Practical Forensic Medicine Nageshkumar G Rao
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1PRACTICAL FORENSIC MEDICINE
2Selected Book Reviews on 2nd Edition (1998)
Keeping pace with the new western ethos of defensive medicine, and the burgeoning consumer suits against doctors in India, it has become necessary for all practicing doctors to keep in touch with the subject of forensic medicine, lest they be overwhelmed in the courts. Practical Forensic Medicine is a boon to the busy doctor, who has little time to wade through thick tomes on subject. The book contains enough material for the medical student to pass forensic medicine Practical Examinations without struggle. One other advantage of this book is that it is readable, concise, yet good enough as a reference for police officers dealing with crime and for lawyers who practice criminal law. This again would be a blessing as a ready reference in the courtroom. The photographs, line drawings, tables, flow charts, etc., used liberally to illustrate the text are a great help.
Prof. B.M. Hegde MD, FRCP (Lond), FRCP (Edinb.), FRCP (Glasg.), FRCP (Dublin), FACC
Vice Chancellor, Manipal Academy of Higher Education, MANIPAL, India
Manipal Linq, May, 2002, pp 27
We all know about our very own knowledgeable Professor Nageshkumar G Rao, who has authored as many as 20 books on forensic medicine, all of which have been highly successful. This time the author springs a surprise on all of us by bringing out a book on practical forensic medicine. This area of forensic medicine had indeed been largely neglected by authors in the field, and undergraduate student was always at a loss when facing the practical examination. No more he has to rely on sketchy senior's notes. The book under review gives all the vital info one must have while facing the practical examination. Common spots and their descriptions are given, which have not been given in any book so far. Students will find this book very useful. All medical officers would also find this book useful as it gives all kinds of medico-legal forms and how to fill them up. Certainly a very commendable effort by the author. The book is richly illustrated and illustrations add to the usefulness of the book. The book is very reasonably priced too, and should be too heavy on the pocket of undergraduate student.
Editor
Jnl of Medico-legal Update,
Vol: III, No: 1-2, Jan-Dec, 1998, pp80.
3PRACTICAL FORENSIC MEDICINE
(For Medical Students, Interns, Medical Practitioners, Hospital Based Duty Medical Officers, Criminologists, Lawyers and Police)
(As per MCI Recommendations in the Gazette of India, May 17, 1997)
THIRD EDITION
Nageshkumar G Rao BSc, MBBS, MD, FIAMLE, FICFMT Professor & Head, Department of Forensic Medicine, Meenakshi Medical College and Research Institute, MAHER Deemed University) Kanchipuram - 631 552, Tamil Nadu Formerly Professor & Head, Director of PG Studies, State Medico-Legal Expert, Department of Forensic Medicine, Kasturba Medical College, (MAHE Deemed University) Manipal - 576 104, Karnataka Professor & Head, Department of Forensic Medicine and Toxicology Sikkim Manipal Institute of Medical Sciences, (Sikkim Manipal University) Gangtok, Sikkim - 737102
4 Published by
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Practical Forensic Medicine
© 2007, Nageshkumar G Rao
All rights reserved. No part of this publication and should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the contributors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and contributors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 1994, House of Research Publication Aid, Manipal
Second Edition: 1998, House of Research Publication Aid, Manipal
Third Edition: 2007, Jaypee Brothers Medical Publishers (P) Ltd, New Delhi
9788180619441
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
5 To My teachers who taught me My students to whom I've taught
“A lamp can never light another lamp unless it continues to burn its own flame............”
6 - Rabindranath Tagore
7Contributors
  1. Dr VV Wase, MD, DTCD, Diplomat NB, LLB, Dean, Professor of Forensic Medicine, (Former Head Department of Forensic Medicine, Grant Medical College, Mumbai), RCSM Government Medical College, Kolhapur, Maharashtra.
  2. Dr Nirmala N Rao, MDS, Associate Dean, Professor and Head, Dept of Oral, Maxillofacial Pathology, Manipal College of Dental Sciences, Manipal 576 104, Karnataka.
  3. Dr BS Venugopal M Com, MA, LLM, PhD Vice Principal, Vaikunta Baliga College of Law, Udupi, Karnataka.
  4. Dr Arun Kumar Agarwal, MS (ENT), Professor and Director, Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, New Delhi.
  5. Dr B Ashoka, MA, LLB, M.Phil, PhD, Professor and Head, Department of Criminology, School of Social Work, Mangalore 575 002, Karnataka.
