1. Medical Jurisprudence and Ethics ............... 3
Medical Council of India (MCI) 3
Functions of MCI 4
State Medical Council (SMC) 4
Duties of a Doctor 5
Privileged Communication 8
Medical Malpractice 9
Unethical Acts 10
Professional Misconduct (Infamous Conduct) 10
Erasure of Name 11
Red Cross Emblem 12
Types of Physician-Patient Relationship 12
Professional Negligence 13
Preventing Medical Litigation 14
Defenses Against Negligence16
Doctrine of Res Ipsa Loquitur 16
Calculated Risk Doctrine 16
Doctrine of Common Knowledge 17
Doctrine of Avoidable Consequence Rule 17
Medical Maloccurrence 17
Novus Actus Interveniens 17
Contributory Negligence 17
Therapeutic Misadventure/Hazard 17
Vicarious Liability/Respondeat Superior 18
Corporate Negligence 18
Products Liability 18
Consent 19
Medical Records 21
Malingering (Shamming) 21
Euthanasia (Mercy Killing) 22
2. Acts Related to Medical Practice ...............25
The Transplantation of Human Organs Act, 1994 25
The Consumer Protection Act, 1986 (CPA) 26
The Workmen's Compensation Act, 1923 28
The Medical Termination of Pregnancy (MTP) Act,
1971 28
The Prenatal Diagnostic Techniques (PNDT) Act, 1994
29
The Mental Health Act, 1987 31
3. Legal Procedure...........................................34
Inquest 34
Police Inquest 35
Contents
Section One
Jurisprudence and Forensic Medicine
Magistrate Inquest 35
Courts of Law 36
Subpoena or Summons 38
Conduct Money 38
Medical Evidence 38
Types of Witness 40
Recording of Evidence 41
Conduct and Duties of a Doctor in the Witness Box 42
4. Identification I ............................................... 45
Corpus Delicti 45
Race and Religion 45
Sex 47
Nuclear Sexing 47
Intersex 48
Sex from Skeletal Remains 51
Age 55
Age from Ossification of Bones 58
Age Determination in Adults Over 25 Years 60
Medico-legal Importance of Age 62
Stature 62
Scars 64
Tattoo Marks 65
5. Identification II .............................................. 70
Anthropometry (Bertillon System) 70
Dactylography (Dactyloscopy) 70
Poroscopy 73
Lip Prints (Cheiloscopy) 74
Hair 74
Superimposition 78
Forensic Odontology 78
Miscellaneous Methods of Identification 80
6. Medico-legal Autopsy ...................................83
Purpose/Objectives of Autopsy 83
Procedure for Medico-legal Autopsies 84
Instruments for Autopsy Examination 84
External Examination 84
Internal Examination 87
Skin Incisions 87
Evisceration Methods 87
Examination Proper 88
Chest 89
Heart 90
Neck 92
Skull and Brain 92
Description of an Organ 94
Report 94
Demonstration of Pneumothorax 95
Demonstration of Air Embolus 95
Collection of Samples 96
Preservation of Viscera 96
Preservation of Samples 97
Samples for Laboratory Investigations 98
Obscure and Negative Autopsy 99
Second Autopsy 99
Examination of Decomposed, Mutilated and
Skeletonized Remains 99
Exhumation 101
7. Autopsy Room Hazards .............................. 104
Commonly Acquired Infections 104
Autopsy of HIV Positive and HBV Patients 104
Autopsy and Disposal of Radioactive Corpse 106
8. Thanatology ................................................ 107
Brain/Brainstem Death 107
Cause, Mechanism and Manner of Death 109
Cause of Death 110
Modes of Death (Proximate Causes of Death) 110
Anoxia 111
Sudden Death 112
Coronary Atherosclerosis 113
9. Signs of Death ............................................ 117
Immediate Changes (Somatic Death) 117
Suspended Animation (Apparent Death) 118
Early Changes (Molecular Death) 118
Cooling of the Dead Body 119
Postmortem Staining 120
Rigor Mortis 123
Cadaveric Spasm 125
Heat Stiffening 125
Cold Stiffening 126
Decomposition/Putrefaction 127
Decomposition of Submerged Body 130
Floatation of a Dead Body on Water 130
