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Textbook of Forensic Medicine and Toxicology
Nageshkumar G Rao
PART I: INTRODUCTION AND EVOLUTION
CHAPTER 1:
Introduction
DEFINITION
FORMER TERMINOLOGIES
CHAPTER 2:
Historical Perspectives
ORIGIN OF THE TERMINOLOGY FORENSIC MEDICINE
4000–3000 BC
3000–1000 BC
1000–50 BC
During the Time of Christ
1st and 5th Century AD
5th–10th Century AD
11th–12th Century AD
12th–15th Century AD
16th–17th Century AD
17th–18th Century
In 19th Century AD
FORENSIC MEDICINE IN INDIA
PART II: MEDICAL JURISPRUDENCE
CHAPTER 3:
Doctor and the Law
INTRODUCTION
COURTS IN INDIA
Supreme Court
High Court
Session's Court (District Session's Court)
Magistrate's Court
Executive Magistrates
Judicial Magistrates
Functions of Chief Judicial Magistrate (CJM)4
Powers of Judicial Magistrates
Special Magistrate
Cases Tried by Judicial Magistrates
Public Prosecutor
Legal Sentences that can be Passed under Law
EXHUMATION
Definition
Objectives
Procedures
Precautions at Exhumation
Time Limit for Exhumation
INQUEST
Definition
Explanation
Types of Inquest
Procurator Fiscal
Magistrate's Inquest
Places of Practice
Police Inquest
Procedure
Postmortem Reports
Place of Practice
Medical Examiner's System
Procedure
COURT PROCEDURES IN CRIMINAL COURTS
Attendance in Court
Subpoena (Summons)
Definition
Explanation
Procedure of Serving the Summons
Rules of Summons
Warrant (Witness Warrant)
Definition
Types
Conduct Money
Definition
Oath Taking
Oath
Recording of Evidence
Examination-in-chief
Cross-examination
Re-examination
Court Questions
MEDICAL EVIDENCE
Documentary Evidence
Medical Certificates
Medicolegal Reports
Dying Declaration
Dying Deposition
Oral Evidence
Types of Oral Evidence
WITNESS
Definition
Classification
Common Witness
Expert Witness
Medical Man (Doctor)
Tips to the Expert Witness
Skilled or Scientific Witness
Two Other Types of Witness
The Behaviour of a Doctor in Court (Rules/Conduct and Duties of a Doctor in a Witness Box)
DOCTOR AND SCENE OF CRIME1–3,7–8,11,14,20,24,
CONDUCT AT THE SCENE
CHAPTER 4:
Ethics of Medical Practice
INTRODUCTION
CHARAKA'S OATH
CODES OF MODERN MEDICAL ETHICS
Hippocratic Oath
Declaration of Geneva
Declaration of Sydney
Declaration of Tokyo
INTERNATIONAL CODE OF MEDICAL ETHICS
Duties of Doctors in General
Duties of Doctors to the Sick
Duties of Doctors to Each Other (Medical Etiquette)
Declaration of Helsinki
CODES OF MEDICAL ETHICS IN INDIA
The Declaration
Declaration of Code of Medical Ethics in India
The Code Proper
Code of Medical Ethics
INDIAN MEDICAL COUNCIL (IMC)
Office of Indian Medical Council
Duration of the Office
Codes of Medical Ethics Prescribed
Functions of Indian Medical Council10–18
Maintenance of Medical Register
Maintenance of Medical Education
Indications for Inspection
Recognition of Foreign Medical Degrees
Appeal against Disciplinary Action
Procedure of Appeal
The Final Decision
Warning Notices
Explanation
STATE MEDICAL COUNCIL (SMC)
Office of State Medical Council
Duration of the Office
Functions of State Medical Council
Maintenance of Medical Register
Disciplinary Control
Disciplinary Enquiry
Procedure
Penal Erasure (Professional Death Sentence)
REGISTERED MEDICAL PRACTITIONER
Definition
Procedure of Getting Registered
Declaration
Merits of Registration as Registered Medical Practitioner
Rights and Privileges of Registered Medical Practitioner
Duties of Registered Medical Practitioner
PROFESSIONAL MISCONDUCT (Synonyms: Infamous Conduct)
Definition
Punishments
Examples
Association with Unqualified Persons
Advertising
Adultery
Abortion
Addiction
Alcohol
Other Examples
PROFESSIONAL SECRECY
Definition
Explanation
Case Example
Medicolegal Significance
CONSENT IN MEDICAL PRACTICE
Definition
Consent and its Validity
Types of Consent
Implied Consent
Expressed Consent
RELEVANCE OF CONSENT IN MEDICAL PRACTICE
Consent in Relation to Certain Diagnostic and Therapeutic Purposes
Rules of Consent
Doctrine of Informed Consent (Synonym: Rule of Full Disclosure, Written Informed Consent, Informed Consent)
Precautions During Consent
Consent and Certain Deviations and Exceptions
Doctrine of Therapeutic Privilege
Doctrine of Emergency
Doctrine of Locoparentis
Consent in Relation to Medicolegal Purposes
CONSENT IN RELATION TO AUTOPSY AND ORGAN TRANSPLANTATION
Consent in Relation to Autopsy Examination
Consent in Relation to Remove and Retain Parts of the Body
Consent in Relation to Organ Transplantation
MEDICAL NEGLIGENCE (Synonyms: Professional Negligence, Malpractice, Malpraxis)
Definition
Explanation
Extent
Doctrine of Res Ipsa Loquitor
Explanation
Examples
Classification
Civil Malpractice (Civil Negligence)
Criminal Malpractice
Burden of Proof and Essential Ingredients of Medical Negligence
Duty
Dereliction/Breach of Duty
Direct Causation
Damage
Other Criteria
Case Examples
INSTRUCTIONS ON PREVENTION OF CHARGES OF NEGLIGENCE
DEFENSES OF A DOCTOR AGAINST CHARGES OF NEGLIGENCE
MEDICAL INDEMNITY INSURANCE
CHAPTER 5:
Euthanasia (Mercy Killing)
INTRODUCTION
DEFINITION
TYPES OF EUTHANASIA
EUTHANASIA AND ITS ETHICAL ASPECTS
INDIAN LAW ON EUTHANASIA
REQUIREMENTS OF EUTHANASIA
ROLE OF THE PHYSICIAN
VOLUNTARY EUTHANASIA—INDIAN DOCTOR'S VIEWPOINT
VOLUNTARY EUTHANASIA AND INDIAN SOCIETY
CHAPTER 6:
Consumer Protection Act and Medical Profession
INTRODUCTION
Purpose of the Act
Application of the Act
Who is a Consumer?
Rights of a Consumer1,5,6,8–10
What is a Complaint?
Procedure for Lodging Complaint and Disposal of Cases1,6
District Level
State Level
National Level
Proper Procedure
Penalty1,4,10
Acts and Apprehensions in Medical Profession
How the Doctors in General should Deal with the Problem if the Profession is kept within the Purview of CPA (1986)?
CONCLUSION
CHAPTER 7:
Human Organ Transplantation: Legal and Ethical Aspects
INTRODUCTION
Regenerative Tissues or Organs
Examples
Nongenerative Tissues or Organs
Concept of Living and Cadaver Donors
THE TRANSPLANTATION OF HUMAN ORGANS ACT, 19941–5,7,9,10
Restrictions of Removal and Transplantation of Human Organs1,2,5,6
Authority for the Removal of Human Organs1,5,9,10
Regulation of Hospitals1–8
Offences and Penalties1
CHAPTER 8:
Ethical and Legal Aspects of AIDS
INTRODUCTION
ENGLISH LAW2,3
US POSITION2–4
INDIAN POSITION2,3,5,
Examples
ISSUES RAISED
Isolationist Response
Integrationist Response
CHAPTER 9:
Medical Records
INTRODUCTION
CONTENTS OF MEDICAL RECORDS
In Medical Cases
Property Rights of Medical Records
Patient's Rights
Medical Records in Court
Submission of Records to Government and Other Agencies
Storage and Disposal of Medical Records
Medical Records and Research
CHAPTER 10:
Medical and Legal Aspects of Anaesthetic and Operative Deaths
INTRODUCTION
ANAESTHETIC DEATHS
Deaths Due to Anaesthesia and Anaesthetic Agents
Anaesthetic Agents
Anaesthetists
Functional Problems
Deaths Due to Factors other than Anaesthesia
MODE AND CAUSE OF DEATH
Cardiac Arrest
Asphyxia of Myocardium
Overdose of Anaesthetic Agents
Reflex Vagal Stimutation
Respiratory Failure
INVESTIGATION AND EXAMINATION OF A CASE OF AN ANAESTHETIC DEATH
AUTOPSY EXAMINATION IN A CASE OF AN ANAESTHETIC DEATH
Precautions
Autopsy Procedure
Chemical Analysis
Bacteriological Examination
Hazards of Transfusion of Blood and Body Fluids
Extraneous Specimens
COMMON MISHAPS IN ANAESTHETIC PRACTICE
Mistaken Identity
Incorrect Positioning of the Patient
Faults in the Anaesthetic Machine
Failure of Suction Apparatus
Perforation of Airway
Electrocution or Burns
Fault with Intravenous Equipment
Mishaps with Drugs
Monitoring of Vital Signs
Human Error
PREVENTING ANAESTHETIC MISHAPS
Proper Maintenance of Equipments
HANDLING CASE OF ANAESTHETIC MISHAP
MEDICOLEGAL CONSIDERATIONS
DEATH ON OPERATION TABLE
Negligence Primarily by Surgeon Alone
Acts of Omission
Acts of Commission
Negligence by Operating Assistants
Corporate Negligence during Surgery or in Postoperative Phase
PART III: FORENSIC PATHOLOGY
CHAPTER 11:
Forensic Identity
INTRODUCTION
Identification of the Living
Identification of the Dead
Pedigree
DEFINITION
CLASSIFICATION
Complete or Absolute Identity
Partial or Incomplete Identity
Legal Identity
CORPUS DELICTI (BODY OF OFFENCE, ESSENCE OF CRIME)
FACTORS ESTABLISHING PERSONAL IDENTITY
AGE AND IDENTITY
Intrauterine Life (IUL)
From Birth to 25 Years Age
Morphological Characteristics
Dentition (Teeth)
Other Factors about Teeth in Determining Age
Gustafson's Method/formula1,4,5,11–15
Other Approved Methods of Establishing Age by Teeth16–18
AGE BY CLOSURE OF SKULL SUTURES1,3,5,6,11
Time of Fusion of Sutures (Table 11.9)1,3,5,6,11,20–22 (Refer Fig. 11.7A)
Ossification of Bones1–6,19,25–26
Skeletal and Dental Changes Occurring in Advanced Old Age3,11,26
Confirmation of Ossification Pattern
Changes in Sacrum and Vertebrae Helpful in Determining the Age
Sacrum
Vertebrae
HEIGHT AND WEIGHT DATA
MEDICOLEGAL IMPORTANCE OF AGE1–6,11,23–24,28–33
SEX AND IDENTITY1–6,8,9,11,22–26
Physical Examination
Gonadal Biopsy
Sex Chromatin (Barr and Davidson Bodies)8,9,11,35–37
Buccal Smear
Vaginal Epethilial Cell (PAP Smear)
Peripheral Blood Smear
Other Methods
Costal Cartilage Calcification Pattern
Footprint Ratio (FPR)
Mandibular Canine Index
Cytogenetics and DNA Analysis
Counting of Sex Material within the Nucleus
Sex Determination in a Dead Body
Meticulous Autopsy Examination of Internal Genital Tract