  6. Dr J Kiran, MD, Professor and Head, Department of Forensic Medicine, Sri Devraj Ursu Medical College, Kolar, and Medico-legal Consultant, Manipal Hospital, Bangalore, Karnataka.
  7. Dr Achal Gulati, MS, Professor, Department of Otolaryngology & Head and Neck Surgery, Maulana Azad Medical College, New Delhi.
  8. Dr Annamma Kurien, MD, DCP, Professor of Pathology, Melaka Manipal Medical College (Manipal Campus), and In-charge Clinical Laboratory, Kasturba Hospital, Manipal -576 104, Karnataka.
  9. Dr B Krishnanand, MD, Professor, Department of Pathology, Kasturba Medical College, Manipal 576 104, Karnataka.
  10. Dr GG Lakshman Prabhu, MS, MCh (Uro), Diplomat NB (Uro), Professor, Department of Urology, Kasturba Medical College and Consultant Urologist, KMC Hospital, Mangalore 575001, Karnataka.
  11. Dr Arbind Kumar, BSc, MD, Diplomat NB (Forensic Med.), Associate Professor, Department of Forensic Medicine, Nalanada Medical College, Patna 800 026, Bihar.
  12. Dr Rodriguez Edmundo Jose, MD, Associate Professor, Department of Forensic Medicine, Goa Medical College, Bambolim 403 202, Goa.
  13. Dr Shelley Khanna Chadha, MS, Associate Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, New Delhi.
  14. Dr Binay Kumar Bastia, MD, Associate Professor, Department of Forensic Medicine, SDM Medical College, Dharwad, Karnataka.
  15. Dr Prabir Kumar Dev, MD, Assistant Professor (Formerly Assistant Professor of Forensic Medicine and Toxicology, SMIMS, 5th Mile, Gangtok - 737 102, Sikkim), Department of Forensic Medicine and State Medicine, North Bengal Medical College, P.O. Susruta Nagar, Siliguri, West Bengal.
  16. 8 Dr. Anand Menon, MD, Assistant Professor, Department of Forensic Medicine, Kasturba Medical College, Mangalore 575 001, Karnataka.
  17. Dr KR Nagesh, MD, Assistant Professor, Department of Forensic Medicine, Kasturba Medical College, Mangalore 575 001, Karnataka.
  18. Dr Ritesh G Menezes, MD, Diplomat NB (Forensic Med.), PGDMLE, Assistant Professor, (Formerly Assistant Professor of Forensic Medicine, Kasturba Medical College, Manipal 576 104, India), Department of Forensic Medicine, Manipal College of Medical Science, Pokhara, Nepal.
  19. Dr Vinod C Nayak, MD, Assistant Professor, Department of Forensic Medicine, Kasturba Medical College, Manipal 576 104, Karnataka.
  20. Dr Pranothi Sinha, MD, Lecturer, Department of Forensic Medicine and Toxicology, SMIMS, 5th Mile, Gangtok - 737 102, Sikkim.
  21. Nageshkumar G Rao BSc, MBBS, MD, FIAMLE, FICFMT Professor and Head
    Department of Forensic Medicine, Meenakshi Medical College and Research Institute (MAHER Deemed University), Kanchipuram - 631 552, Tamil Nadu.
9Review Panel
  1. Prof (Dr) L Thirunavukkarasu, MD, DFM, Head, Department of Forensic Medicine, (Former Head, Department of Forensic Medicine, Bangalore Medical College, Bangalore and Past President, Karnataka Medico-legal Society), St. John's Medical College, Bangalore 560 034, Karnataka.
  2. Prof (Dr) MS Usgaonkar, MD, DFM, Head, Department of Forensic Medicine, Krishna Institute of Medical Sciences Deemed University, Karad 415 110, Maharashtra.
  3. Prof (Dr) PC Sarmah, MD, LLB, Head, Department of Forensic Medicine and Toxicology (Formerly Head, Department of Forensic Medicine and Toxicology, Gauhati Medical College, Gauhati), Sikkim Manipal Institute of Medical Sciences, Gangtok - 737 102, Sikkim.
  4. Prof (Dr) MM Nadig, BSc, LLB, LLM, PhD, Principal, Vaikunta Baliga College of Law, Udupi 576 102, Karnataka.
  5. Prof (Dr) PK Chattopadhyay, MSc, PhD, Director, Amity Institute of Advanced Forensic Sciences Research and Training (Former Head, Department of Forensic Sciences, Punjabi University, Patiala, Punjab), Sector 125, Noida, UP.