Entomology 130
Adipocere (Saponification) 131
Mummification 132
Estimation of Time Since Death (TSD) or Postmortem
Interval (PMI) 132
Preservation of Dead Bodies 135
Presumption of Survivorship 135
Presumption of Death 135
10. Asphyxia ...................................................... 138
Pathophysiology of Asphyxia 138
Etiology of Asphyxia 138
Clinical Effects of Asphyxia 139
Hanging 140
Autopsy of Neck (Asphyxial Deaths) 141
Postmortem Findings in Hanging 142
Medico-legal Questions 144
Lynching 144
Judicial Hanging 145
Strangulation 145
Ligature Strangulation 146
Postmortem Examination 146
Medico-legal Questions 147
Throttling or Manual Strangulation 147
Postmortem Examination 148
Medico-legal Questions 150
Hyoid Bone Fractures 150
Suffocation 151
Café-coronary 152
Drowning 154
Postmortem Examination 157
Medico-legal Questions 161
Hyperventilation Deaths 161
Sexual Asphyxia (Autoerotic Asphyxia/Hypoxyphilia,
Asphyxiophilia) 162
11. Injuries......................................................... 165
Classification of Wounds/Injuries 165
Abrasion 166
Bruise/Contusion 168
Lacerated Wound 172
Incised Wound 174
Chop Wounds 176
Stab Wound 176
Defense Wounds 180
Therapeutic or Diagnostic Wounds 180
Fabricated Wounds (Fictitious/Forged Wounds) 180
12. Firearm Injuries .......................................... 183
Classification of Firearms 183
Rifled Firearms 183
Smooth Bore Firearms/Shotguns 184
Bore (Gauge/Calibre) 185
Bullet 186
Cartridge 187
Gunpowders (Propellant Charge) 188
Mechanism of Discharge of Projectile 189
Wound Ballistics and Mechanism of Injury 189
Firearm Wounds 190
Characteristics of Shotgun Wounds 191
Characteristics of Rifled Firearms Wounds 192
Firearm Wounds on Skull 194
Exit Wounds 194
x x Review of Forensic Medicine and Toxicology
Contents x x i
Peculiar Effects of Firearms 195
Postmortem Examination 196
Preservation and Marking of Exhibits 197
13. Regional Injuries ........................................ 204
Craniocerebral Injuries 204
Soft Tissue Injury 204
Skull Fractures 205
Coup and Contre-coup Injury 208
Brain Injury 209
Cerebral Concussion 209
Diffuse Axonal Injury (DAI) 210
Cerebral Contusion and Laceration 211
Intracranial Hematoma 212
Extradural/Epidural Hematoma (EDH) 213
Subdural Hematoma (SDH) 214
Subarachnoid Hematoma (SAH) 216
Intracerebral Hematoma (ICH) 218
Diffuse Injury to the Brain 219
Spinal Cord 221
Neck 222
Vertebral Column 222
Chest 223
Lungs 223
Heart 223
Abdomen 224
Kidneys 225
Bones and Joints 226
14. Thermal Injuries ......................................... 232
Cold Injury 232
Heat Injury 234
Heat Hyperpyrexia or Heat Stroke 234
Burns 236
Postmortem Examination 238
Medico-legal Questions 241
Scalds 242
Electrical Injuries (Electrocution) 243
Judicial Electrocution 246
Lightning Stroke 246
15. Transportation Injuries ............................... 249
Pedestrian Injuries 249
Injuries Sustained by Vehicle Occupants 252
Role of Seat Belts and Air Bags 253
Motorcycle and Cycle Injuries 254
Postmortem Examination 254
Alcohol, Drugs and Trauma 255
Railway Injuries 255
16. Explosion Injuries and Fall from Height .. 257
Explosion Injuries 257
Mechanism of Action 257
Classification of Injuries 257
Medico-legal Aspects 259
Fall from Height 259
Injury Patterns 260
17. Medico-legal Aspects of Injuries ............... 263
Simple Hurt/Injury 264
Grievous Hurt/Injury 264
Punishments 265
Cause of Death from Wounds 265
Medico-legal Questions 269
Injury Report 272
18. Decompression, Radiation and Altitude
Sickness ...................................................... 276
Decompression Sickness 276
Autopsy in Decompression Sickness 276
Ionizing Radiation Reactions 276