Skeletal Examination11,22,23
Medicolegal Importance of Sex Identity
Concealed Sex
Intersex
IDENTITY BY OTHER FACTORS
Race and Racial Characters
Cephalic Index
Religious Factors in Establishing the Racial Identity
Dactylography (Dermatoglyphics, Dactyloscopy, Galton System, Finger-print Study)
Classifications of Finger-print Pattern
Other Terminologies of Ridge Pattern
Maintenance of Finger-print Records
Methods of Taking Finger-prints
Medicolegal Importance of Finger-print
Use of Computer System for Finger-print Study
Age of the Finger-print
Finger-prints and Scaring Trauma
Foetal Development of Epidermal Rings
POROSCOPY
Indications
FOOT-PRINTS
Procedure of Taking Foot-print
Collecting Foot-print Impression Left in the Soil or Sand
Note
Foot-print of Newborn Infants
COMPLEXION
BODY FEATURES
Identikit
PRINTS OF OTHER BODY AREAS
Ear Prints
Nose Prints
Palato Prints (Rugoscopy)
Lip Prints (Cheiloscopy)
Electrocardiogram (ECG)
Nail Prints
Hairs
Confirmation of Hair
Confirmation as Human Hair
Site of Origin of Hair
Injury to Hair
Singed Hair
Hair and Stains on it
Hair and Poisoning
Hair and Identity
Miscellaneous Information from Hair
STATURE
DEFORMITIES
Moles and Naevi
Birthmark
Medicolegal Importance
TATTOO MARK
Pigments Used
Diversity, Alterations and Elimination of Tattoo Marks
Making a Faint Tattoo Visible
Confirming Tattooing in Attempted Erasure Cases
Medicolegal Importance
SCARS
Medicolegal Importance
ANTHROPOMETRY (BERTILLON'S SYSTEM, BERTILLONAGE)
Principle
Disadvantages
OCCUPATIONAL STIGMA
SUPERIMPOSITION
The Technique
Opinion
Disadvantages of Superimposition Technique
VIDEO SUPERIMPOSITION
Step I
Step II
Step III
DNA FINGERPRINTING
BRAIN FINGERPRINTING69
Introduction
Explanation
Medicolegal Significance
TRACE EVIDENCE FACTORS
Locard's Principle of Exchange
Hairs and Fibers
CHAPTER 12:
Forensic DNA Profiling
INTRODUCTION
FORENSIC GENETICS
DEOXYRIBOSE NUCLEIC ACID
Advantages of Using DNA for Identification5–13
Disadvantages
THE BASICS OF MOLECULAR BIOLOGY1–2,12–16
Extraction, Detection and Visualisation of DNA
TANDEMLY REPETITIVE DNA
Minisatellites
Polymerase Chain Reaction (PCR)24
Microsatellites25–27
SHORT TANDEM REPEAT DNA PROFILING28–32
CLASSIFICATION OF STRs
STR MUTATIONAL MECHANISMS
STR RESOLUTION TECHNIQUES
STR Analysis and Automation
Use of Allelic Ladders
Nonspecific Amplification Peaks
ENVIRONMENTAL CONTAMINATION
ACCEPTANCE OF DNA EVIDENCE AT THE LEGAL FORUM
STANDARDISATION OF STR NOMECLATURE AND TECHNIQUE
POPULATION GENETICS41–49
Y-CHROMOSOME POLYMORPHISMS34–40
Development of Y-Chromosome Specific STR Systems
FORENSIC APPLICATIONS OF Y STRs9–15, 34–40
Y STR MULTIPLEXING STRATEGIES39–49
PHYLOGENETIC VALUE OF Y-CHROMOSOME SPECIFIC STRs
DETECTION OF DNA
Areas to Look for DNA on or off the Crime Scene
Collection, Storage and Transport of DNA Evidence
APPENDIX I
Match Probability
Formula:
Example
Power of Discrimination
Formula:
Example
CHAPTER 13:
Thanatology
INTRODUCTION
DEFINITION OF DEATH
SOMATIC DEATH (SYNONYMS: SYSTEMIC DEATH, CLINICAL DEATH)
Definition
Explanation
MOLECULAR DEATH (SYNONYM: CELLULAR DEATH)
Definition
Explanation
CONCEPT OF DEATH
BRAINSTEM DEATH AND ORGAN TRANSPLANTATION
Cerebral/Cortical Death
Causes
Brainstem Death
Beating Heart Donor
Causes
Diagnosis of Brainstem Death
Brainstem Reflexes
Time of Death
Whole Brain Death
THE MODE, MANNER, MECHANISM AND CAUSE OF DEATH
I. MODES OF DEATH
Syncope (Fainting)
Mechanism
Causes
Clinical Features
Autopsy Findings
Asphyxia
Mechanism
Gordon's Hypothesis (1944)21,24–26
Clinical Features of Asphyxia
Postmortem Appearances of Asphyxia
Coma
Mechanism
Causes
Autopsy Findings
II. MANNER OF DEATH
III. MECHANISM OF DEATH
IV. CAUSE OF DEATH
Immediate Cause
Antecedent Cause
Contributory Cause
MEDICOLEGAL IMPORTANCE OF DEATH
Death and the Indian Penal Code (IPC)
Disposal of the Body
Tissue and Organ Transplantation
Legal Presumption of Death
Question of Presumption of Survivorship
Issuing of Death Certificate
SUDDEN DEATH (RAPID DEATH, SUDDEN NATURAL DEATH)
Cause
Cardiovascular System
Respiratory System
Intracranial Vascular Lesions
Psychiatric Patients
Gastrointestinal System
Gynaecological Conditions
Endocrinal Causes
Iatrogenic Causes17,21,27
Miscellaneous Causes17,21,27
Special Causes in Children17,21,27,28
CHANGES AFTER DEATH (SYNONYM: POSTMORTEM CHANGES, SIGNS OF DEATH)11–13,16,17,20,21,27
1. Immediate Changes
2. Early Changes
3. Late Changes
Medicolegal Importance of Postmortem Changes
INSENSIBILITY
Respiratory Arrest
Circulatory Arrest
SUSPENDED ANIMATION (SYNONYM: APPARENT DEATH)
Classification
Causes
Medicolegal Importance
POSTMORTEM COOLING (SYNONYM: ALGOR MORTIS)
Definition
Mechanism of Cooling
Measuring the Cadaveric Temperature
Rate of Cooling
Factors Controlling Rate of Cooling
POSTMORTEM CALORICITY
Definition
Causes
EYE CHANGES
SKIN CHANGES
POSTMORTEM LIVIDITY
Definition
Mechanism
Site
Time of Onset
Fixation
Colour of Postmortem Lividity
Hypostasis of the Visceral Organs/Internal Organs
Medicolegal Importance of Postmortem Lividity
MUSCLE CHANGES
PRIMARY FLACCIDITY
RIGOR MORTIS (SYNONYM: CADAVERIC RIGIDITY)
Mechanism
Testing for Rigor in Cadaver
Onset of Rigor
Time Taken for Onset of Rigor Mortis
Secondary Flaccidity
Position Opted on Complete Development of Rigor Mortis
Postmortem Interval and Rigor Mortis
Conditions Resembling Rigor Mortis
Cadaveric Spasm (Synonym: Instantaneous Rigor, Death Clutch, and Cataleptic Rigidity)
Heat Stiffening (Synonym: Pugilistic Attitude)
Cold Stiffening
Gas Stiffening
Factors Affecting Rigor Mortis
POSTMORTEM DECOMPOSITION
Autolysis
PUTREFACTION
Mechanism
Bacterial Action
Onset of Putrefaction
External Changes
Colour Changes of Skin
Colour Changes of Skin and Postmortem Interval
Marbling of Skin
Evolution of Foul Smelling Gases
Postmortem Interval by Putrefying Gas Collection
In Summer-in General
CADAVERIC ENTOMOLOGY (Forensic Entomology/Fauna of Cadaver/Appearance of Maggots)
Colliquative Putrefaction17,20,27
Internal Changes
Rapidly Putrefying Organs
Slowly Putrefying Organs
Conditions Influencing Putrefaction
Condition of Body
Cause of Death
The Surrounding Atmosphere
The Medium in which the Body Lies
Putrefaction in Water
Destruction by Animals16,21,29
SKELETONISATION
ESTIMATION OF TIME SINCE DEATH/ POSTMORTEM INTERVAL (PMI)
Changes in Gastrointestinal and Urinary Tract
Changes in Biological Fluids
Growth of Hair and Nails
Scene of Death Particulars
Carbon Dating
CONDITIONS THAT REPLACE PUTREFACTION
ADIPOCERE FORMATION
MUMMIFICATION
MACERATION
PROCESS OF PRESERVING THE DEAD BODY20–21,41,49,50
Embalming
Freezing
Taxidermy
CHAPTER 14:
Postmortem Examination
DEFINITION
CLASSIFICATION
Clinical/Pathological/Academic Autopsy
Medicolegal Autopsy
Anatomical Autopsy
CONSENT FOR AUTOPSY
MEDICOLEGAL AUTOPSY
OBJECTIVES
Legal Formalities
AUTHORISATION ORDER
Identification of the Deceased
Facts about the Case
Place of Performing Autopsy
Qualifications
Medicolegal Autopsy Guidelines
Autopsy Procedure
External Examination
Internal Examination
DISSECTING CRANIAL CAVITY
Scalp Incision
Removing the Skull Cap
Opening Dura Mater
Removing the Brain
Dissection of Brain
DISSECTING THORACIC AND ABDOMINAL CAVITIES
Incisions
I-Shaped Incision
Y-Shaped Incision
Modified Y-Shaped Incision
Elongated X-shaped Incision
Removing the Abdominal and Thoracic Viscera
Opening Abdominal Cavity
Opening the Thoracic Cavity (Figs 14.13A to E)
Dissection of Heart
Closing the Body
Examination of Spinal Cord
Special Procedures for Specific Cases
Poisoning Case
Hanging/Strangulation Cases
Firearms Injuries
Drowning
Burns
Criminal Abortion
Road Traffic Accidents
NEGATIVE AND OBSCURE AUTOPSY
Negative Autopsy
Causes
Obscure Autopsy
Causes
Medicolegal Importance of Negative or Obscure Autopsy
FOETAL AUTOPSY
Objective
Legal Formalities
Procedure
External Examination
Internal Examination
Examination of Skull and Brain
Examination of Thorax and Abdomen
HYDROSTATIC TEST (FLOATATION TEST)
Principle
Procedure
Interpretation
Fallacies
STOMACH BOWEL TEST (BRESLAU'S SECOND LIFE TEST)
Principle
Procedure
Inference
Other Findings Suggestive of Live Birth
AGE OF THE FOETUS
WHETHER THE CHILD WAS BORN ALIVE OR NOT
Live Born Child
Dead Born Child
Stillborn Child
MURDER, SUICIDE OR ACCIDENT
FIREARMS INJURIES
KNIFE WOUNDS
HANGING, STRANGULATION AND SUFFOCATION
DROWNING
SELECTED SPECIAL PROCEDURE OF AUTOPSY
DEMONSTRATION OF AIR EMBOLISM
Procedure
Observations
Measuring the Amount of Air
DEMONSTRATION OF PNEUMOTHORAX
Procedure
DEMONSTRATION OF THROMBI IN THE CALVES
Causes
Procedure
RECONSTRUCTION OF THE SKULL FOR PERSONAL IDENTIFICATION AND DETERMINATION OF TYPE OF VIOLENCE
REMOVAL OF THE JAW FOR DENTAL IDENTIFICATION
EXAMINATION OF THE CERVICAL SPINE FOR WHIPLASH INJURY
Procedure
REMOVAL OF SPINAL CORD BY ANTERIOR APPROACH
Procedure
FIXATION OF THE BRAIN
AUTOPSY PHOTOGRAPHY
SECOND AUTOPSY
Advantages
EXAMINATION OF BONES
Conflagrated Human Remains — Unburnt and Burnt Skeletal Remains
EXAMINATION OF MUTILATED BODIES OR FRAGMENTS
ILLUSTRATIVE CASES
Alavandar Murder Case
The Drum Murder Case
The Ruxton Case
The Baptist Church Cellar Murder
The Acid-bath Murder
EXAMINATION OF DECOMPOSED BODIES
POSTMORTEM DESTRUCTION BY PREDATORS
ARTEFACTS (SYNONYM: ARTIFACT)
Therapeutic Artefacts
Agonal Artefacts
Postmortem Artefacts
Artefacts Induced by Transportation/ Storage/Handling, etc.
