (By a local amendment this age has been reduced to 13 years for the state of Manipur).

3. According to International Labor Conference (1948 session), young persons between 15-17 years shall not be employed in factories, mines, railways and ports for a period of at least 12 consecutive hours. 4. According to Section 13 (2) (iv) of The Hindu Marriage Act 1955, a wife may divorce her husband if her marriage (whether consummated or not) was solemnized before she attained the age of 15 years, and she has repudiated the marriage after attaining that age but before attaining the age of 18 years. 5. According to Section 160 of The Criminal Procedure Code (India), a police ofcer has power to require attendance of witnesses, but he cant compel a male person below 15 years (or any woman) to attend at any place other than the place in which such male person (or woman) resides. Medicolegal importance of 16 years of age 1. Under section 375 of the I.P.C, sexual intercourse with a woman even with her consent is rape, if she was below 16 years of age. 2. According to the Indian law, a child under 16 years of age, who is serving a sentence for some offence, can not be kept in a jail. He has to be conned in a Childrens Home. 3. According to section 361 of I.P.C, whoever takes or entices any minor under 16 years of age if a male, (or under 18 years of age if a female, or any person of unsound mind) out of the keeping of the lawful guardian of such minor (or person of unsound mind), without the consent of such guardian, is said to kidnap such minor (or persons) from lawful guardianship. 4. According to Section 22 of United Provinces Excise Act, a licensed vendor is not permitted to sell any spirit or intoxicating drug to persons under 16 years of age. 5. According to The Bombay Children Act 1948, a child means a boy or girl under 16 years. If such a child commits an offence, he becomes a youthful offender, and shall not be sentenced to death.
AXIS Vol.1, Issue 2 (Winter 2009)

6. Under the Bombay Prevention of Hindu Bigamous Marriage Act 1946, a minor means any person who is below 16 years of age (Under the Indian Majority Act 1875, a minor is a person below 18 years) 7. According to Englands Tattooing of Minors Act 1969, tattooing of persons under the age of 16 has been made illegal since 1969. 8. According to Section 363-A of I.P.C, kidnapping or maiming of a minor for the purpose of begging is an offence. If the person merely kidnaps, the sentence is 10 years and a ne. If he maims, the sentence is life imprisonment and a ne. For the purposes of this section a minor is a male below the age of 16 years, and a female below 18 years. This is an interesting section, as the ages for minors are different for males and females. 9. According to Section 2(aa) of The Immoral Trafc (Prevention) Act, 1956 of India, a child means a person who has not completed the age of sixteen years. 10. According to Section 2(cb) of The Immoral Trafc (Prevention) Act, 1956 of India, a minor means a person who has completed the age of sixteen years but has not completed the age of eighteen years. 11. Under the Children and Young Persons Act 1933 & 1952 of UK, it is an offence for a person over 16 years to have a child under 12 years in a room with an unguarded re. 12. According to section 16 of Indian Arms Rules 1962, any person below the age of sixteen years but not below the age of twelve years may be allowed to use a rearm for the purpose of training in the use of such re-arm in the immediate presence, or under the direct supervision and guidance of an adult instructor or the licensee. No person below the age of sixteen years shall be allowed to carry a rearm requiring a license, in a public place, except in the immediate presence and supervision of the person who is lawfully entitled to carry such rearm.

13. According to section 9 of the Indian Arms Act 1959, a person below 16 years of age can not keep any rearm or ammunition in his possession. 14. Since 1st July 2007, a citizen of 16 years can vote in Austria. Austria thus became the rst member of the European Union, and the rst of the worlds leading democracies, to adopt a voting age of 16 for all purposes. 15. According to the immigration rules of New Zealand, if a person has applied for permanent residence in that country, and has a dependent child (whether natural or adopted), who is aged 16 years or younger, is single, and is totally or substantially reliant on the principal applicant, then he may be included in the application for permanent residence. 16. In many countries, if a child is less than 16 years, than slightly different rules apply for getting the passports (called child passports). Medicolegal importance of 17 years of age 1. According to International Labor Conference (1948 session), young persons between 15-17 years shall not be employed in factories, mines, railways and ports for a period of at least 12 consecutive hours. 2. According to the Indian Mines Act 1923, no person who hasnt completed his 17th year shall be allowed to be present in any part of a mine which is below ground unless a certicate of tness is granted. 3. According to Section 44 of The Juvenile Justice (Care and Protection of Children), Act 2000, a juvenile or child over seventeen years of age but less than eighteen years of age would stay in the after-care organization till he attains the age of twenty years. Medicolegal importance of 18 years of age 1. Under section 5 (iii) of Hindu Marriage Act 1955, the age for marriage for a girl is 18 years. If a girl marries before this age, the punishment is prescribed in section 18 (a)
AXIS Vol.1, Issue 2 (Winter 2009)

of the same act. It is simple imprisonment which may extend to 15 days, or ne which may extend to 1000 Rs, or with both. The marriage is not dissolved. 2. According to section 361 of I.P.C, whoever takes or entices any minor under 18 years of age if a female, (or under 16 years of age if a male, or any person of unsound mind) out of the keeping of the lawful guardian of such minor (or person of unsound mind), without the consent of such guardian, is said to kidnap such minor (or persons) from lawful guardianship. 3. According to Indian Majority Act 1875, a person attains majority when he/she attains the age of 18 years. 4. According to Section 4(a) of the The Hindu Minority and Guardianship Act 1956, a person who is below 18 years of age is a minor. 5. According to Section 87 of I.P.C, a person under the age of 18 years can not give valid consent, whether express or implied, to suffer any harm which may result from an act not intended or not known to cause death or grievous hurt (example: fencing, surgical operations by a doctor) 6. According to section 366-A of I.P.C, whoever procures any girl under the age of 18 years for the purposes of illicit intercourse with another person, shall be punishable with imprisonment which may extend to ten years and shall also be liable to a ne. 7. According to section 372 of I.P.C, whoever sells, lets to hire, or otherwise disposes of any person under the age of 18 years for the purposes of prostitution or illicit intercourse with any person or for any unlawful or immoral purpose, shall be punished with imprisonment of either description for a term which may extend to ten years and shall also be liable to a ne. 8. According to section 373 of I.P.C, whoever buys, hires, or otherwise obtains possession of any person under the age of 18 years for the purposes of prostitution or illicit intercourse with any person or
7