Altitude Illness 278
19. Starvation Deaths ....................................... 279
Mode of Starvation 279
Pathophysiology 279
Signs and Symptoms 279
Postmortem Findings 280
Medico-legal Questions 280
20. Infanticide and Child Abuse ...................... 282
Postmortem Examination of Infants 282
Age of Fetus 283
Rule of Hasse 285
Demonstration of Centres of Ossification 285
Features of Dead-Born Fetus 285
Signs of Live Birth 286
Postmortem Examination 286
Infant Death 289
Battered Baby Syndrome (Caffey/Maltreatment
Syndrome) 290
Sudden Infant Death Syndrome (SIDS, Cot Death or
Crib Death) 293
21. Anesthetic Deaths ....................................... 296
Death during Administration of Anesthesia 296
Deaths Directly Related to Administration of an
Anesthetic 296
Postmortem Examination 297
22. Abortion ....................................................... 299
Classification of Abortion 299
Criminal Abortion 300
Complications of Criminal Abortion 302
Duties of a Doctor in Suspected Criminal Abortion 303
Examination of a Woman with Alleged History of
Abortion 303
Postmortem Examination 304
Trauma and Abortion 304
23. Impotence and Sterility ............................. 306
Causes of Impotence and Sterility in Males 306
Causes of Impotence and Sterility in Females 307
xxi i Review of Forensic Medicine and Toxicology
Examination of a Person in an Alleged Case of
Impotence and Sterility 307
Sterilization 308
Artificial Insemination (AI) 310
Surrogate Mother 312
24. Virginity, Pregnancy and Delivery ............ 313
Normal Female Anatomy (in Virgins) 313
Medico-legal Aspects 314
Presumptive Signs/Symptoms 315
Probable Signs of Pregnancy 316
Positive/Conclusive Signs of Pregnancy 318
Pseudocyesis (Spurious/False/Phantom Pregnancy)
319
Superfecundation 319
Superfetation 319
Legitimacy and Paternity 319
Signs and Symptoms of Recent Delivery in Living 320
Signs of Remote Delivery in Living 321
Medico-legal Aspects of Pregnancy and Delivery 321
Nullity of Marriage and Divorce 322
25. Natural Sexual Offences............................ 325
Rape 325
Duties of a Doctor in case of an Alleged Victim of
Rape 328
Examination of the Rape Victim 328
Examination 329
Corroborative Signs of Rape 333
Rape on Deflorate/Sexually Active Woman 334
Rape on Children 334
Medico-legal Questions 336
Rape Trauma Syndrome 336
Examination of Rape Accused 337
Incest 338
Adultery 338
26. Unnatural Sexual Offences ....................... 340
Sodomy 340
Examination of Passive Agent of Sodomy 340
Opinion 342
Examination of Active Agent of Sodomy 342
Tribadism/Lesbianism 343
Bestiality (Zoophilia) 343
Buccal Coitus 343
27. Sexual Perversions/Deviations .................. 345
Sadism (Algolagnia) 345
Masochism (Passive Algolagnia) 345
Transvestic Fetishism (Eonism) 346
Voyeurism (Scoptophilia) 346
Exhibitionism 346
Fetishism 346
Frotteurism (Toucherism) 347
Pedophilia 347
Masturbation (Onanism) 347
Indecent Assault 348
28. Postmortem Artifacts .................................. 349
Artifacts due to Postmortem Changes 349
Third Party Artifacts 350
Environmental Artifacts 351
Other Artifacts 352
29. Forensic Psychiatry .................................... 353
Delusion 353
Hallucination 354
Illusion 354
Impulse 354
Obsession 355
Lucid Interval 355
Role of Forensic Psychiatrist 356
Psychiatric Assessment 357
Classification of Mental and Behavioral Disorders 358
Organic Mental Disorders 358
Schizophrenia 359
Mood (Affective) Disorders 361
Neurotic and Somatoform Disorders 361
Behavioral Syndromes 363
Mental Retardation 363
Mental Disorder and Responsibility 364
30. Bloodstain Analysis .................................... 371
Bloodstain Pattern Analysis 371