Artefacts Induced by Embalming, Decomposition, etc.
Artefacts Induced by Predators or Deliberate Mutilation/Dismemberment by the Criminals
Artifacts Induced by Improper Autopsy Procedures
Heat Effects
CASE—Dead Bodies Recovered from Railways Track—Appreciation of Artefacts
CARE IN THE POSTMORTEM ROOM
CARE OF THE TECHNICAL STAFF
EMBALMING
ENTOMOLOGY OF THE CADAVER AND THE POSTMORTEM INTERVAL
Collection, Preservation and Dispatch of the Specimens
PSYCHOLOGICAL AUTOPSY
Introduction
Applicability of Psychological Autopsy
AUTOPSY ON A BODY OF HIV INFECTION
Additional Precautions4
CHAPTER 15:
Violent Asphyxial Death
LEARNING OBJECTIVES
INTRODUCTION
DEFINITION OF ASPHYXIA
ETIOLOGY OF ASPHYXIA
PATHOPHYSIOLOGY OF ASPHYXIA
ANOXIA
Gordon's Classification of Anoxia
CLINICAL EFFECTS OF ASPHYXIA
CLASSIFICATION OF MECHANICAL/ VIOLENT ASPHYXIA
HANGING
Definition
Causes of Death
Classification of Hanging1–6
Mechanism of Hanging
AUTOPSY FINDINGS
EXTERNAL
I. Findings in the Face
II. Findings in the Neck
III. Findings in Other Parts of the Body
External Autopsy Findings in Cases of Vagal Inhibition Death
INTERNAL
Bloodless Dissection of Neck
Forensic Anatomy of Hyoid Bone and Larynx
Hyoid Bone
Larynx
Cricoid Cartilage
Thyroid Cartilage
Mechanism of Fracture and Fracture Dislocation of Hyoid Bone
MEDICOLEGAL ASPECTS OF HANGING
Postmortem Hanging (Postmortem Suspension)
Suicidal Hanging
Homicidal Hanging
Accidental Hanging
Judicial Hanging
Lynching
Difficulties in Diagnosis of Death from Hanging
STRANGULATION
Definition
Classification of Strangulation
Ligature Strangulation
Postmortem Appearances
External
Internal
Manual Strangulation (Throttling)
Autopsy Findings
External
Internal
Mugging (Arm-Locks)
Bhansdola
Garroting
Palmar Strangulation
Medicolegal Aspects of Strangulation
SUFFOCATION
Definition
Classification
ENTRAPMENT
ENVIRONMENTAL SUFFOCATION
SMOTHERING
Definition
Autopsy Findings
Medicolegal Importance
Overlaying
Homicidal Smothering
Suicidal Smothering
CHOKING
Definition
Mechanism of Choking
Medicolegal Importance
GAGGING
Causes
Mechanism
Autopsy Findings
TRAUMATIC ASPHYXIA
Definition
Causes
Cause of Death
Autopsy Findings
Medicolegal Importance
POSITIONAL ASPHYXIA
RIOT-CRUSH
BURKING
Medicolegal Importance
DROWNING
Definition
Incidence
Mechanism and Causes of Death in Drowning
Mechanism of Drowning
Pathophysiology of Drowning
Recent Advances
Effect of Type of Water Inhaled
Current Concept
Older Concepts
Classification of Drowning
i. Typical Drowning
ii. Atypical Drowning
Dry Drowning
Mechanism of Death
Immersion Syndrome (Hydrocution, Vagal Inhibition)
Submersion of the Unconscious
Secondary Drowning (Near Drowning Syndrome)
POSTMORTEM FINDINGS OF DROWNING
External
I. Findings in the Face
II. Findings in the Skin
III. Findings in the Hands
Internal
Lung Findings
Middle Ear Findings
Haemorrhage in Petrous Temporal and Mastoid Bone
Changes in Heart
Findings in Other Viscera
Diatom Test
Procedure
Inference
Medicolegal Aspects of Drowning
PART IV: CLINICAL FORENSIC MEDICINE
CHAPTER 16:
Trauma, Injury and Wound
CLASSIFICATION
Legal Classification
Medicolegal Classification
Classification Depending on Order of Importance
MECHANICAL TRAUMA
Mechanism
Impact of a Moving Object
Impact of a Virtually Non-moving Object on Actively Moving Victim
Classification
Blunt Force Trauma
Sharp Force Trauma
Firearm Injuries
ABRASION
Definition
Causes
Clinical Findings
Classification of Abrasions
Scratches
Grazes
Brush Burns (Brush Abrasion, Tangential Abrasion)
Rope Burns
Pressure Abrasion (Friction Abrasion, Crushing Abrasion)
Impact Abrasions (Imprint Abrasion, Contact Abrasion, Patterned Abrasion)
Age of Abrasion (Time since Injury)
Differential Diagnosis
Postmortem Abrasion
Postmortem Injuries (Erosions, Pseudoabrasions)
Excoriation of the Skin by Excreta (Fecal Matter)
Pressure Sores
Medicolegal Importance of Abrasions
CONTUSION (Bruise, Haematoma)
Definition
Causes
Clinical Findings
Examination of a Bruise
Lesion
Classification of Bruises
Superficial Bruises
Deep/Delayed/Migratory/Ectopic Bruises
Patterned Bruises
Factors Affecting Bruising
Type of Tissue/site Involved
Age Factor
Sex Factor
Colour of Skin
Natural Diseases
Gravity Shifting of Blood
Age of the Bruise (Time since Injury)
For Deeper Bruises
Differential Diagnosis
Artificial Bruises (Fabricated wounds)
Postmortem Bruising1,2,3,4
Can Be Misinterpreted as Postmortem Lividity
Medicolegal Importance
Bruise is of Lesser Importance than an Abrasion
However Contusion can Help Law and Criminal Investigation
LACERATION (Tears, Gashes Ruptures)4–6,9,15,16
Definition
Causes
Clinical Findings
Lesion
Classification of Laceration
Split Laceration (Incised-like Laceration)
Stretch Laceration
Avulsion (Avulsed Laceration)
Medicolegal Importance
INCISED WOUND4,6,8,9,17,18
Definition
Clinical Findings
Lesion
Examination of Incised Wound
Direction of the Wound
Beveling cuts
Age of Incised Wounds (Time since Injury)
Medicolegal Importance
STAB WOUNDS (Punctured Wound)2–12,18,19
Definition
Clinical Findings
Examination of the Wound
Volitional Activities
Classification
Complications
Medicolegal Importance
CHOP WOUNDS (Chop Lacerations)
Clinical Findings
Examination of the Wound
Medicolegal Importance
CHAPTER 17:
Regional Injuries
HEAD INJURY
Classification
Causes
SCALP INJURIES
Forensic Anatomy of Scalp
Precautions in Examining the Scalp Wound
Medicolegal Importance
FACIAL INJURIES
Injuries to the Eyes
Injuries to the Nose
Injuries to the Ears
Injuries to the Lips
Injuries to the Teeth
Injuries to the Facial Bones
Medicolegal Importance of Facial Trauma
SKULL INJURIES
Forensic Anatomy of Skull5,7
Mechanism of Injury to Skull2–13
Violence Acting/Force of the Active Blows or Passive Impact
Site of Injury on the Skull
Age of the Victim
Sequence of Skull Injuries
Classification of Skull Fracture
I. Fractures of the Vault of the Skull
Fissured Fracture (Figs 17.3C and 17.4A)
Depressed Fracture (Fractures ala signature/ Signature fracture/Bone impression fracture)
Comminuted Fracture (Crushed Fracture)
Stellate Fracture (Radiating Fracture)
Mosaic Fracture (Spider's Web Fracture)
Elevated Fracture
Diastactic Fracture (Diastasis, Suture Line Fracture)
Gutter Fracture
Pond Fracture (Indented Fracture)
Perforating Fracture (Punctured Fracture/Hole Fracture)
Cut Fracture
Combined Fracture
II. Fracture of Base of the Skull
Fracture of the Anterior Cranial Fossa
Fracture of the Middle Cranial Fossa
Fracture of the Posterior Cranial Fossa