for any unlawful or immoral purpose, shall be punished with imprisonment of either description for a term which may extend to ten years and shall also be liable to ne. 9. According to Indian Factories Act 1948, Adult is a person who has completed his 18th year. A person less than 18, but more than 15 years of age is adolescent. 10. According to section 305 of I.P.C, whoever abets the suicide of child below 18 years, would be punishable with death, or imprisonment for life, and shall also be liable to a ne. 11. According to exception 5 of section 300 of I.P.C., culpable homicide is not murder when the person who died was above 18 years of age and he/she risked death with his own consent. 12. Under Childrens Act 1960, a child is sent to childrens home on commission of an offence, but is not retained there beyond the age of 18 years. 13. According to the Children and Young Persons Act 1933 of England, a person below 18 years can not be sentenced to death. 14. According to Section 363-A of I.P.C, kidnapping or maiming of a minor for the purpose of begging is an offence. If the person merely kidnaps, the sentence is 10 years and a ne. If he maims, the sentence is life imprisonment and a ne. For the purposes of this section a minor is a female below 18 years (or a male below the age of 16 years). This is an interesting section, as the ages for minors are different for males and females. 15. This is the age for voting in India and several other countries. 16. In Australia (and several other countries), a person must be 18 years of age or older to contest for public ofce at Federal, state or local government level. [Please note that age of candidacy may not necessarily be the same as age of voting in many countries.]

17. According to Section 2 (k) of The Juvenile Justice (Care and Protection of Children), Act 2000 (India), a juvenile or child means a person who has not completed the eighteenth year of life. 18. According to section 3 (4) (a) of the Medical Termination of Pregnancy Act 1971 (India), if the pregnant woman has not attained the age of 18 years, her pregnancy can not be terminated, except with the consent in writing of her guardian. 19. According to Section 13 (2) (iv) of The Hindu Marriage Act 1955 (India), a wife may divorce her husband if her marriage (whether consummated or not) was solemnized before she attained the age of 15 years, and she has repudiated the marriage after attaining that age but before attaining the age of 18 years. 20. According to Section 2 (f) of The Transplantation of Human Organs Act, 1994 (India), a donor means any person not less than 18 years of age, who voluntarily authorizes the removal of any of his human organs for therapeutic purposes. 21. According to Section 2(ca) of The Immoral Trafc (Prevention) Act, 1956 of India, a major means a person who has completed the age of eighteen years. According to Section 2(cb) of the same Act, a minor means a person who has completed the age of sixteen years but has not completed the age of eighteen years. Medicolegal importance of 19 years of age 1. Under Maine law, a court order requiring the payment of child support (in cases where payments are made by one parent to the other following disputes between them) remains in force as to each child until the order is altered by the court or until that child attains 19 years of age. Medicolegal importance of 20 years of age 1. Section 293 I.P.C. if a person sells, lets to hire, distributes, exhibits or circulates obscene objects to any person under 20
8

AXIS Vol.1, Issue 2 (Winter 2009)

years of age, then on rst conviction, he would be sentenced to an imprisonment of 3 years and a ne of 2000 Rs. On the second conviction, the punishment would be 7 years and a ne of 5000 Rs. 2. According to Section 44 of The Juvenile Justice (Care and Protection of Children), Act 2000, a juvenile or child over seventeen years of age but less than eighteen years of age would stay in the after-care organization till he attains the age of twenty years. Medicolegal importance of 21 years of age 1. Under section 5 (iii) of Hindu Marriage Act 1955, the age for marriage for a boy is 21 years. If a boy marries before this age, the punishment is prescribed in section 18 (a) of the same act. It is simple imprisonment which may extend to 15 days, or ne which may extend to 1000 Rs, or with both. The marriage is not dissolved. 2. Under section 366-B of I.P.C., whoever imports into India from any country outside India or from the State of Jammu and Kashmir any girl under the age of 21 years with intent that she may be, or knowing it to be likely that she will be, forced or seduced to illicit intercourse with another person, shall be punishable with imprisonment which may extend to 10 years and shall also be liable to ne. 3. When a minor is under the guardianship of the Court of Wards, or is under a guardian appointed by the Court, he is not deemed to attain majority until he is 21 years of age. 4. Under section 16 of Indian Arms Rules 1962, an adult means a person who has completed the age of twenty one years. Medicolegal importance of 25 years of age 1. According to Article 84 (b) of The Constitution of India, minimum age for contesting for the membership of Parliament is 25 years. 2. According to Article 173 (b) of The Constitution of India, minimum age for
AXIS Vol.1, Issue 2 (Winter 2009)

contesting for the membership of any State Legislative Assembly is 25 years. 3. This is the maximum age for entry into government services in some countries. 4. According to section 27 of the Punjab Excise Act 1914, the State Government may lease the right of manufacturing, supplying and selling any Country Liquor or intoxicating drug only to a person above 25 years of age. According to section 29 of the same Act no licensed vendor can sell or deliver any liquor or intoxicating drug to any person under the age of twenty ve years. According to section 30 of this Act, no person who is licensed to sell liquor or intoxicating drugs on his premises can employ any man under the age of 25 years (women of any age can not be employed). Medicolegal importance of 30 years of age 1. According to Article 84 (b) of The Constitution of India, this is the minimum age for election to the Council of States (Rajya Sabha). 2. According to Article 173 (b) of The Constitution of India, this is the minimum age for election to the State Legislative Council. 3. In Nigeria, a person must be at least 30 to be a Representative in parliament.