Presumptive Tests for Blood 371
Confirmatory Tests for Blood 373
Species Identification 374
Genetic Markers in Blood 375
Medico-legal Application of Blood (Groups) 376
31. Seminal Stain and Other Biological
Samples ...................................................... 380
Purpose of Seminal Identification 380
Examination of Seminal Stains 380
Confirmatory Tests 382
Identification of Species Origin 383
Individualization of Seminal Stains 384
Identification of Biological Samples and Body Fluids
384
32. DNA Fingerprinting ..................................... 386
RFLP 386
PCR 388
Specimen Selection and Preservation 390
Uses of DNA Fingerprinting 390
Limitations of DNA Testing 391
33. Torture and Custodial Deaths.................... 393
Types of Torture 393
Medical Practitioner and Torture 395
Custodial Deaths 396
Contents xxii i
34. Medico-legal Aspects of HIV ..................... 397
HIV Testing Policy 397
Health Care Workers and HIV Infection 397
Partner Notification 398
Clinical Trials and HIV 399
Blood Donation and HIV 399
36. General Toxicology .................................... 411
Medico-legal Aspects of Poisons 411
Classification of Poisons 412
Factors Modifying the Action of Poisons 413
Diagnosis of Poisoning in Living 413
Diagnosis of Poisoning in Dead 414
Failure to Detect Poison 416
Duties of a Doctor in a Case of Suspected Poisoning
416
Management of Poisoning Cases 417
Removal of Unabsorbed Poison 418
Administration of Antidotes 420
Elimination of Poison by Excretion 421
Samples Preserved for Toxicological Analysis 422
37. Corrosive Poisons ....................................... 427
Mineral Acids 427
Vitriolage (Vitriol Throwing) 428
Oxalic Acid (Acid of Sugar) 429
Carbolic Acid (Phenol) 430
Strong Alkalis (Caustic Alkalis) 431
38. Inorganic Metallic Irritants Arsenic ......... 433
Signs and Symptoms (Acute Poisoning) 433
Treatment 434
Postmortem Findings 435
Chronic Arsenic Poisoning 435
Postmortem Imbibition of Arsenic 436
39. Inorganic Metallic Irritants Mercury ........ 438
Signs and Symptoms (Acute Poisoning) 438
Treatment 439
Postmortem Findings 439
Chronic Mercury Poisoning (Hydrargyrism) 439
40. Inorganic Metallic Irritants Lead ............. 441
Chronic Lead Poisoning (Plumbism/Saturnism) 442
Signs and Symptoms 442
Treatment 444
Postmortem Findings 445
Section Two
Toxicology
41. Inorganic Metallic Irritants Copper ......... 446
Signs and Symptoms (Acute Poisoning) 446
Treatment 447
Postmortem Findings 447
Chronic Copper Poisoning 447
42. Inorganic Metallic Irritants Thallium....... 449
Signs and Symptoms 449
Treatment 449
Postmortem Findings 450
43. Other Inorganic Metallic Irritants .............. 451
Cadmium 451
Barium 452
Zinc 452
Metal Fume Fever (MFF) 453
Methemoglobinemia Inducing Agents 453
44. Non-metallic and Mechanical Irritants ...... 455
Phosphorus 455
Chronic Phosphorus Poisoning 456
Mechanical Irritants 456
45. Organic Irritants Vegetable...................... 458
Ricinus Communis (Castor) 458
Croton Tiglium (Jamalgota) 459
Abrus Precatorius (Rati, Gunchi, Jequirity) 459
Suis 460
Semecarpus Anacardium 460
Capsicum Annum 461
Calotropis ( Rubber Bush') 461
Ergot 462
46. Organic Irritants Animal ........................... 464
Snakes 464
Signs and Symptoms of Ophitoxemia 467
Management 469
Postmortem Findings 471
Medico-legal Aspects 472
Cantharides (Spanish Fly) 472
Scorpions 472
Bees and Wasps 473
35. Newer Techniques and Recent
Advances .................................................. 400
Polygraph 400
Brain Fingerprinting (Brain Mapping) 400
Narco-Analysis 401
Question Bank I ............................................... 403
xxiv Review of Forensic Medicine and Toxicology