Fracture around Foramen Magnum (Ring Fracture)
Hinge Fracture (Transverse Fracture/Motor Cyclist's Fracture)
Longitudinal Fracture
Clinical Features of Fracture Skull
Fracture of Anterior Cranial Fossa
Fracture of Middle Cranial Fossa
Fracture of Posterior Cranial Fossa
Complications of Fracture Skull
Time since Injury of Skull Fracture
INJURY TO MENINGES
Forensic Anatomy of Meninges
Meningeal Injury
BRAIN INJURIES/TRAUMATIC BRAIN INJURY (TBI)2,5,6,17–28
Etiology
Mechanisms
Accelerating Injury
Decelerating Injury
Shear Strain/Rotational Injury
Coup Injury
Contrecoup Injury
Role of Meninges and CSF in Preventing Traumatic Brain Injury (TBI)
Stereotactical Theory24
Cerebral Concussion (Stunning Brain Shock, Commotio Cerebri)
Reversible Cerebral Concussion
Irreversible Concussion
Diffuse Neuronal Injury
Diffuse Axonal Injury (DAI)5,17–26,29,31,33
Microscopic Examination Findings of DAI
DAI and the Biochemical Cascades
Cerebral Contusions2–13,19,24,30
Causes
Site
Complications
Cerebral Laceration2–13
Cause
Site
Types
Clinical Features
Complications
Healing
Cerebral Irritation
Cerebral Compression
Causes
Pathology and pathogenesis2–13
Autopsy Evidences of Cerebral Compression27
Mechanism of Sleep and Unconsciousness
Medicolegal Importance
INTRACRANIAL HAEMORRHAGE2,4–5,7,11,17,19,37,39
Forensic Anatomy of Brain Membranes
Causes
Classification
I. Intra-axial Haemorrhage
II. Extra-axial Haemorrhage
EXTRADURAL HAEMORRHAGE (EDH)38
Incidence
Mechanism
Common Causes Encountered in Routine Medicolegal Practice
Pathology
Clinical Findings
Autopsy Finding
Medicolegal Importance
SUBDURAL HAEMORRHAGE (SDH)38,39
Incidence
Mechanism
Pathology
Site
Classification
Clinical Findings
Autopsy Findings
Medicolegal Importance
SUBARACHNOID HAEMORRHAGE (SAH)40
Specific Causes and Mechanism
SAH of Traumatic Origin
SAH of Spontaneous Origin
Site
Pathology
Clinically
Autopsy Finding
Medicolegal Importance
INTRACEREBRAL HAEMORRHAGE (PARENCHYMATOUS HAEMORRHAGE)
Causes
Size
Site
Medicolegal Importance
INTRAVENTRICULAR HAEMORRHAGE
PONTINE HAEMORRHAGE
Causes
Types
Medicolegal Importance
CEREBRAL OEDEMA
Causes
Diagnosis
Brain Oedema Severity Score Scale
CT Scan Features
Intracranial Pressure
Cause of Death in Head Injuries
SPINE AND SPINAL CORD INJURIES
Causes
Classification
Concussion of Spinal Cord
Infant Whiplash-Shake Injury Syndrome
Medicolegal Significance of Whiplash Injury
Compression of Spinal Cord
Pithing
Laceration of Spinal Cord
Examples
INJURIES TO NECK AND NECK STRUCTURES
Medicolegal Importance
INJURY TO CHEST/THORAX AND THORACIC STRUCTURES2,4–11,41,42
Incidence
Classification
Medicolegal Importance
ABDOMINAL INJURIES2,4–11,43–48
Classification
Causes
Complications
LIMB SKELETAL BONE INJURIES7,48–51
Types of Bone Fractures
Special Considerations for Children
Incidence
Causes
Complications
Medicolegal Importance
JOINT INJURIES
Medicolegal Importance
CHAPTER 18:
Transportation Injuries
TRAUMA IN ROAD TRAFFIC ACCIDENTS
Trauma Sustained by Pedestrians
Primary Impact Injuries
Secondary Impact Injuries
Tertiary Impact Injuries (Synonyms: Secondary Injuries)
Trauma Sustained by Cyclist/Motorcyclist
Trauma Sustained by Occupants of Vehicles
Driver
Front Seat Occupants
Back Seat Occupants
RAILWAY DISASTER TRAUMA
Classification
Collision and Derailment Trauma
Falling from a Speeding Train
Hit by a Speeding Train
Medicolegal Importance of Railway Disaster Trauma
AIR DISASTER TRAUMA
Incidence
Causes
Mechanism
Classification
Crash Accident Injuries
Flight Accident Injuries
Medicolegal Importance
INTOXICATION
CHAPTER 19:
Effects of Injury
HAEMORRHAGE
External Haemorrhage
Internal Haemorrhage
The Respiratory Tract
The Pericardial Sac [Haemopericardium]
Intracranial Haemorrhages
Bleeding into Serous Cavities
Bleeding into the Gastrointestinal Tract
Bleeding into Soft Tissues
Other Practical Points
INJURY TO VITAL ORGANS
VAGAL INHIBITION
INFECTION AND SEPTICAEMIA2,3,4,10–12
EMBOLISM
Injury and Embolism1–4,13,14
Fat Embolism
Air Embolism (Gas Embolism)
Pulmonary Air Embolism (via Right Side of Heart)
Systemic Air Embolism
Gas Embolism and SCUBA Diving
Amniotic Fluid Embolism
Thrombotic Embolism
ADULT RESPIRATORY DISTRESS SYNDROME (ARDS)2,4,19–22
SUPRARENAL HAEMORRHAGE1,2,4
ANTEMORTEM AND POSTMORTEM INJURIES
CHAPTER 20:
Firearms and Explosive Injuries
INTRODUCTION
HISTORICAL ASPECT
IMPORTANT TERMS
FIREARMS AND AMMUNITIONs—BALLISTICS
INTERNAL/INTERIOR/INITIAL BALLISTICS (Within the Gun)5
EXTERNAL BALLISTICS (FROM GUN TO TARGET)5
ELEMENTARY BALLISTICS
GENERAL CONSIDERATIONS
Structure of the Firearms in General
Chemical Constituents in Firearm Ammunitions
TYPES OF FIREARMS
RIFLED FIREARMS (GUNS)
Rifling of a Gun
Purpose of Rifling
Pattern of Rifling
Rifling Marks
Calibre of a Gun
Classification of Guns/Rifled Firearms
Cartridge of a Gun
SMOOTH BORE FIREARMS (SHOTGUNS)
Calibre of a Shotgun
Chocking of Shotguns
Types of Chokes
Advantages of Choking for a Shotgun
Classification of Shotguns
Cartridge of a Shotgun
WOUND BALLISTICS (Firearm Wounds)
RIFLED FIREARM WOUNDS (Gunshot Wounds)
General Consideration
Heat Combustion Effects
Soiling of the Wound
Blast Effect
Facial Distortion Effects
Medicolegal Importance
Cherry Red Discolouration
Medicolegal Importance
Abrasion and Grease Collar
Wound of Entry
Contact Shot Range
Close Shot Range
Near Shot Range
Distant Shot Range
Wound of Exit
Other Findings
PECULIAR EFFECTS OF RIFLED FIREARMS/ GUNSHOT WOUNDS
Large Atypical Entrance Wound
Bullet Bruise
Bullet Graze (Bullet Slap)
Ricochet Bullet
Examples
Single Entry and Multiple Exit Wounds
Multiple Wounds of Entry and Exit, but a Single Bullet Recovered
Entry Wound Present, But No Exit Wound or Bullet Recovered
GUTTER FRACTURE (Refer Fracture Skull)
Tandem (Piggy Back) Bullet Effect
Frangible Bullet Effect
Dum Dum Bullet Effect
Rayalaseema Phenomenon
Souvenir Bullet
Magic Bullet
Concealed Firearm Wound
SHOTGUN WOUNDS (Smooth Bore Firearm Wounds)
General Considerations of Shotgun Wounds
Wound of Entry
Wound of Entry at Different Ranges
Blow Back Effect
Estimation of Range of Firing by Examining Wound of Entry
For Ranges up to 3 m
For Ranges beyond 3 m
AUTOPSY EXAMINATION OF CASES OF FIREARM FATALITIES
Examination of Clothing
Examination of the Wounds
Internal Autopsy Examination
GUNPOWDER RESIDUES TESTS
MEDICOLEGAL QUESTIONS ON FIREARM INJURIES
Kinds of the Firearms
Range of Firing
Direction of Firing
Cause of Death
Accident, Suicide or Homicide?
Fake Firearm Wounds
Position of Weapon
How Long Victim Survived after Injury?