Medicolegal importance of 35 years of age 1. According to Article 58 (1) (b) of The Constitution of India, this is the minimum age for appointment as the President of India. 2. According to Article 66 (3) (b) of The Constitution of India, this is the minimum age for appointment as the Vice-President of India. 3. According to Article 157 of The Constitution of India, this is the minimum age for appointment as the Governor of any State. 4. According to Section 4 (3) (i) of The Pre-

natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act 1994, no prenatal diagnostic technique shall be used or conducted unless the age of the woman is above 35 years. 5. In Mexico a person must be at least 35 to be President or a Senator, as specied in the 1917 Constitution of Mexico. 6. In Nigeria, a person must be at least 35 to be a Senator or State Governor. Medicolegal importance of 40 years of age 1. In Italy a person must be at least 40 to be a Senator, as specied in the 1947 Constitution of Italy. 2. In Nigeria, a person must be at least 40 years of age to be elected President or Vice President. Medicolegal importance of 50 years of age 1. In Italy a person must be at least 50 to be President of the Republic, as specied in the 1947 Constitution of Italy. Medicolegal importance of 55 years of age 1. According to section 765.03 of the State of Wisconsin Statute, persons who are nearer of kin than 2nd cousins cannot marry. But rst cousins can marry if the female was above 55 years of age (the idea is that the couple should not be able to reproduce, which is the main biological reasoning behind prevention of incest). The section states: 765.03 Who shall not marry; divorced persons. (1) No marriage shall be contracted while either of the parties has a husband or wife living, nor between persons who are nearer of kin than 2nd cousins except that marriage may be contracted between rst cousins where the female has attained the age of 55 years or where either party, at the time of application for
AXIS Vol.1, Issue 2 (Winter 2009)

a marriage license, submits an afdavit signed by a physician stating that either party is permanently sterile. Relationship under this section shall be computed by the rule of the civil law, whether the parties to the marriage are of the half or of the whole blood. A marriage may not be contracted if either party has such want of understanding as renders him or her incapable of assenting to marriage. Medicolegal importance of 60 years of age 1. This is age of retirement from Government service in several countries including India (and Delhi University) Medicolegal importance of 65 years of age 1. According to Section 10 (2) of the Consumer Protection Act 1986, every member of the District Forum shall hold ofce for a term of ve years or up to the age of 65 years, whichever is earlier, and shall not be eligible for reappointment. District Forum is a kind of civil court which delivers judgments in cases of consumer grievances. Similarly the State Commission and the National Commission (mentioned below) are also akin to civil courts which are higher in rank to District Forum. 2. According to section 42, Title 14 of Louisiana Code, Aggravated rape is a rape committed upon a person sixty-ve years of age or older or where the anal, oral, or vaginal sexual intercourse is deemed to be without lawful consent of the victim because it is committed under any one or more of the following circumstances: (i). When the victim resists the act to the utmost, but whose resistance is overcome by force. (ii). When the victim is prevented from resisting the act by threats of great and immediate bodily harm, accompanied by apparent power of execution. (iii). When the victim is prevented from
10

resisting the act because the offender is armed with a dangerous weapon. (iv). When the victim is under the age of thirteen years. Lack of knowledge of the victims age shall not be a defense. (v). When two or more offenders participated in the act. (vi). When the victim is prevented from resisting the act because the victim suffers from a physical or mental inrmity preventing such resistance. Medicolegal importance of 67 years of age 1. According to Section 16 (3) of the Consumer Protection Act 1986, every member of the State Commission shall be below 67 years of age.

Medicolegal importance of 70 years of age 1. According to Section 20 (3) of the Consumer Protection Act 1986, every member of the National Commission shall be below 70 years of age. 2. This is the age prescribed by some State Governments which qualies a person to get pension from Old Age Pension Scheme. Although no age is immune from a medicolegists scrutiny, as can be made out from the list above, the truth is that about 90% of a medicolegists work falls within the age range of 10 to 20 years. This is fortunate, because this is the age range which can be most accurately opined upon. The more difcult cases begin after this age, when all the teeth have erupted and most of the bones have united.

Methods of Age Estimation in the Living

The age of an individual can be determined from (1) Teeth, (2) Ossication of bones, and (3) Secondary sex characters (Aggrawal and Busuttil, 1991). General development in case of children may help to some extent but is generally not useful from a medicolegal point of view. As mentioned earlier, the determination of age is much more accurate in earlier years of life, up to around 20 years. After this the accuracy declines drastically. to the alveolar bone by the periodontal membrane. Tooth development The alveolar cavities which contain teeth are formed around the fourth month of intrauterine life. Development of the tooth begins with the formation of cellular tooth germ within the alveolar bone, in the shape of the crown. The deciduous teeth commence mineralization at about 20 weeks of intrauterine life, and by 28 weeks, all of the deciduous teeth have commenced mineralization (Cameron and Sims, 1974). The anterior buccal cusp of the lower rst permanent molar begins to mineralize a week or two before birth. Thus at birth the rudiments of all the temporary teeth and of the rst permanent molars may be found in the jaws. Two sets of teeth There are two sets of teeth - temporary (also known as deciduous or milk teeth) and permanent. During childhood the temporary

Teeth
Structure of teeth Teeth are composed of three parts- the crown, which projects above the gum margin, the root, which remains buried within the alveolar bone and gum, and the neck which is a small part between the crown and the root. The teeth are composed mainly of dentine. It is covered on the crown by the enamel and on the root by cementum. The cementum is attached
AXIS Vol.1, Issue 2 (Winter 2009)

11

set erupts. By the age of 2 to 3 years, the temporary set is complete. At the age of six, the rst permanent tooth-the rst molar-erupts. Gradually the permanent set replaces the temporary set. The last permanent tooth to erupt is the third molar, also known as the wisdom tooth which erupts sometime between 18 to 25 years. There are 20 temporary teeth. These include 2 incisors, 1 canine and 2 molars in each quadrant of the jaw. The permanent teeth are 32 in number. These include 2 incisors, 1 canine, 2 premolars and 3 molars. Dental formula The dental formula is a handy and convenient way of representing the number and type of teeth in an individual. It appears as a fraction with two numeralsone appearing as a numerator and the other appearing as a denominator. Each numeral consists of four digits, the rst representing the number of incisors in a quadrant, the second, number of canines, the third, number of premolars Tooth Lower Central Incisor Upper Central Incisor Upper Lateral Incisor Lower Lateral Incisor First Molar Canine Second Molar

and the fourth, number of molars. The upper numeral represents the number of teeth in the upper quadrants, and the lower represents the number in the lower quadrants. The dental formula of a baby with a full set of temporary teeth is 2102/2102 This means that a baby with a full set of temporary teeth has 2 incisors, 1 canine, no (0) premolars and 2 molars. Both upper and lower quadrants show the same conguration. There are thus 5 teeth in each quadrant, making the total number of teeth in a baby equal to 20. The dental formula of an adult individual is 2123/2123 This means that an adult individual has 2 incisors, 1 canine, 2 premolars and 3 molars. Both upper and lower quadrants show the same conguration. There are thus 8 teeth in each quadrant, making the total number of teeth in an adult equal to 32. Age of Eruption 6 months 8 months 10 months 12 months 14 months 18 months 24-30 months