47. Somniferous Poisons (Narcotic Poisons) .. 475
Opium 475
Signs and Symptoms 476
Treatment 476
Postmortem Findings 477
Body Packers 477
Chasing the Dragon 477
Chronic Morphine Poisoning (Morphinism) 478
Fentanyl 478
48. Inebriants Alcohol .................................... 479
Signs and Symptoms (Acute Poisoning) 481
Treatment 482
Postmortem Findings 482
Medico-legal Aspects 482
Chronic Alcoholism (Systemic Effects) 482
Delirium Tremens 483
Alcoholic Hallucinosis 484
Wernicke's Encephalopathy 484
Korsakoff's Psychosis 484
Drunkenness 485
Diagnosing a Case of Drunkenness 485
Laboratory Investigations 486
Collection of Samples in Living 487
Methyl Alcohol (Methanol) 488
Isopropyl Alcohol 490
Ethylene Glycol 490
49. Barbiturates ................................................. 493
Signs and Symptoms 493
Management 494
Treatment 494
Postmortem Findings 494
Barbiturate Automatism (Self-poisoning) 495
50. Deliriants Dhatura/Datura ......................... 496
Dhatura/Datura 496
Signs and Symptoms 496
Treatment 497
Postmortem Findings 497
51. Deliriants Cannabis .................................. 499
Signs and Symptoms 499
Treatment 500
Run-amok 500
52. Deliriants Cocaine .................................... 501
Signs and Symptoms 501
Treatment 502
Cocainism (Cocainomania/Cocainophagia) 502
Magnan's Syndrome/Cocaine Bugs 503
53. Spinal and Peripheral Nerve Poisons ...... 504
Strychnos Nux-vomica (Kuchila) 504
Curare 506
Conium Maculatum (Hemlock) 506
54. Cardiac Poisons .......................................... 507
Aconite (Monk's Hood, Mitha Zaher, Bish) 507
Nicotiana Tabacum (Tobacco) 508
Digitalis Purpurea (Foxglove) 508
Nerium Odorum (White Oleander, Kaner) 509
Cerbera Thevetia (Yellow Oleander, Pila Kaner) 510
Quinine 510
55. Hydrocyanic Acid........................................ 512
Signs and Symptoms 512
Treatment 513
Postmortem Findings 514
Judicial Execution 514
56. Asphyxiants ................................................. 516
Carbon Monoxide (CO) 516
Carbon Dioxide (CO2) 518
Hydrogen Sulphide (H2S) 518
57. War Gases and Biological Weapons...... 521
War Gases 521
Types of Chemical Warfare Agents (CWAs) 521
Biological Weapons 522
Types of Biological Warfare Agents 522
58. Agricultural Poisons ................................... 525
Organophosphorus Compounds (OPCs) 525
Signs and Symptoms 526
Treatment 527
Postmortem Findings 529
Endrin 530
Naphthalene 531
Paraquat 531
Pyrethrins and Pyrethroids 532
59. Alphos (Aluminum Phosphide) .................. 534
Signs and Symptoms 534
Treatment 535
Postmortem Findings 536
60. Medicinal Poisons ...................................... 538
Paracetamol (Acetaminophen) 538
Iron 539
Antipsychotic Drugs (Tranquillizers) 539
Antihistaminics 540
Tricyclic Antidepressants (TCAs) 541
Benzodiazepines 541
Acetylsalicylic Acid (Aspirin) 542
Chloral Hydrate 543
61. Drug Dependence....................................... 545
Patterns of Drug Use Disorders 545
DSM-IV Criteria for Diagnosis of Substance
Dependence 546
Psychoactive Substances 546
Contents x x v
Complications of Drug Abuse 549
Postmortem Findings 550
62. Kerosene Oil Poisoning ............................. 552
Signs and Symptoms 552
Treatment 553
Postmortem Findings 553
63. Food Poisoning .......................................... 554
Bacterial Food Poisoning 554
Botulism (Allantiasis) 555
Superscripts in the text refer to answers of the MCQs given at the end of the chapters.
Lathyrus Sativus ('Kesari Dhal') 555
Mushrooms 556
Argemone Mexicana (Prickly Poppy) 556
Question Bank II .............................................. 558
Index .................................................................... 561