  6. Prof (Dr) Ramdas Nayak, MD, Head, Department of Pathology, Kasturba Medical College, Mangalore 575 001, Karnataka.
  7. Prof (Dr) M Narayana Reddy, MD, LLB, LLM, Formerly Head, Department of Forensic Medicine, Osmania Medical College and General Hospital, Hyderabad 500 095, A.P.
  8. Prof (Dr) Ananda K, MD, Head, Department of Forensic Medicine, Kempegowda Institute Medical Sciences, Bangalore 560 004, Karnataka.
  9. Prof (Dr) S Girish, MD, LLB, Head, Police Surgeon, Dept of Forensic Medicine, Government Medical College, Thiruvanathapuram, Kerala.
  10. Prof (Dr) B Shantha Kumar, MSc (F Sci), MD, DFM, PGDMLE, Dip. NB (Forensic Med.), Head, Police Surgeon, Department of Forensic Medicine, Stanley Medical College, Chennai, 600 001, Tamil Nadu.
  11. Prof (Dr) P Sampath Kumar, MD, Head, Police Surgeon, Department of Forensic Medicine, Sri Ramachandra Medical College and Research Institute (Deemed University), Porur, Chennai – 600 116, Tamil Nadu.
  12. Prof (Dr) B Siva Reddy, MD, DFM, Head, Department of Forensic Medicine, Rajah Muthiah Medical College, Annamalai Nagar 608 002, Tamil Nadu.
  13. Prof (Dr) BM Nagaraj, MD, PGDMLE, Head, Department of Forensic Medicine, Dr. Ambedkar's Medical College, KG Halli, Bangalore 560 045, Karnataka.
  14. Prof (Dr) A Momonchand Singh, MD, Head, Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal 795 004, Manipur.
  15. Prof (Dr) SK Verma, MD, FIAFM, FICFMT, Department of Forensic Medicine, University College of Medical Science, New Delhi 110 095.
  16. Prof (Dr) Sanjoy Das, MD, Department of Forensic Medicine, Himalayan Institute of Medical Sciences, Dehradun 248 140, Uttaranchal.
10Foreword to the Third Edition
Practical forensic medicine is the essence of medico-legal aspects of medical practice, and every doctor is required to know its importance and understand all of its issues irrespective of their specialty. Today forensic medicine has cast its mantle on every facet of the dealings between medicine and society. Significance of practical forensic medicine is evident in the Judiciary system, without which justice can never be achieved.
This book ‘PracticalForensic Medicine’ gives a complete coverage of examining, reporting and writing opinions for a variety of medico-legal cases. It also furnishes a clear coverage of diagnosis, management and prevention of an entire spectrum of medico-legal problems. Data in this book are factual, reliable and scientifically accurate and are based on thorough analysis of recent literature. It is well structured with separate sections dealing with each and every aspect in detail. Topics such as Forensic Histopathology, Forensic Aspectsof Clinical Pathology, Embalming, Ideal Mortuary, Varsity Examination Methodology, OSPE, etc. are new to this edition, while other topics have been revised drastically. Further, the striking new design, illustrations and photographs reflect the efforts put into the making of this book.
Professor Nageshkumar G Rao is a celebrated teacher, a researcher and an eminent author in the Indian forensic scenario, currently with us as Professor and Head of the Department of Forensic Medicine at Meenakshi Medical College and Research Institute. I compliment Prof. Rao and his team of contributors and review panel members for this comprehensive practical book and wish success in their venture!
Dr E Muniratnam Naidu, MDS
Vice Chancellor, MAHER Deemed University
12, Vembuliamman Koil Street, West KK Nagar
Chennai 600078, Tamil Nadu, India
11Foreword to the Third Edition
I have known Dr Nageshkumar G Rao for more than two decades. He is an experienced expert and learned teacher in the subject of Forensic Medicine and Toxicology. He is member of Indian Congress of Forensic Medicine and Toxicology from the beginning and was awarded fellowship in the year 2003.