Medicolegal Importance of Bullet
CRIME SCENE INSTRUCTIONS
EXPLOSIVES AND EXPLOSIVE INJURIES
TAXONOMY OF EXPLOSIVES
BLAST INJURIES
Mechanisms of Injuries
Types of Blast Injuries
OTHER INJURIES (Table 20.8)
Ear Injury
Abdominal Injury
Brain Injury
Burns Injuries
Disruptive Injuries
Air Blast Hurl Injuries
Flying Missile Injuries
Injuries due to Falling Masonry
Effects due to Toxic Gases in a Bomb Blast
Distance Blast Injuries
Mortality/Morbidity
INJURIES DUE TO ANTIPERSONNEL LANDMINES
Pattern of Injury
Pattern 1
Pattern 2
Pattern 3
Type of Injury to Foot
Grade 1 Injury
Grade 2 Injury
Grade 3 Injury
Grade 4 Injury
Pathological Aspects of Limb Injury
Prevention of Antipersonnel Mine Injuries (Figs 20.21 and 20.22)
EMERGENCY MANAGEMENT OPTIONS
Mass Casualties Predictor76–80
PATTERNS OF HOSPITAL USE
MEDICAL MANAGEMENT OPTIONS
CHAPTER 21:
Effects of Cold and Heat
HYPOTHERMIA
Trench Foot
Frostnip and Frostbite
Incidence
Factors Modifying Effects of Cold
Pathophysiology of Cold
Paradoxical Undressing
Pathophysiology
What Causes Paradoxical Undressing?15
Frost Bite
Incidence
Causes
Clinical Findings
Treatment
Postmortem Findings
Medicolegal Importance
HYPERTHERMIA (HYPERPYREXIA)
Progression
Causes
Predisposing Factors
Pathophysiology of Hyperthermia
Signs and Symptoms
Clinical Manifestations
Heat Cramps
Heat Exhaustion (Heat Collapse, Heat Syncope, Heat Prostration)
Heat Stroke (Heat Hyperpyrexia, Sunstroke, Systemic Hyperthermia, Thermic Fever)
Treatment
First Aid
Passive Cooling
Active Cooling
Hydration
Prevention
Susceptible Populations
Medicolegal Importance
Postmortem Findings
SCALDS1–9
Causes of Moist Heat
Clinical Features
Medicolegal Importance
DEATH DUE TO FIRE (DEATH DUE TO BURNS)
Definition
Incidence of Burns
Classification of Burns
Effects of Burns
Factors Modifying Effect of Burns6–7
Superficial Burns
Partial Thickness Burns
Full Thickness Burns
Causes of Death in Burns
Death Occurring within Few Hours
Death Occurring within Few Days
Postmortem Appearances of Burns1–9
External
Internal
Medicolegal Importance
CHAPTER 22:
Electrocution, Lightning and Radiation
ELECTROCUTION
Effect due to Passage of Electricity
Local Effects
Constitutional Effects
Causes of Death
Medicolegal Aspects
LIGHTNING
Lightning While in an Automobile/Using Telephone/ I-pod Music System
Cause of Death in Lightning
Postmortem Features of Lightning Death
External
Internal
Findings on the Clothing
Medicolegal Aspects
RADIATION
Factors that Determine Severity of Exposure
Types of Radiation Exposure
Effects of Radiation
IONISING RADIATION (IR)
Sources of IR Injurious to Human Health
Natural
Intentional Exposure
Accidental Exposure
Therapeutic Exposure to IR
Medicolegal Aspect
CHAPTER 23:
Trauma in its Medicolegal View Points
IPC SECTIONS RELEVANT TO TRAUMA
Injury (Section 44, IPC)
Definition
Explanation
Hurt (Section 319, IPC)
Definition
Examples
Grievous Hurt (Section 320, IPC)
Definition
Examples and Explanations
Punishment for Hurt and Grievous Hurt
Section 323, IPC
Section 324, IPC
Section 325, IPC
Section 326, IPC
Dangerous Weapon
Means Causing Hurt or Grievous Hurt
HOMICIDE
LAWFUL HOMICIDE
UNLAWFUL HOMICIDE
Culpable Homicide (Section 299, IPC)
Definition
Examples
Punishment for Culpable Homicide Not Amounting to Murder (Section 304, IPC)
Murder (Culpable Homicide Amounting to Murder)
Differences between Grievous Hurt, Culpable Homicide and Murder
Mental Elements in Culpable Homicide
Rash or Negligent Homicide (Section 304 A)
Rash and Negligent Act
Section 336, IPC
Section 337, IPC
Section 338, IPC
Abetment of Suicide (Sections 305, 306, IPC)
Dowry Death (Section 304 B, IPC)
EXAMINATION OF AN INJURED1–5
MEDICAL MANAGEMENT
Medicolegal Management
I. Specific Measures
II. General Measures
COMPLICATIONS OF INJURIES
Injuries of Medicolegal Importance
APPENDICES
Appendix 1: Police Intimations
Medicolegal Case
Appendix 2: Injury/Wound Report
Accident Register
Injury Report
Appendix 3: Discharge Certificate
Appendix 4: Referring an Injury Case to Second Hospital
CHAPTER 24:
Domestic Violence—Medical and Legal Aspects
INTRODUCTION
DEFINITION
INCIDENCE
MEDICAL ASPECTS OF DOMESTIC VIOLENCE
Physical Violence
Psychological Abuse
Sexual Abuse
EFFECTS OF DOMESTIC VIOLENCE ON CHILDREN AND TEENAGERS
DOMESTIC VIOLENCE AND LAW—INDIAN SCENARIO
THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE ACT, 2005
Main Features of the Act
RIGHTS GRANTED TO WOMEN
LIABILITIES AND RESTRICTIONS IMPOSED UPON THE RESPONDENT
AUTHORITIES RESPONSIBLE AND THEIR FUNCTIONS
PROCEDURE OF FILING COMPLAINT AND THE COURTS DUTY
PENALTY/PUNISHMENT
APPEAL
THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE RULES, 2005
DOMESTIC VIOLENCE AND LAW—GLOBAL SCENARIO
Basic for Granting
Contents
Enforcement
Criminal Domestic Violence Prosecutions
Prenuptial Agreements
Employment Issues
CONCLUSION
CHAPTER 25:
Torture and Medical Profession
DEFINITION OF TORTURE
METHODS OF TORTURE
Physical Torture
Case Example
Types of Physical Torture
Psychological Torture
Sexual Torture
PHARMACOLOGICAL TORTURE
Case Examples
Sequelae of Torture
Management of Torture Victims
Medicolegal and Ethical Aspects of Torture
Torture and Human Rights
Torture and Forensic Experts
CHAPTER 26:
Sexual Jurisprudence
VIRGINITY
Signs of Virginity
Genital Signs
Extragenital Signs
Hymen
Types of Hymen
Other Variants of Hymen
Rupture of Hymen (Deflorated)
Other Causes of Rupture of Hymen
Changes in the Hymen after Rupture
Hymen Examination
Procedure of Examination
Medicolegal Importance of Virginity
Defloration
Medicolegal Importance of Defloration
IMPOTENCE/ERECTILE DYSFUNCTION (ED) AND STERILITY
Causes of Impotence
In Males
Causes of Sterility in Males (Figs 26.8A to E)
In Female
The Question of Impotence Arises under the Following Conditions1,4,6
ARTIFICIAL INSEMINATION (AI)1–6
Types
Indications
Medicolegal Aspects
Precautions
TEST TUBE BABY (IN VITRO FERTILISATION/IVF)
SURROGATE MOTHER14,15
Semen Bank
STERILISATION
Types
Methods
Legal Safeguards for Permanent Sterilisation18
PREGNANCY
Diagnosis
Subjective Signs
Objective Signs
Probable Signs
Positive Signs of Pregnancy
Medicolegal Importance
DELIVERY
Signs of Recent Delivery in the Living
Signs of Recent Delivery in the Dead
Signs of Remote Delivery in the Living
Signs of Remote Delivery in the Dead
Medicolegal Importance
PATERNITY
Diagnosis of Paternity
Medicolegal Importance
LEGITIMACY
Presumption in Favour of Legitimacy
Medicolegal Importance
SEXUAL OFFENCES
Classification
Natural Sexual Offences
Unnatural Sexual Offences
Sexual Deviations (Sexual Perversions)
RAPE
Legal Definition
Rape and Law
Punishment for Rape
Dangers of Rape1–16
EXAMINATION OF CASE OF SEXUAL ASSAULT
Examination of the Scene
Medical Examination of the Victim
Findings in a Virgin Victim
Findings in Deflorated Woman Victim
Findings in a Child Victim
DETECTION OF SEMEN
Process of Collecting Biological Samples
Screening Tests
Confirmatory Tests
BLOOD GROUP TYPING
Enzyme Typing
DNA Profiling
POSTCOITAL INTERVAL (PCI)
SIGNIFICANCE OF MEDICAL EXAMINATION OF SEXUAL ASSAULT
Examination of the Accused
Feigned Rape
Medicolegal Questions on Rape
INCEST
Medicolegal Importance
UNNATURAL SEXUAL OFFENCES
Definition
Classification
SODOMY (Anal Intercourse, Greek Love, Buggary)
Medicolegal Importance
LESBIANISM (Female Homosexuality, Lesbian Love, Tribadism)
Examination of a Case
Medicolegal Importance
BUCCAL COITUS (Sin of Gomorrah, Coitus Per Oris, Fellatio, Cunnilingus)
Examination of a Case
Diagnostic Findings
Medicolegal Importance
BESTIALITY
Examination of a Case
Signs in Accused
Signs in Animals
SEXUAL DEVIATIONS (Sexual Perversions)
Definition
Types of Sexual Perversions
Psychological Aspect
Onset of Sexual Perversion
Eonism/Transvestism
Exhibitionism
Fetishism
Masochism
Sadism
Lust Murder
Sadomasochism
Necrophagia
Necrophilia
Voyeurism
Blue Film
Troilism
Masturbation
Nymphomaniac
Satyriasis
Frotteurism
Undinism
Indecent Assault
LAWS IN RELATION TO SEXUAL OFFENCES IN INDIA20,21,29
ABORTION (MISCARRIAGE, FOETICIDE)32–35
Definition
Products of Conception
Classification
Natural Abortion (Spontaneous Abortion)
Incidence
Causes
Differential Diagnosis of Blood per Vagina
Medical Termination of Pregnancy/MTP (Justifiable Abortion, Therapeutic Abortion)
Abortion Law in India
MTP Act Rules 1975 to Be fulfilled
Methods of Inducing MTP
Criminal Abortion
Motive for Criminal Abortion
Methods Adopted in Inducing Criminal Abortion
Extrauterine Means
Uterine Means
Cause of Death in Criminal Abortion
Signs of Criminal Abortion
Examination of a Case of Criminal Abortion
Examination of the Alleged Woman (Victim)
Examination of Material Alleged to have been Expelled out
Medicolegal Aspects
Medicolegal Importance of Placenta
Relevant Sections in Laws on Abortion in India20,21
CHAPTER 27:
Infanticide, Foeticide and Child Abuse
INTRODUCTION
Incidence
INFANTICIDE
Definition
Investigation in a Case of Death of a Newborn and Infant
Whether the Child is Viable or Not?
Medicolegal Importance
Principles
Measuring Crown-heel Length
LIVE BORN, STILLBORN AND DEAD BORN CHILD4–7
Live Born Child
Stillborn Child
Dead Born Child
Establishing Whether Live Born?
External Autopsy Findings
Internal Autopsy Findings
Changes in the Lungs
Confirmatory Tests for Respiration in Lungs
Plaquet's Test
Hydrostatic Test (Floatation Test)
Procedure
Inference
Explanation
Fallacies
Histology of Lung
Heart Changes
Establishing Whether Dead Born
Grades of Maceration (Table 27.6)
Time of Survival If Live Born
Cause of Death
FOETICIDE
Statutes and Case Laws in Relation to Foetus in India
BATTERED BABY SYNDROME18–21 (Synonyms: Caffey Syndrome)
Definition
Causes
Injuries Sustained
Diagnosis of the Syndrome
Medicolegal Importance
SUDDEN INFANT DEATH SYNDROME—SIDS18–21 (Synonyms: Cot Death, Crib Death)
Definition
Incidence
Causes
Autopsy Findings
Medicolegal Importance
CHILD SEXUAL ABUSE (CSA)
Examination of the CSA Case
Reflex Anal Dilation Test
CHAPTER 28:
Forensic Psychiatry
INTRODUCTION
MENTAL HEALTH ACT, 19871–5
Chapter I
Chapter II
Chapter III
Chapter IV
Chapter V
Chapter VI
Chapter VII
Chapter IX
Chapter X
CURRENT CONCEPT
SYMPTOMS OF MENTAL ILLNESS
Affect
Abreaction
Aphasia
Cognition
Confabulation
Delirium
Medicolegal Importance
Delusion (Disorder of Thought)
Definition
Classification
Medicolegal Importance
DÈJÀ VU
Disorientation
Fugue
Hallucination (Disorder of Perception)
Causes
Classification/Types
Illusion (Disturbance of Perception)
Insight
Intelligence Quotient (IQ)
Lucid Interval
Medicolegal Importance
Mood
Neurosis
Obsession (Disorder of Posession of Thought)
Panic
Phobia
Psychopath (Sociopath)
Medicolegal Importance
Psychosis
Classification
Examples
Stupor
Trance
Twilight State (Psychomotor Automatism)
Undue Influence
DISORDERS OF THE MIND AND BEHAVIOUR
Aetiology
Classification
Most Commonly Accepted Classification
DEMENTIA
CLASSIFICATION
Organic Dementia
Senile Dementia
Other Types of Dementia
Drug-induced Psychoses
Alcoholic Psychoses
Heroin/Morphine Psychoses
Cannabis Psychosis
Cocaine Psychoses
LSD Psychoses
Confusional State Psychoses
Clinical Manifestations
Psychosis Following Epilepsy
SCHIZOPHRENIA (SCHIZOMA)
Clinical Manifestations
Classification
Clinical Manifestations
Paranoid Status
Clinical Manifestations
Medicolegal Importance
DIAGNOSIS OF MENTAL ILLNESS AND CERTIFICATION1–9
Preliminary Particulars
Presenting Complaints
History of Present Illness
Past History
Family History
Personal History
Physical Examination
Examination of Mental Status/Conditions
Investigations
Diagnostic Formulation
Certification1–6, 23
Feigned Insanity
Purpose
Medicolegal Importance
RESTRAINT OF MENTALLY ILL
Immediate Restraint
ADMISSION TO PSYCHIATRIC HOSPITAL
Voluntary or Direct Restraint
Reception Order on Petition
Reception Order other than on Petition
Reception after Judicial Inquisition
Reception of Mentally Ill Criminal
Reception of the Escaped Mentally Ill
Discharge of Mentally Ill from Psychiatric Hospital
RESPONSIBILITIES OF AN INSANE
Civil Responsibilities
Criminal Responsibilities
HISTORICAL ASPECTS OF CONCEPT OF CRIMINAL RESPONSIBILITY10–19
The Historical Treatment of the Mentally Abnormal Offender18–21
R – v - Arnold (1724)24
R - v - Earl Ferrers (1760)25
R – v - Hadfield (1800)26
R – v - Bellingham (1812)27
R - v - M'Naghten (1843)28
Diminished Responsibility
CHAPTER 29:
Forensic Radiology
INTRODUCTION
SCOPE OF FORENSIC RADIOLOGY
Identification
Radiology and Trauma
Radiology and Battered Child
Radiology and Firearm Injuries
Radiology and Asphyxial Death
Radiography and Smuggling
USES OF FORENSIC RADIOLOGY
FINAL COMMENTS
CHAPTER 30:
Forensic Engineering
INTRODUCTION
DEFINITION
EXPLANATION
CASE EXAMPLE HANDLED BY FORENSIC ENGINEERS
INVESTIGATION OF DAMAGE DUE TO FIRE
Chemistry of Fire
Getting Started
Centroid Method
Warehouse or Box Method
Weighted Centroid Method
Sequential Analysis
Combination of Methods
Arson and Incendiary Fires
ELECTRICAL SHORTING
Characteristics of Primary Shorting
Characteristics of Secondary Shorting
MOTOR VEHICLE ACCIDENT
Skid Marks
Examination of Skid Marks
Methods of Examination
Momentum Method
Energy Method
BUILDING COLLAPSE DUE TO ROOF LEAKAGE
EXPLOSIONS
Deflagrating Explosion
Detonating Explosion
PART V: FORENSIC TOXICOLOGY
CHAPTER 31:
General Principles
INTRODUCTION
DEFINITIONS
Toxicology
Forensic Toxicology
Clinical Toxicology
Toxinology
Drugs
Poison
Overdose
CLASSIFICATION OF POISONS
ACTION OF POISONS
Factors Influencing the Action of Poison
Route of Administration
Idiosyncrasy
Age
Addiction
Dose
Health of Individual
Concentration of Poison
Chemical State of Poison
Physical State of Poison
Toxicity Rating of Poisons
Lethal Dose (Fatal Dose)
OCCUPATIONAL TOXICOLOGY
ENVIRONMENTAL TOXICOLOGY
ECOTOXICOLOGY
TOXICITY, HAZARD AND RISK
Toxicity
Hazard
Risk
Routes of Exposure
Duration of Exposure
Presence of Mixtures
Environmental Considerations
CLASSIFICATION OF OCCUPATIONAL/ ENVIRONMENTAL POISONS
Air Pollutants
Carbon Monoxide
Sulphur Dioxide
Nitrogen Oxides
Ozone
SOLVENTS
Halogenated Aliphatic Hydrocarbons
Aromatic Hydrocarbons
INSECTICIDES
Chlorinated Hydrocarbon Insecticides
Organophosphorous Insecticides
Carbamate Insecticides
Botanical Insecticides
HERBICIDES
Chlorophenoxy Herbicides
Bipyridyl Herbicides
ENVIRONMENTAL POLLUTANTS
DIAGNOSIS OF POISONING
Certain Condition Arousing Suspicion of Poisoning
DUTIES OF A DOCTOR IN A POISONING CASE
General Measures
Dealing with Unconscious Patient
Dealing with Conscious Patients
Specific Measures
DECONTAMINATION
Gastric Lavage
The Equipment
Other Requirements
Procedure
Position of the Patient
Introduction of the Tube
Confirmation of Tube in the Stomach
Washing/Lavaging the Stomach
Complications
Contraindications
EMESIS (VOMITING)
Activated Charcoal
Contraindications
Brands Available
Dose
Precautions
Complications
Catharsis
Whole Bowel Irrigation
Indications
Precautions
Complication
METHODS FOR ENHANCING ELIMINATION OF TOXINS
Urinary Alkalization
Multiple-dose Activated Charcoal
Extracorporeal Techniques
Diaphoresis
ADMINISTRATION OF ANTIDOTES
Classification According to Action
Physical/ Mechanical Antidotes
Chemical Antidotes
Universal Antidote
Physiological/Pharmacological (Antagonists) Antidotes
Chelating Agents
SYMPTOMATIC LINE OF TREATMENT
SELECTION OF VISCERA
COLLECTION OF VISCERA
PRESERVATION OF VISCERA
PRESERVATION OF BLOOD AND URINE
Note
Sending Viscera to Chemical Examiner2
DUTIES OF A DOCTOR TOWARDS SUSPECTED/ACTUAL CASE OF POISONING1–7
Medical Duties
Medicolegal/Forensic Duties
PREPARATION OF DOCUMENT FROM MEDICAL WITNESS FOR AN AUTOPSY SURGEON
Autopsy Findings/Details
External Findings
Internal Findings
Analytical Details
Cause of Death
THE INDIAN PENAL CODE (IPC), CRIMINAL PROCEDURAL CODE (CRPC) AND INDIAN EVIDENCE ACT (IEA)
NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCE ACT, 1985 (NDPS ACT)
THE DRUG AND MAGIC REMEDIES ACT, 1954
THE DRUGS CONTROL ACT, 1950
THE PHARMACY ACT, 1948
THE DRUGS AND COSMETICS RULES, 1945
THE DRUGS AND COSMETICS ACT, 1940
THE POISON ACT, 1919
APPARATUS AND REAGENTS
REFERENCE COMPOUNDS AND REAGENTS
PRACTICAL ASPECTS OF ANALYTICAL TOXICOLOGY
WET CHEMISTRY
Qualitative Analytical Tests
Colour Tests (Bedside Tests)
Principle
Advantages
Disadvantages
Precautions
Quantitative Analytical Methods
Chromatography
Basic Principle
Gas Chromatography (GC)
Structure and Basics
Procedure
Pyrolysis Gas Chromatography
Thin Layer Chromatography (TLC)
Mass Spectrometers
Equipment
Procedure
Spectrophotometers
Ultraviolet, Visible and Infrared Spectrometers
Procedure
ROLE OF POISON CENTRES
STAFFING PATTERNS AND FINANCIAL CONSIDERATIONS2
CHAPTER 32:
Corrosive Poisons
INORGANIC ACIDS: SULPHURIC ACID, NITRIC ACID, HYDROCHLORIC ACID
Physical Properties
Action
Signs and Symptoms
Treatment
Avoid
Give
Causes of Death
Postmortem Findings
Chemical Tests
Medicolegal Importance
HYDROFLUORIC ACID
Physical Properties
Fatal Dose
Fatal Period
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
CARBOLIC ACID (Phenol)
Physical Properties
Other Members of Phenol Group
Routes of Absorption
Action
Metabolism and Excretion
Signs and Symptoms
Diagnosis
Fatal Dose
Treatment
Postmortem Findings
Medicolegal Importance
OXALIC ACID (Acid of Sugar)
Physical Properties
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
FORMIC ACID (Methanoic Acid, Formylic Acid)
Signs and Symptoms
Treatment
Medicolegal Importance
SALICYLIC ACID
STRONG ALKALIES
Mechanism of Action
ANHYDROUS AMMONIA
Physical Properties
Action
Signs and Symptoms
Fatal Dose
Treatment
Postmortem Findings
OTHER ALKALIES
Potassium Hydroxide and Sodium Hydroxide
Fatal Dose
Ammonium Carbonate
Potassium and Sodium Carbonate
Signs and Symptoms
Tests
Fatal Period
Treatment
Postmortem Appearance
Medicolegal Importance
CHAPTER 33:
Irritant Poisons
GENERAL CHARACTERISTICS OF IRRITANT POISONS
Specific Characteristics of Irritant Poisons
NON-METALLIC IRRITANTS
Phosphorus
Derivatives of Phosphorus
Action
Liver Changes
Bone Changes
Lung Changes
Kidneys Changes
Signs and Symptoms
Acute Poisoning
Chronic Poisoning
Treatment
Acute Poisoning
Chronic Poisoning
Autopsy Findings
External
Internal
Medicolegal Importance
CHLORINE
Properties
Action
Signs and Symptoms
Treatment
Postmortem Appearance
Medicolegal Importance
BROMINE
Action
Signs and Symptoms
Fatal Dose and Period
Diagnosis
Treatment
Postmortem Findings
Medicolegal Importance
IODINE
Properties
Action
Signs and Symptoms
Acute Poisoning
Chronic Poisoning
Treatment
Postmortem Findings
Medicolegal Importance
FORMALDEHYDE (FORMALIN, METHYL ALDEHYDE, METHYLENE OXIDE6)
Properties
Action
Signs and Symptoms
Treatment
Postmortem Appearances
Medicolegal Importance
ARSENIC (Sankhyal, Somalkar)
Sources
Absorption
Action
Signs and Symptoms
Acute Fulminating Type
Subacute Type (Gastroenteritis Type)
Chronic Type
Diagnosis
Treatment
Postmortem Findings
Internal
Chemical Test
Medicolegal Importance
MERCURY (Quick Silver, Liquid Metal, Para, Padarasa)
Absorption
Action
Toxic Compounds
Signs and Symptoms
Acute Poisoning
Chronic Poisoning (Hydrargyrism/Mercurialism)
Treatment
Postmortem Changes
Medicolegal Importance
LEAD (SHISHA)
Absorption
Action
Toxic Compounds
Signs and Symptoms
Acute Poisoning
Subacute Poisoning
Treatment of Acute and Subacute Poisoning
Laboratory Diagnosis of Chronic Lead Poisoning
Treatment
Postmortem Changes
Acute Poisoning
Chronic Poisoning
Medicolegal Importance
COPPER (Thambe, Blue Vitriol)
Copper Sulphate
Copper Subacetate or Verdigris
Signs and Symptoms
Acute Poisoning
Treatment
Autopsy Finding
Chronic Poisoning
Sign and Symptoms
Treatment
Autopsy Finding
Medicolegal Importance
IRON
Action
Signs and Symptoms
Diagnosis
Treatment
Medicolegal Importance
INTRODUCTION
ABRUS PRECATORIUS
Toxic Principles1,2
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
RICINUS COMMUNIS (Castor Oil Plant)
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
Croton Tiglium
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
CALOTROPIS
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
SEMICARPUS ANACARDIUM
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
CAPSICUM ANNUM
Signs and Symptom
Treatment
Medicolegal Importance
EUCALYPTUS GLOBUS
Signs and Symptoms
Treatment
Medicolegal Importance
AZADIRACHTA INDICA
Signs and Symptoms
Treatment
Medicolegal Importance
COLCHICUM AUTUMNALE17
Plant Description
Signs and Symptoms
Postmortem Findings
Medicolegal Importance
ERGOT
Characteristics
Signs and Symptoms
Treatment
Medicolegal Importance
SNAKES AND SNAKE BITES
Epidemiology of Snake Bite2,3
Feature of Snakes in General1–5
Classification of Snakes
VENOMOUS SNAKES
Colubridae
Elapidae
Viperidae
Hydrophiidae
Atractaspidae
The Major Families and Species of Venomous Snakes in India
Features of Venomous and Non-venomous Snakes
POISON APPARATUS
SNAKE VENOM
Toxic Principles in Snake Venom
Types of Snake Venoms
Neurotoxic Venom
Haemotoxic Venom
Myotoxic Venom
NONVENOMOUS SNAKES
Important Features
VENOMOUS SNAKEBITE (OPHITOXAEMIA/ENVENOMATION)
Incidence
Entry of Venom on Snake Bite
Degree of Toxicity
Signs and Symptomatology
1. Neurotoxic Venomous Snake Bite
2. Haemotoxic Venomous Snake Bite
3. Myotoxic Venomous Snake Bite
TREATMENT OF SNAKE BITE
Principle8,9
1. Allaying of the Anxiety and Fear
2. Prevention of the Spread of Venom
First Aid
Dangers of Tourniquets, Compression Bandages and Other Occlusive Methods13
3. Antivenom Treatment13
Indications for Antivenom
Contraindications to Antivenom13
Timing of Antivenom
Antivenom Specificity
Administration
Dosage
Response to Antivenom: Time to Possible Response
Antivenom Reactions
Ancillary Treatment
Local Envenomation
Polyspecific/Polyvalent Antivenom
Mode of Administration
Dose Schedule
Specific Antivenom Serum
General Measures
Postmortem Findings
Medicolegal Aspects
INSECTS
Cantharides (Spanish Fly, Blister Beetle, Lytta)
Signs and Symptoms
Postmortem Findings
Medicolegal Importance
CENTIPEDES
Signs and Symptoms
SCORPIONS
Signs and Symptoms
Treatment
BEES, WASPS, HORNETS, ANT
Action
Treatment
MECHANICAL IRRITANT POISONS
Powdered Glass
Symptoms
Diagnosis
Treatment
Medicolegal Importance
CHAPTER 34:
Neurotoxics
CEREBRAL NEUROTOXICS
Somniferous Poisons (Narcotics)
Inebriant Poisons
Deliriant Poisons
SPINAL NEUROTOXICS
PERIPHERAL NEUROTOXICS
OPIUM (AFIM) DERIVATIVES
Classification
Distribution
Botanical Name
Common Name
Plant Description1,6
Toxic Part
Active Principle
Phenanthrine Derivatives
Benzyl-isoquinoline Derivatives
Action
Signs and Symptoms
ACUTE POISONING
Opioid Intoxication
Signs and Symptoms of Central Nervous System
Stage of Excitement
Stage of Depression (Stupor)
Stage of Narcosis
Signs and Symptoms of Cardiovascular System
Signs and Symptoms of Gastrointestinal Tract
Fatal Dose
Fatal Period
Toxicity Rating
Treatment
Differential Diagnosis
Acute Poisoning/Opiate Overdose
Circumstances of Poisoning
Signs and Symptoms
Acute Complication of Overdose
Opioid Withdrawal (Withdrawal Syndrome, Abstinence Syndrome, Cold Turkey)
CHRONIC POISONING (Synonym: Opium/Opiate Addiction, Morphinomania, Morphinism, Opioid Dependence, Opioid Abuse)
Diagnostic Criteria or Opioid Dependence and Severity of Opioid Dependence
Severity of Opioid Dependence
Medical Complications
Treatment of Chronic Poisoning
Postmortem Findings
External
Internal
PETHIDINE (MEPERIDINE)
Action
Signs and Symptoms
Treatment
Postmortem Appearances
Pethidine Addiction
Medicolegal Importance1–5,16
CLASSIFICATION
INTRODUCTION
ETHYL ALCOHOL (Synonyms: Alcohol, Ethanol, Grain Alcohol)
Physical Properties
Production
Absorption of Ethyl Alcohol
Distribution
Blood Alcohol Concentration (BAC)
Calculating Alcohol Level in Blood/Tissue
Widmark's Formula to Estimate Alcohol in Blood6,12
Example
Metabolism and Excretion
Action
Causes of Death
ALCOHOL POISONING
Acute Alcohol Poisoning (Alcoholic Intoxication/Alcohol Overdose)
Causes
Signs and Symptoms
Stage of Coma
Treatment5,7,10,12,13
Postmortem Appearance1–4, 6–7
Chronic Alcohol Poisoning (Synonyms: Alcohol Addiction, Alcoholism, Ethanolism)
Common Abstinence Syndrome
Alcoholic Hallucinosis
Alcohol Seizures (Rum Fits)
Alcohol Ketoacidosis
Causes
Clinical Features
Diagnosis
Treatment
Delirium Tremens
Causes
Signs and Symptoms10
Treatment
Medicolegal Importance
Wernicke-Korsakoff Syndrome
Alcohol and Heart
Cardiac Dysfunction
Alcohol Cardiomyopathy
Treatment of Chronic Alcohol Poisoning
Psychotherapy
Treatment of Withdrawal Syndrome
Aversion Therapy (Alcohol De-addiction Therapy, Alcohol Detoxification Therapy)
Therapeutic Dose
DRUNKENNESS
Definition
Procedure of Examination for Drunkenness Certification
Objectives
Consent
Preliminary Data
History
Physical Examination
Eyes
Laboratory Investigation
Differential Diagnosis
Final Opinion
Authentication
Drunkenness and Medicolegal Importance
Drunkenness and Medical Practice
Drunkenness and Disorderly Conduct
Driving, Drunkenness and Law
Drunkenness and Criminal Responsibility7
Drunkenness and Contractual Obligations/Wills
Medicolegal Importance
METHYL ALCOHOL
Synonyms
Composition
Physical Properties
Absorption and Metabolism
Elimination
Signs and Symptoms
Treatment
Postmortem Appearance
Preservation of the Viscera
Chemical Analysis
Medicolegal Importance
ISOPROPANOL (Isopropyl Alcohol, IPA)
Classification
Properties
Absorption and Action
Signs and Symptoms
Treatment
Postmortem Appearances
Medicolegal Appearances
ETHYLENE GLYCOL
Classification
Properties
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
CHLOROFORM
Classification
Properties
Action
Signs and Symptoms
Treatment
Postmortem Appearances
Medicolegal Importance
ETHER
Classification
Properties
Action
Signs and Symptoms
Postmortem Appearances
Medicolegal Importance
CHLORAL HYDRATE (C2H3CbO2) (Trichloroacetaldehyde)
Classification
Physical Properties
Action
Signs and Symptoms
Acute Poisoning
Chronic Poisoning (Chloral Hydrate Addiction)
Treatment
Postmortem Findings
Medicolegal Importance
SLANG NAMES
Introduction
Classification
Absorption, Distribution and Excretion1–5
Mechanism of Action1,3,5,6
Central Nervous System Effects
Pulmonary Effects
Cardiovascular Effects
Mortality/Morbidity
Pregnancy
Signs and Symptoms
Acute Intoxication8
Differential Diagnosis
Barbiturate Automatism
Chronic Intoxication (Barbiturate Addiction)11–13
Signs and Symptoms
Laboratory Tests to Confirm Poisoning
Assessing the Severity of Poisoning
Management of Poisoned Patient
Treating Chronic Barbiturate Poisoning
Postmortem Findings5,11,13–15
Medicolegal Importance
INTRODUCTION
ACTION
SIGNS AND SYMPTOMS
FATAL DOSE AND FATAL PERIOD
TREATMENT
Postmortem Appearances
MEDICOLEGAL IMPORTANCE
HAZARDS FROM PESTICIDES
BIOMAGNIFICATION IN FOOD, WATER AND CROPS
MEDICOLEGAL IMPORTANCE FOR ALL INSECTICIDES10
ORGANOCHLORINES (CHLORINATED HYDROCARBONS)5,14–18
Classification
Properties
Action
Signs and Symptoms
Treatment
Postmortem Appearances
ORGANOPHOSPHOROUS INSECTICIDES2–13
History
Chemistry
Classification
Older Classification
Modern Classification
Uses of Organophosphorus (OP) Compounds
Absorption, Fate and Excretion
Pathophysiology
Signs and Symptoms
Diagnosis
Management/Treatment5–13
Gastric Lavage
Cathartics
Activated Charcoal
Syrup of Ipecac
Atropine Administration
Dose
Pralidoxime (2 PAM Chloride, 2-PAM, Protopam) Administration
Dose
Complications
Precautions during Treatment
Fatal Dose, Fatal Period and Toxicity Rating
Postmortem Findings10
CARBAMATES3,11,19
Classification
Action
Signs and Symptoms
Treatment
Postmortem Appearances
ALUMINIUM PHOSPHIDE10,20,21
Mode of Action
Signs and Symptoms
Treatment
Medicolegal Points and Source
NAPHTHALENE (MOTHBALLS)20,21
Action
Signs and Symptoms
Treatment
Postmortem Appearance
Medicolegal Importance
HYDROCARBONS
CLASSIFICATION
ACTION
SIGNS AND SYMPTOMS
TREATMENT
POSTMORTEM FINDINGS
CLASSIFICATION
SOURCE
CANNABIS PREPARATIONS
SIGNS AND SYMPTOMS
Cannabis Addiction
HASHISH INSANITY
FATAL DOSE
FATAL PERIOD
TREATMENT
POSTMORTEM FINDINGS
MEDICOLEGAL IMPORTANCE
CLASSIFICATION
SOURCE
COMMON NAMES
DISTRIBUTION
PROPERTIES
SIGNS AND SYMPTOMS1–6
Acute Poisoning
Severe Complications of Acute Cocaine Poisoning
Essential Investigations in Cocaine Intoxication Cases
Fatal dose
Treatment
Prognosis
Postmortem Findings
Cocainism
Causes
Signs and Symptoms
Magnan's Symptom (Cocaine Bugs)
Treatment
Medicolegal Importance
TOXIC PART
ACTIVE PRINCIPLES
ACTION
SIGNS AND SYMPTOMS
COMPLICATIONS
DIFFERENTIAL DIAGNOSIS
TREATMENT
POSTMORTEM FINDINGS
External
Internal
MEDICOLEGAL IMPORTANCE
CHAPTER 35:
Cardiac Poisons
DISTRIBUTION
FAMILY
PLANT VARIETIES AND DESCRIPTIONS
TOXIC PARTS
TOXIC PRINCIPLES
ACTION
ROUTES OF ABSORPTION
SIGNS AND SYMPTOMS
General Manifestations with All Three Oleanders
Specific Manifestation with each Oleander
FATAL DOSE
FATAL PERIOD
TREATMENT
POSTMORTEM APPEARANCES
Nerium Odourum
Cerbera Thevetia
MEDICOLEGAL IMPORTANCE
DISTRIBUTION
COMMON NAME
BOTANICAL NAME
FAMILY
PLANT DESCRIPTION
TOXIC PARTS
TOXIC PRINCIPLE
ACTION
ROUTES OF ABSORPTION
SIGNS AND SYMPTOMS
Typical Aconitine Poisoning
FATAL DOSE6
TREATMENT
POSTMORTEM APPEARANCES
MEDICOLEGAL IMPORTANCE
DISTRIBUTION
TOXIC PARTS
TOXIC PRINCIPLES
ACTION
ABSORPTION AND METABOLISM
SIGNS AND SYMPTOMS
Mild Poisoning
Acute Poisoning
Nicotine Withdrawal Symptoms
Chronic Poisoning
FATAL DOSE
FATAL PERIOD
TREATMENTS
POSTMORTEM FINDINGS6–9
MEDICOLEGAL IMPORTANCE
CHAPTER 36:
Asphyxiants
CLASSIFICATION
Chemical Asphyxiants
Simple Asphyxiants
Respiratory/Pulmonary Irritant Asphyxiants
Systemic Asphyxiants
CARBON MONOXIDE (CO)
Properties
Sources
Mechanism of Action
Signs and Symptoms
Acute Poisoning
Fatal Dose and Fatal Period
Chronic Poisoning
Delayed Deaths
Diagnosis
Treatment
Postmortem Findings
Collection of Blood Sample for Chemical Analysis
Medicolegal Importance
CARBON DIOXIDE (CO2)2,5,8
Properties
Signs and Symptoms
Fatal Dose and Period
Fatal Concentration
Fatal Period
Treatment
Postmortem Findings
Medicolegal Importance
WAR GASES
Qualities of Ideal War Gas
Classification
Lachrymators (Tear Gases)
Action
Treatment
Lung Irritants (Asphyxiants, Choking Gases)
Action
Treatment
Postmortem Findings
Vesicants (Blister Gases)
Action
Treatment
Sternutators (Nasal Irritants, Vomiting Gases)
Action
Treatment
Paralysants (Nerve and Blood Poisons)
Nerve Gases
Mechanism of Action10
Signs and Symptoms of Nerve Gas Poisoning
Miscellaneous War Gases
Yellow/red rain
Symptoms
METHYL ISOCYANATE (MIC)12,13
Classification
Properties
Medicolegal Importance
Action
Signs and Symptoms
CYANIDE (PRUSSIC ACID, CYANOGEN)2,5,12–19
Properties
Action
Sources
Uses
Absorption
Causes of Death
Signs and Symptoms
Acute Poisoning
Central Nervous System
Chronic Poisoning
Fatal Dose
Fatal Period
Treatment
Principle
Schedule of Treating Cyanide Poisoning
Administration of Antidote
Specific Antidote—Amyl Nitrite Therapy
Other Antidotes
Latest Therapy16–19
Prognosis
Postmortem Appearances
External
Internal
Viscera Preserved for Chemical Examination
Medicolegal Aspects
AMMONIA (NH3)2,5,20
History
Properties
Uses
TWA, STEL AND IDLH FOR AMMONIA
Usual Fatal Dose
Pathophysiology
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
CHAPTER 37:
Domestic Poisons
DOMESTIC/HOUSEHOLD POISONS
HYDROCARBONS
Aliphatic Hydrocarbons
Toxicity Rating
Mode of Action
Signs and Symptoms
Acute Poisoning
Chronic Poisoning
Treatment
Postmortem Findings
Medicolegal Importance
Aromatic Hydrocarbons3,4
Medicolegal Importance
DISHWASHING POWDERS AND GRANULES, LIQUIDS, DETERGENTS, DISINFECTANTS, METAL POLISHES AND COSMETICS
DOMESTIC/HOUSEHOLD POISONS READY RECKONER
MEDICAL HOUSEHOLD POISONS
GARDEN POISONS
CHAPTER 38:
Poisoning by Therapeutic Substances
ASPIRIN
Signs and Symptoms
Treatment
Medicolegal Importance
PARACETAMOL
Mode of Action
Some Preparations Sold in India
Signs and Symptoms
Treatment
Postmortem Findings
Medicolegal Importance
INSULIN
CHAPTER 39:
Food Poisoning and Poisonous Foods
BACTERIAL FOOD POISONING
Infectious Type
Toxic Type
Botulism Type
INFECTIOUS TYPE
Signs and Symptoms
Treatment
Postmortem Appearances
MUSHROOMS
Action
Signs and Symptoms
Treatment
Medicolegal Importance
CHAPTER 40:
Drug Dependence and Drug Abuse
HALLUCINOGENS (PSYCHEDELICS)
LSD
Mescaline
Peyote
Action of Hallucinogens in General4–5
Signs and Symptoms
Complications of Bad Trip
Effects of Prolonged Consumption
Fatal Dose
Treatment
Medicolegal Importance of Hallucinogens5
STIMULANTS
Signs and Symptoms
Treatment
Medicolegal Importance
ORGANIC SOLVENT
Action
Signs and Symptoms
Treatment
Medicolegal Importance
DRUG DEPENDENCE
Drug Dependence
Drug Addiction
Drug Habituation
Drug Abuse
Aetiology of Drug Dependence
Consequences of Drug Dependence
Mechanism of Drug Addiction
Signs and Symptoms of Drug Addiction
Withdrawal Symptoms (Abstinence Syndrome)
Treatment of Addiction
Mechanism of Drug Habituation
Signs and Symptoms of Drug Habituation
Appendices
APPENDIX 1: QUESTION BANK
FORENSIC MEDICINE VIVA VOCE QUESTIONS
MEDICAL JURISPRUDENCE
FORENSIC PATHOLOGY
CLINICAL FORENSIC MEDICINE
FORENSIC TOXICOLOGY
FORENSIC MEDICINE THEORY UNDERGRADUATE QUESTIONS
MEDICAL JURISPRUDENCE
FORENSIC PATHOLOGY
CLINICAL FORENSIC MEDICINE
FORENSIC TOXICOLOGY
FORENSIC MEDICINE THEORY POSTGRADUATE QUESTIONS
MEDICAL JURISPRUDENCE
FORENSIC PATHOLOGY
CLINICAL FORENSIC MEDICINE
FORENSIC TOXICOLOGY
GENERAL, BASICS AND RECENT ADVANCES
APPENDIX 2: SYLLABUS AND VARSITY EXAMINATION AID
(A) GOALS AND OBJECTIVES IN FORENSIC MEDICINE AND TOXICOLOGY
GOALS
OBJECTIVES
(B) UG THEORY—FORENSIC MEDICINE AND TOXICOLOGY SYLLABUS AND CLASS SCHEDULE
SEMESTER III
SEMESTER IV
SEMESTER V
(C) UG PRACTICAL—FORENSIC MEDICINE AND TOXICOLOGY SYLLABUS AND CLASS SCHEDULE
SEMESTER III
SEMESTER IV
SEMESTER V
(D) SPECIFICATION TABLE FOR THEORY EXAMINATION
(E) SPECIFICATION TABLE FOR PRACTICAL EXAMINATION (ADOPTING OBJECTIVE STRUCTURED PRACTICAL EXAMINATION—OSPE METHOD)
APPENDIX 3: LAWS OF RELEVANCE TO MEDICAL PROFESSION IN INDIA
APPENDIX 4: STARVATION AND NEGLECT AND LAW
INDEX
TOC
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