Table 1: Ages of Eruption of Temporary Teeth Tooth Molar, 1st Incisor, Central Incisors, Lateral Premolar, 1st Premolar, 2nd Canine Molar, 2nd Molar, 3rd Age of Eruption 6 years 7 years 8 years 9 years 10 years 11 years 12 years 18-24 years Mama Is In Pain Papa Can Make Medicine

Table 2: Ages of Eruption of Permanent Teeth

AXIS Vol.1, Issue 2 (Winter 2009) 12

The permanent incisors, canines and premolars are also known as successional permanent teeth. They are called this because they come in succession to temporary teeth. The permanent molars are the superadded teeth. They are called this because they are added over and above the teeth already present. They do not replace any teeth. Thus the total number of teeth in an individual changes only with the appearance of molars. The replacement in each quadrant is like this: The 2 permanent incisors replace the 2 temporary incisors The 1 permanent canine replaces the 1 temporary canine. The 2 permanent premolars replace the 2 temporary molars. The 3 Permanent molars do not replace any teeth. They are the superadded teeth. Temporary teeth It is important to know the ages of eruption of both temporary and permanent teeth. Before proceeding further, it is important to keep in mind that in general, the lower (mandibular) teeth appear earlier, both in case of temporary and permanent teeth. There are some important exceptions, as we shall shortly see. The ages of eruption of temporary teeth, with a few weeks variation on either side, is like this: Unless otherwise indicated, these ages are true for the maxillary teeth. Mandibular teeth would appear a few weeks earlier. The exception mentioned earlier occurs in the case of lateral incisors, which appear earlier in the upper jaw (as a rule of the thumb, lower teeth always appear rst) Permanent Teeth The order of appearance of permanent teeth, with a few months variation on either side is like this: These eruption ages are true for maxillary teeth. Generally speaking, the mandibular teeth would appear a few months earlier.
AXIS Vol.1, Issue 2 (Winter 2009)

The major exception is in the case of canines, which appear almost 2 years earlier. Thus the lower canine would appear at 9 years of age. Premolars are an exception in the sense that they appear earlier in the upper jaw rst. Thus lower rst premolar would appear at 10 years, and lower second premolar would appear at 11 years. The whole subject of dental eruption, especially of permanent dentition may sound complex, but can thankfully be remembered by an interesting mnemonic. Mama Is In Pain; Papa Can Make Medicine The rst letter of each word indicates the rst letter of the maxillary tooth. The mnemonic can be decoded as indicated in Table 2. Interestingly there is yet another good mnemonic for remembering the same sequence. Mother is in bed; baby comes Monday morning Here the letter b in bed and baby should remind us of the word Bicuspid, which is sometimes used for Premolars. The rest of the letters are as in the previous mnemonic. The stage of mixed dentition Before the age of 6 years (when the rst permanent molar appears), all the teeth in a childs mouth are deciduous. After the age of 12 years (when the second permanent molar appears), all the teeth are permanent. Between the ages of 6-11, some teeth are deciduous and some are permanent, this is the stage of mixed dentition. It can be rather tricky to examine a child in this age group as one would have to differentiate between the temporary and the permanent teeth. A few pointers could be helpful. The deciduous teeth are usually whiter and the enamel is less transparent than that of the permanent teeth. This is usually described by saying that deciduous
13

teeth are china-white in colour, while permanent teeth are ivory-white in colour. The deciduous teeth are in most dimensions smaller than the permanent teeth. However deciduous molars are wider mesiodistally than the permanent premolars, which will

Usually there are no depressions or perikymata on the labial surface of the crowns of the deciduous incisors. These surfaces are smooth. Incisal edges of the deciduous teeth generally show no pits, while those of permanent teeth show pits (mamelons).

Figure 2: Panorex view of a child between 8-9 years of age. take their places (Brand and Isselhard, 1986). Crowns of deciduous teeth are more bulbous and the cusps are more pointed when the teeth rst erupt (Rogers, 1988). Deciduous teeth have shorter crowns with respect to their roots. The crowns have a marked constriction at the cervix, appearing as if they are being squeezed with a rubber band (Woelfel and Scheid, 1997). The enamel seems to bulge close to the cervical line, rather than gradually tapering (Osborn, 1981). Many other differences are described, but they can not be elicited clinically. For instance it is suggested that pulp chambers are relatively larger in deciduous teeth and that the pulp horns extend rather high placing them much closer to the enamel than in the permanent teeth (Brand and Isselhard, 1986). In case of doubt, the best thing is to have a panorex view of the teeth done, which can immediately show all the permanent and deciduous teeth of mouth erupted or unerupted. This is a relatively new method of taking dental radiographs (Mason and Bourne, 1998). Originally this was called the orthopantomograph, and the derivation OPG derived from this term is still in common use. However its more modern name is dental panoramic tomograph (DPT). Many specialists like to call it by the simpler name Panorex view. For taking this Figure 3: A Line Diagram of the X-Ray seen in Figure 2.
AXIS Vol.1, Issue 2 (Winter 2009) 14

radiograph, a special DPT machine is used and it takes a panoramic lm by having a motor-driven X-ray tube and lm cassette holder which circle round the subjects face. The subject sits or stands upright and special supports keep the head still during an exposure time of up to 15 seconds. The cassette holds a special extra-oral 13 x 31 cm lm. This view is particularly helpful in the medicolegal examination of teeth, as it shows all the teeth along with their roots and crowns in a single view. Panorex view immediately enables a medicolegal specialist to tell which of the teeth he examined were deciduous. An example is shown in gure 2. This subject, whose age was later determined to be between 8 and 9 years of age, was brought to the author for age estimation, as he had stolen some valuables from a lady, and his lawyer had claimed a childrens jail on account of his tender age. Figure 3 is a line diagram drawn from the same X-ray plate depicting some salient features of the teeth. In general, if one can see a tooth below another, obviously the one visible in the mouth is the deciduous tooth (the tooth below is the permanent tooth waiting to erupt). If no tooth is present below a tooth, that tooth has got to be the permanent tooth. On clinical examination of this child the rst permanent molar was visible, but not the second permanent molar enabling one to say that the subject was between 6 and 12 years of age. Further narrowing of the age could be done by the help of this X-ray. Both permanent incisors have erupted, but not the rst premolar. These ndings could enable the author to say that the child was between 8 and 9 years of age. An interesting fact to keep in mind is that the total number of teeth in a childs mouth only changes when the superadded teeth (the molars) come. The molars come in a mathematically beautiful rhythm at 6, 12,