Many textbooks are available on the subject, but there are a few on practical aspects of Forensic Medicine. Factually this is the practical knowledge and hands on experience. Though the book is apparently designed for the physician or the forensic experts to deal with day to day work of Clinical Forensic Medicine, Forensic Pathology and Toxicology, it is the students of Forensic Medicine who are undoubtedly the ultimate target aimed. To achieve this, the author has selected relevant topics under the headings of Clinical Forensic Medicine, Jurisprudence Forensic Pathology, ForensicAspects of Clinical Pathology,Varsity Examination Methodology, comprising of Modern Methods of University Examination like “Objective Structured Practical Examination (OSPE).” The topics like Embalming, Ideal Mortuary and Ancillary Material are relevant as they help the experts to organize mortuary and embalming facilities in the regional centers.
I am sure that the readers will be benefited by the text in learning the practical aspects of forensic medicine and shall be able to apply the practical experience in their future carrier.
I wish Dr Rao all the best.
Dr TD Dogra, MD
Professor and Head, Department of Forensic Medicine
President, Indian Congress of Forensic Medicine and Toxicology (ICFMT)
All India Institute of Medical Science
Ansari Nagar, New Delhi, India
12Foreword to the Third Edition
Professor Rao is a well-known teacher in Forensic Medicine in India. It was my good fortune that I learnt my profession from him. It is a unique opportunity, rather honour for me for having been asked by my own teacher to write a foreword for the new revised edition of his book ‘Practical Forensic Medicine’. It is almost a decade since I did my post graduation from Manipal and now I am so far away from my alma mater, at Sikkim; yet my teacher remembers me among so many PGs who took training under him during all these years. This is also a contentment for me for the reason that, it is from the first edition of this book I learnt my practical forensic training those days staying in Manipal and today I have been asked to write the foreword for this new revised 3rd edition.
After Camps’Practical Forensic Medicine Book of 1970s from London, I think this book is the first one of its kind from India and undoubtedly would be the best one among the current forensic literature in existence. This contains information on almost every aspect of practical forensic problems presented most authentically maintaining high standards. I feel every essential aspect is described with all details as required. I am amazed at the amount of material available in the revised edition, and also fascinated by the masterly way it is presented.
The sections on Jurisprudence, Forensic Pathology and Forensic Aspects of Clinical Pathology enfold several new chapters such as IPC Sections, Crime Scene Investigation, Forensic Histopathology, Embalming, Ideal Mortuary, Haematology, Blood Grouping, Semen Analysis, Pregnancy Tests, Urine Analysis, etc. offering the basic information with relevant applied forensic aspects, act as a buffer for not only forensic practitioners but also the hospital based duty medical officers, interns, and students preparing for practical forensic medicine examination. I am sure the book will be also of use for the practitioners of allied specialties such as forensic sciences, criminology, criminal justice, and law enforcement.
I recommend this book also to every registered medical practitioner especially to those who are working in an environment prone to forensic problems with current trends of defensive medical practice.
I wish a grand success for this new edition.
Dr Krishna B Gurung, MD
Medico-legal Specialist to Government of Sikkim,
S T N Hospital, Gangtok, Sikkim, India
13Foreword to the Second Edition
This is an excellent piece of work by Dr Nageshkumar G Rao, Professor and Head of the Department of Forensic Medicine, KMC, and Manipal. The second edition of Practical ForensicMedicine is very concise and practical oriented, covers almost all the common medico-legal problems in medicine that one is likely to come across in day to day practice and is meticulously objective.
The importance of such a publication in today's context cannot be over emphasized. Never before have our hospitals and doctors being subjected to such severe public scrutiny as in the recent years. There is an increasing trend in crime rate due to relentless increase in population, industrialization and urbanization. Psychological and emotional stress often leads to alcoholism, violence and sexual assaults and hence an increase in number of medico-legal cases.
Unfortunately, the young doctors particularly when confronted with such medico-legal cases are not in a position to deal with the situation due to lack of knowledge in the field. The common problems that one faces on such occasions are providing proper and timely intimation to police authorities, preparation of injury reports, preservation of trace of evidences, custody of medico-legal records, disposal of dead bodies and documents, drunkenness certificates, certificate of death, dealing with brought dead cases, etc.
This edition on ‘Practical Forensic Medicine’ provides immense information on how to deal with such situations in an appropriate manner. In fact, every medical student and doctors should possess a copy of such publication to avoid embarrassing situation when confronted with medicolegal cases.
We are grateful to Dr Rao, for bringing out this edition for the benefit of medical profession in general and particularly to the students. Besides, it is also beneficial to the legal profession and police authorities.
I wish him all the success in his endeavours.