and 18 to 24 years. Thus the total number of teeth would change only at these ages. During the period of mixed dentition, the age of a child could easily be calculated by this formula: (Age in years 5) x 4 = Number of permanent teeth in the mouth.

Ossication of Bones
Ossication of bones provides a very useful method of estimation of age in the living. Most bones develop either from cartilage or from bro-membranous structures. Different bones begin and complete their ossication at different but almost xed periods of life. These changes can be studied by X-rays and thus provide the medicolegal specialist with a very strong tool. It is useful to keep in mind a few facts before proceeding further. Firstly the ages referred to here vary from place to place as they depend upon dietetic, hereditary and geographic factors. Secondly, the ossication takes place slightly earlier (by about a year) in females than in males. An important exception is skull sutures, which obliterate earlier in males than in females. And lastly ossication is seen earlier in tropical climates than in temperate ones. Unless otherwise stated, the ages mentioned here refer to Indian males.

Figure 4: A Useful Way to Remember Ages of Ossication of Some Major Bones

AXIS Vol.1, Issue 2 (Winter 2009)

15

The range of ages at which various bones commence and complete fusion is so complex and confusing as to deter a beginner from taking any substantial interest in this eld of study. But fortunately a few tricks of the trade can be useful. One of the best is illustrated in gure 4. Imagine a person reclining on a sand beach as shown in the diagram. His elbows are sinking in the sand somewhat. Now draw four lines parallel to the horizontal plane; the lowest one passes through the elbow, the next through the hip and ankle joints, the next through the shoulder and knee joint, and the uppermost passes through the wrist joint. Those epiphyses which fall on a particular line fuse at a particular age.

helps the mind to easily latch a joint to a particular age. Several important exceptions exist which must be borne in mind. Ossication around the shoulder joint The center for the head of humerus appears during the rst year of life, the greater tubercle at 3 years and the lesser tubercle at 5 years. The three centers unite to form a big epiphysis at around 6 years, which in turn unites with the shaft at 18 years (refer to gure 5). The coracoid and acromion both ossify from two centers, each of which is visible on a radiograph. The center for the tip of coracoid appears by about 11 years and unites by 16 years. The center at the tip of acromion appears at 15 years and unites by 18 years. The clavicle begins to ossify before any other bone in the body (Williams and Warwick, 1980). Two centers appear in the shaft between the 5th and 6th weeks of intrauterine life, and fuse about the forty-fth day. The secondary center for the sternal end appears around 19 years of age and unites with the shaft by 21 years. This is the usual gure accepted by Indian medicolegal practitioners.

Figure 5: Anterior-Posterior view of the Right Shoulder Joint in a Subject between 8-9 years of age. Thus all epiphyses around the elbow joint would complete fusion by 16 years, all epiphyses around hip and ankle joints by 17 years, all epiphyses around shoulder and knee by 18 years and all epiphyses around wrist by 19 years. It must however be stressed that this is a very general rule and probably its main utility is that it
AXIS Vol.1, Issue 2 (Winter 2009)

Figure 6: X-Ray of the elbow showing all four centres (medial epicondyle, capitulum, trochlea and lateral epicondyle) separately.
16

However it is useful to remember that the variation here can be quite large. Jit and Kulkarni (1976) in one of the largest studies of its kind, having studied the sternal epiphyses in 684 Indian Punjabees (people living in the province of Punjab), came to the conclusion that the sternal end appeared from 11 to 19 years and united between 18-25 years. Figure 5 is an Anterior-Posterior (AP) view of the shoulder joint of the same subject whose panorex view we saw earlier. The head of the humerus, lesser tubercle and the greater tubercle have united together (age > 6 years), but have not united with the shaft (<18 years). The centers for the tip of acromion (<15 years) and the tip of coracoid (<11 years) have not appeared and the sternal end of the clavicle has not appeared (<19 years). So by examining just this X-ray, one could condently say that the age of the subject was between 6 and 11 years. The actual age of the subject was 8 and a half years.

Ossication around the elbow joint The ossication of the lower end of the humerus is more complex than that at its upper end. Four different centers of ossication appear here. The rst center to appear is at the capitulum, which appears at 1 year, the medial epicondyle appears between 5-7 years, the trochlea appears at 10 years and the lateral epicondyle at 11 years. The centers for capitulum, trochlea and lateral condyle unite together to form a conjoint epiphysis around 14 years, which unites with the shaft at 15 years. The medial epicondyle joins the shaft separately at 16 years. The head of the radius appears at 5 years and that of the ulna at 9 years. Both unite with the shaft at 16 years Figure 6 is the AP view of the left elbow joint of a male, who had killed a person, and had applied for immunity under section 83 of the Indian Penal Code. He claimed an age of less than 12 years. In the X-ray all four centers (medial epicondyle, capitulum, trochlea and lateral epicondyle) can be seen separately, indicating the age is around 12-13 years.

Figure 8: Anterior Posterior view of wristage assessed as between 12 and 16 years of age. Figure 7: Anterior-Posterior View of the elbow

AXIS Vol.1, Issue 2 (Winter 2009)

17

Figure 7 is also the AP view of the elbow joint. Here three centers (capitulum, trochlea and lateral epicondyle) have united to form a conjoint epiphysis (>13) but the conjoint epiphysis has not joined with the shaft (<15). Thus the opinion given regarding the age was between 13-15 years. Ossication around the wrist joint The wrist joint presents quite a number of bones for radiological analysis. This is one of the reasons why many workers regard this as the single most important joint in the estimation of age (Greulich and Pyle, 1959). Other advantages stem from the little irradiation required and the ease of radiographic positioning (Roche et al., 1988). The lower end of radius appears at 2 years and that of ulna at 6 years. Both unite with the shaft at about 19 years. The order of appearance of ossication centers in the carpal bones is: Capitate 2 months; Hamate 3 months; Triquetral 3 years; Lunate 4 years; Scaphoid, Trapezium and Trapezoid 4-5 years; and Pisiform 9-12 years.

The metacarpals show more variation. Reasonable estimates can be made from the head of the rst metacarpal (thumb), which unites by 16 years. The heads of the other metacarpals unite by 17 years. An interesting fact is that the head of the rst metacarpal is towards the wrist joint, while the heads of other metacarpals are away from the wrist joint. Figure 8 is the AP view of the wrist joint of a female, who had had voluntary sexual intercourse with her boy friend. The question was whether she was below the age of consent (16 years) or not. Sexual intercourse with a girl below the age of consent, even with her consent is considered statutory rape. Since her 1st metacarpal was not united, it was opined that she was less than 16 years of age. This was corroborated by other ndings too. Ossication in the sternum This is a bone quite often neglected by medicolegal practitioners, but good corroborative use can be made of this bone in age estimation. The sternum consists of three parts the manubrium sterni, the body of the sternum and the xiphoid process. The body of the sternum has four sternebrae. The centers for the manubrium sterni and the sternebrae appear during interuterine life and are not important from a medicolegal angle (as far as estimation of age in the living is concerned). The center for the xiphisternum appears at 3 years of age, but can show vast variation. The union of the four sternebrae occurs from the bottom upwards. The gures which this author has used with success are: union of 3rd and 4th sternebrae at 15 years, that of 2nd and 3rd at 20 years and that of 1st and 2nd at 25 years. The xiphisternum often unites with the body at 40 years. The manubrium sterni can unite with the body after 60 to 70 years, and quite often remains ununited. Figure 9 shows the lateral view of the sternum of an 18 year old male.
18

Figure 9: Lateral View of the Sternum of an 18 year old male.

AXIS Vol.1, Issue 2 (Winter 2009)

As bone begins to be laid from these two centers, the acetabular cup assumes the shape of a triradiate cartilage, which becomes noticeable in radiographs by 13 years. The triradiate cartilage disappears by 15 years. The head of femur appears by 1 year, the greater trochanter by 4 years and the lesser trochanter by 14 years. All these centers unite with the shaft by 17 years. Figure 10 is an AP view of both of the hip joints of a 13 year old male. He was referred to this author as he had claimed a place in a childrens home on account of his being below 18 years of age. The center for iliac crest has not appeared (<14 years). Triradiate cartilage could be seen (<15 years), and the greater trochanter has not united with the shaft (<18 years) A combination of these ndings enables us to tell that the age of the subject is below 14 years.

Figure 10: X-Ray of the hip-joint of a 13 year old male. Ossication around the hip joint The hip joint is probably the third most useful joint for age estimation after the wrist and elbow joints. The ischiopubic ramus unites by 7-8 years. The iliac crest appears at 14 years of age and unites with the ilium by 20 years. The center at the tip of the pubis appears at 14 years and at the tip of ischium at 16 years. These two centers unite with the rest of the bone by 20 years. Ossication in the acetabular cup begins from two separate centers, one or other of which is often termed the os acetabuli. One is between the ilium and pubis, and the other is between the ilium and ischium.

Figure 12: X-Ray of the hip joint of a male child less than one year of age. Figure 11 depicts the x-ray of the hip joint of a 2.5 year old male child, whose parents had divorced and the question was about the custody of the child. According to the prevalent law in India, normally a minor who has not completed the age of 5 years
19

Figure 11: X-Ray of the hip joint of a 2.5 year old male.

AXIS Vol.1, Issue 2 (Winter 2009)

shall be in the custody of the mother. In this case the father had claimed that the child was older than 5 years and he should be in his custody a claim contested by the childs mother. The X-ray shows that the head of femur has appeared (> 1 year), but the greater trochanter has not yet appeared (age < 4 years). Clearly the child was below ve years. From other criteria we could deduce that the child was about 2.5 years of age. Figure 12 shows the X-ray of a young child less than one year of age, who had won the rst prize in a baby show meant for children less than one year of age. The cash prize was rather big, and it was claimed by several other contestants (their parents in fact) that the child who eventually won the prize was related to the organizers and that is why they allowed a child older than one year to contest. The X-ray shows that the lower end of femur has appeared (>9 m Intrauterine Life). The upper end of the tibia can be seen faintly (it appears just at birth). The upper end of the femur has not appeared (<1 y) and the upper end of bula has also not appeared (<4 y). By taking all these ndings in consideration, we could easily say that the child was less than one year of age. Ossication around the knee joint The center for the lower end of femur appears at 9th months of intrauterine life. The center in the upper end of the tibia appears just at birth and in the upper end of bula at 4 years. All these three centers unite with their respective shafts by 18 years. Figure 13 is the AP view of the left knee joint of a male younger than 18 years, who was caught snatching a bag from a lady. He claimed asylum in a juvenile home on account of his being less than 18 years, a fact which was contested by the police. The X-ray of his knee shows that the lower end of femur, upper end of tibia & bula have not united, which makes it very simple to opine that his age is less than 18 years.
AXIS Vol.1, Issue 2 (Winter 2009)

Figure 13: X-Ray of the Knee joint of a male less than 18 years of age. Ossication around the ankle joint The center for the lower ends of both tibia and bula appear at 1 year of life and unite with their respective shafts at 17 years. The primary center for the calcaneum appears in the 5th month of intrauterine life, and the secondary center at 6 years, it unites by 16 years. Figure 14 shows the X-ray of an 8 year old male who was caught stealing some coal from railway wagons. His lawyer claimed that he was less than 7 years of age and thus was not legally responsible for his crime.

Figure 14: X-Ray of the ankle joint of an eight and a half year old male.
20

The X-ray of the ankle shows that the secondary center in the calcaneum has appeared (>6 years), but has not united (<14 years). Thus just from one x-ray the author could say that the child was between 6 and 14 years of age. Other criteria including teeth helped opine that his actual age was 8 years. Inputs from other specialties Pediatricians have been using some interesting methods for calculating bone age for quite some time. They compare the bone age with chronological age of the children for diagnosing several disorders, which show a characteristic relationship between the two. For instance hormonal deciencies, notably those of thyroid and growth hormone usually cause retardation in bone age by as much as 3 or more years. Most chronic disorders that impair growth as the consequence of metabolic causes or undernutrition will result in a bone age retardation by two years or so. In contrast, certain conditions can accelerate bone growth so that it exceeds chronological age. Thyrotoxicosis, sexual precocity and to a lesser extent simple exogenous obesity are amongst the disorders which advance bone age. As far as this author is aware, these methods have not been used for medicolegal estimation of age, but there is no reason why they cant be used. A brief look at these methods would be useful for those desirous of starting such a venture. Most of these methods can be divided into two broad groups. In one group the atlas method-, an atlas is used to compare the radiographs of various joints and once the X-rays are exactly matched, the ages are read off directly from the atlas. In the other group a scoring method-, a scoring is done for each bone in an X-ray according to some prescribed rules, and the nal age is read off some tables. Leading the rst group of methods is the method of Pyle et al. (1971) And the undoubted leader of the other group is the method of Tanner and Whitehouse,
AXIS Vol.1, Issue 2 (Winter 2009)

often known as the TW II method. Tanner and colleagues developed this method in 1962 (Tanner et al., 1962), which was later upgraded in 1975 (Tanner et al., 1975). Consequently the rst system came to be known as the TW 1 method and the second as TW II method (sometimes written as TW 1 and TW 2 methods). The method of de Roo and Schrder (1976) falls in the rst group, while the Fels method (Roche et al., 1988) falls in the second group. For details of these methods, the original publications must be consulted. Several authors have tried to compare the accuracy and ease of these methods (Buckler, 1983; Cole et al., 1988; Milner et al., 1986; van Lenthe et al., 1998) The general consensus is that while the atlas methods led by the method of Greulich and Pyle, are easier to perform, the scoring methods result in much more accurate ageing methods. Before an attempt is made to use these methods for medicolegal estimation of age, it must be remembered that the data for these methods was derived from children taken from a particular nation, so the data may not work well for other nations, or even within different areas of the same nation. The method of Pyle for instance, is based on American Population, and it is widely believed that this method does not give accurate results for British subjects. On the other hand, the method of Tanner and Whitehouse is based on British Children. Some authors have made an interesting attempt to adapt these well-established methods for their own needs in intelligent ways. Cole et al (1988) thought that the atlas of Greulich and Pyle did not give accurate results for the local population of Middlesbrough, so they examined 200 hand radiographs of their own local children and after studying them thoroughly devised this interesting equation; Recalibrated GP age = Nominal GP age x 1.065 + 0.129

21

Nominal GP age refers to the age which Greulich Pyle atlas suggests, and the recalibrated GP age refers to the age which comes after recalibration. The authors are convinced that this formula gives quite accurate ages for their own population. This method can be kept in mind by prospective workers wanting to use these methods for their own population. Secondary Sex characteristics Secondary sex characteristics only give a very vague idea of the age and are obviously not very helpful from a medicolegal angle. But sometimes they can provide good corroborative evidence. Hair rst appears around the pubes, then in the axilla region and nally over the face. In the male, ne downy hair begins to appear around the pubes by 14 years and in the axilla region by 15 years, and on the chin and upper lip between 16 to 18 years. The color of the hair becomes darker, and they become somewhat thicker in a couple of years. Hair on the inner sides of the thigh and on the scrotum may appear after 18 years. The Adams apple becomes more prominent by 16 to 18 years. In the females, menstruation starts by 12 to 13 years. Breasts begin to develop by about 13 years. Fine downy hair appears on the mons veneris by about 13 years. They become thicker and darker in about a couple of years. Estimation of age in older persons Estimation of age after 25 poses a real challenge, as by that time all teeth have erupted and most bones have united. Closure of skull sutures helps to some extent here. In general the skull sutures close in this pattern. An antero-posterior (Towne) view of the skull must be done to visualize all major sutures. This view quite comfortably shows the sagittal, coronal and the lambdoid suture. The same sutures can also be seen in postero-anterior radiographs of the
AXIS Vol.1, Issue 2 (Winter 2009)

skull. Both these X-rays must be advised, as different sutures may be seen clearly in different positions. The basisphenoid suture is visible in submento-vertical radiograph of the skull. An X-ray of lumbar and cervical spine often shows lipping of the vertebrae and the appearance of osteophytes after the age of 40 years. A chest x-ray may show ossication of costal cartilages. As earlier stated, X-rays of the sternum may be of some use after the age of 40 years. X-rays of neck may be tried to see the ossication of thyroid and laryngeal cartilage as well as the union of greater cornu of the hyoid with its body. The author routinely uses these X-rays for estimating the age of middle aged people. Features such as arcus senilis (>40 years), hair in the auditory meatus (>50 years), graying of hair (>40 years), loss of scalp hair (>40 years), the appearance of cataracts (>50 years) and loss of teeth (>60 years) are too variable to be of any use from a medicolegal angle.

Figure 15: Ultrasound of the wrist of the author himself. All proximal carpal bones can be seen.

22

The Indian Oil Corporation then claimed that the ages of several IBP workers were not correct. Nine such employees were sent to the author for assessment of age. The usual procedure is to undertake a thorough physical and dental examination, after which x-rays are requested from the radiologist. Atypical x-ray form will include any identication marks noted on the individual. Also a picture is afxed on the X-ray form. This is to ensure, that the subject is not switched when he/she is transferred to the X-ray unit, which in a large hospital is often quite a distance away from the forensic medicine department. The radiologist ensures that it is the same subject by matching the photograph and the identication marks. After the X-rays are received, all data is reviewed once again and a nal report prepared to be handed over to the police or to other proper authorities. The report typically consists of three parts the preliminaries, the main body of the report and the opinion. An important practical point is to take the consent of the individual. According to law, any physical examination of an individual without his consent may amount to assault. However if the patient is arrested, then consent may not be necessary (Aggrawal and Busuttil, 1991). It is important to note that an opinion is given only after careful consideration of all parameters general physical development, dental eruptions and ossication of bones. The author is tempted to say in the end that estimation of age is probably a judicious mix of ne art, rigorous science, careful judgment and shrewd intuition. This art can only be learnt with practice. No amount of rote learning without practice is going to be of any help.

Figure 16: Spiral CT of the Skull of an 11 year old male. Newer methods Newer imaging methods have recently been applied for estimation of age. Main among them are imaging by ultrasound (Bilgili et al., 2003; Castriota-Scanderbeg et al., 1998; Schulz et al., 2008) - see gure 15, echocardiography (Belozerova, 2006) and computed tomography (Schulze et al., 2006; Yang et al., 2006) - see gure 16. Estimation of age in actual practice Estimation of age is usually done on the request of the police for criminal cases, but in some exceptional cases, it is also done in civil cases. Many a time an employer contests the age of his employees, asserting that they are older than what they claim and that they are not t for the job because of their advancing age. Such a scenario is more common when a smaller company is absorbed by a larger company. The management of the larger company usually wants to dispense with the old employees and usually claims that the age of the employees is much more than they claim. In a recent case, a smaller company Indo Burma Petroleum (IBP) was taken over by Indian Oil Corporation (IOC).

AXIS Vol.1, Issue 2 (Winter 2009)

23

References
AGGRAWAL, A. (2000) Age Estimation in the Living - Some Medicolegal Considerations. Anil Aggrawals Internet Journal of Forensic Medicine and Toxicology. Delhi. AGGRAWAL, A. & BUSUTTIL, A. (1991) Age Estimation in the Living. The Police Surgeon (Journal of the Association of Police Surgeons), 38, 33-36. BELOZEROVA, L. M. (2006) Biological Age Estimation Using Echocardiography [Article in Russian]. Adv Gerontol, 19, 90-2. BILGILI, Y., HIZEL, S., KARA, S. A., SANLI, C., ERDAL, H. H. & ALTINOK, D. (2003) Accuracy of Skeletal Age Assessment on Children from Birth to 6 Years of Age with the Ultrasonographic Version of the Greulich-Pyle Atlas. Journal of Ultrasound Medicine, 22, 683-390. BRAND, R. W. & ISSELHARD, D. E. (1986) Anatomy of Orofacial Structures, London, The CV Mosby Company. BUCKLER, J. M. (1983) How to make the most of bone ages. Arch Dis Child, 58, 761-763. CAMERON, J. M. & SIMS, B. G. (1974) Forensic Dentistry, Edinburgh and London, Churchill Livingstone. CASTRIOTA-SCANDERBEG, A., SACCO, M. C., EMBERTI-GIALLORETI, L. & FRARACCI, L. (1998) Skeletal age assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods. Skeletal Radiology, 27, 271-277. COLE, A. J. L., WEBB, L. & COLE, T. J. (1988) Bone age estimation: a comparison of methods. The British Journal of Radiology, 61, 683-686. DE ROO, T. & SCRDER, H. J. (1976) Pocket Atlas of Skeletal Age, The Hague, Martinus Nijhoff Medical Division. GREULICH, W. W. & PYLE, S. I. (1959) Radiographic Atlas of Skeletal Development of the Hand and Wrist, Stanford, Stanford University Press. JIT, I. & KULKARNI, M. (1976) Times of Appearance and Fusion of Epiphysis at the Medial End of the Clavicle. Indian Journal of Medical Research, 64, 773-782. MASON, R. & BOURNE, S. (1998) A Guide to Dental Radiography, Oxford, Oxford University Press. MILNER, G. R., LEVICK, R. K. & KAY, R. (1986) Assessment of bone age: a comparison of the Greulich and Pyle, and the Tanner and Whitehouse methods. Clinical Radiology, 37 OSBORN, J. W. (1981) Dental Anatomy and Embryology, Oxford, Blackwell Scientic Publications.

AXIS Vol.1, Issue 2 (Winter 2009)

24

PYLE, S. I., WATERHOUSE, A. M. & GREULICH, W. W. (1971) Radiographic Standard of Skeletal Development of the Hand and Wrist, Stanford, USA, Stanford University Press. ROCHE, A. F., CHUMLEA, C. & THISSEN, D. (1988) Assessing the Skeletal Maturity of the Hand-Wrist: FELS Method, Springeld, Illinois, Charles C. Thomas. ROGERS, S. L. (1988) The Testimony of Teeth, Springeld, Charles C. Thomas. SCHULZ, R., ZWIESIGK, P., SCHIBORR, M., SCHMIDT, S. & SCHMELING, A. (2008) Ultrasound studies on the time course of clavicular ossication. International Journal of Legal Medicine, 122, 163-167. SCHULZE, D., ROTHER, U., FUHRMANN, A., RICHEL, S., FAULMANN, G. & HEILAND, M. (2006) Correlation of age and ossication of the medial clavicular epiphysis using computed tomography. Forensic Sci Int, 158, 184-9. TANNER, J. M., WHITEHOUSE, R. H. & HEALY, M. J. R. (1962) A new system for estimating skeletal maturity from the hand and wrist with standards derived from a study of 2600 healthy British children. Part II. The scoring system., Paris, International Child Centre. TANNER, J. M., WHITEHOUSE, R. H., MARSHALL, W. A., HEALY, M. J. R. & GOLDSTEIN, H. (1975) Assessment of skeletal maturity and prediction of adult height., London, Academic Press. VAN LENTHE, F. J., KEMPER, H. C. & VAN MECHELEN, W. (1998) Skeletal maturation in adolescence: a comparison between the Tanner-Whitehouse II and the Fels method. Eur J Pediatr, 157, 798-801. WILLIAMS, P. L. & WARWICK, R. (1980) Grays Anatomy, Edinburgh, Churchill Livingstone. WOELFEL, J. B. & SCHEID, R. C. (1997) Dental Anatomy - Its Relevance to Dentistry, Baltimore, Williams and Wilkins. YANG, F., JACOBS, R. & WILLEMS, G. (2006) Dental age estimation through volume matching of teeth imaged by cone-beam CT. Forensic Science International, 159, S78-S83.

AXIS Vol.1, Issue 2 (Winter 2009)

25