Dr (Brig) VP Bhaskaran, MD
Medical Superintendent, Kasturba Hospital
Manipal, Karnataka, India.
14Foreword to the Third Edition
The management of medico-legal cases has evolved over the past eight years, since the second edition of this book. The changes have been in detail rather than in principle, and they have necessitated substantial revision of the book. The text has been revised, with appropriate addition and substitution of content and remarkably improved illustrations. Further, the book has been given a better graphic design and typography. The colour printing has also given it the most modern look.
I am pleased to mention about the elite group of thirty six intellectuals from the pertinent specialty have co-authored/reviewed this edition. The co-authors have helped in revising the contents, while the review panel members have done the necessary critical evaluation.
This book is primarily intended for interns, undergraduate and postgraduate medical students. In the modern times of ever increasing litigations, this book should find a valued place on the shelves of forensic experts, general practitioners and hospital based duty medical officers, nurses, criminalists, lawyers and police.
Any suggestions and constructive criticism regarding this book is most welcome. Kindly send all your communications to my e-mail address: prof.nkgr@gmail.com.
Nageshkumar G Rao
Chennai
October 01, 2006
15Preface to the Second Edition
Gone are the days where a doctor is considered next to God almighty. The enactment of Supreme Court in 1995, to include medical services in the Consumer Protection Act of 1986 in India, has declared the dawn of patient as consumer and doctor as the provider, breaking open a new culture of doctor-patient relationship. Accordingly every doctor whatever be his specialty is to be very careful in performing his duty towards the sick. In response to public litigation petition, Supreme Court of India in 1989 delivered a judgement stating:
‘Every doctor is duty bound to attend to, and protect the lives of an injured victim brought before him, regardless of injury.’
Thus every injured person should get medical care immediately as to save life. However, this does not render a doctor immune to the Medico-legal responsibilities that follow. He will not be excused if he fails in giving proper care. The obligation of a doctor in this regard, is therefore, ‘total, absolute and paramount’.
As a consequence the former concept of all Medico-legal cases stood as the domain of only Government Doctors has collapsed and no doctor can refuse to treat Medico-legal cases. Even when facilities for treatment are not available with him/her one is expected to provide at least first aid measures and all possible measures prior to referring to the nearest hospital with better facilities.
The second edition has been now revised thoroughly taking proper care to implement Revised Syllabus Recommended by Medical Council of India as published in the Gazette of India, May 1997, making it more unique and first of its kind ever published in India, suitable for the recommendation by every Indian Universities for their affiliated Medical Colleges. Though this book will be basically meant for the medical students for learning the Practical aspects of Forensic Medicine, it will be of great help also to the interns as well as medical practitioners.
Trust the revised edition will find a favourable response.
Nageshkumar G Rao
October 01, 1998
16Preface to the First Edition
Every medical doctor is bound to know the medico-legal aspects of matter pertaining to modern medical practice. Be it a free Governmental hospital or a well equipped tertiary care private hospital, legally a treating doctor will not get any immunity in medico-legal matters. With introduction of COPRA in India, medical profession has turned more vigilant on an erring doctor. Doctors have to be more vigilant about the legal and ethical formalities in handling their cases in routine medical practice. Doctors are also supposed to know the legal procedure as medical experts are often called in the court of law as expert witness.
Practical Forensic Medicine, I am sure is the first Indian book is the need of the hour, meant to be a ready source for the medical professionals, interns, undergraduates and postgraduates students of forensic medicine.
Book provides guidance on formalities and procedure of examining and drafting the certificate/final opinion on routine medico-legal case, medico-legal autopsy, collecting, preserving and dispatch of viscera and other ancillary materials to chemical examiner, histopathology examination at pathology laboratory, etc. The book also provides information on spotters which are often kept in the university examination. These are soft specimens of forensic significance; fresh plant specimens of toxicological concern; instruments and appliances of clinical forensic medicine interest; weapon of assault of medico-legal importance. Photographs, line-drawings, sketches, simple flow charts and tables have been given at appropriate places rendering easy understanding, recollection and reproduction of the subject.
This book will be successful only if our professional colleagues impart and implement this in the respective training of practical forensic medicine in their respective departments, promoting uniformity in teaching Practical Forensic Medicine.
Nageshkumar G Rao
October 01, 1994
17Acknowledgements
While it is not possible to name all those who have helped me in compiling this revised edition of the book, I would like to thank following in particular: