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Modern Textbook of Forensic Medicine & Toxicology
Putul Mahanta
SECTION 1: FORENSIC MEDICINE
CHAPTER 1:
Introduction and History of Forensic Medicine
WHAT IS FORENSIC MEDICINE?
AUTOPSY
Religious and Social Attitudes of Autopsy6
PHYLOGENESIS OF FORENSIC MEDICINE IN INDIA
FUTURE OF FORENSIC MEDICINE
CHAPTER 2:
Legal Procedures
LEGAL PROCEDURES
INQUEST
Definition
Types of Inquest
Police Inquest
Magistrate Inquest
Coroner's Inquest
Medical Examiner's System
COURTS
Courts of Law and their Powers
Civil Courts
Criminal Courts
Supreme Court
High Court
Sessions Court
Magistrate's Court or Court of Magistrates
PUNISHMENT (LEGAL SENTENCES) AUTHORIZED BY LAW IN INDIA
MEDICAL EVIDENCE
Evidence
Types
Oral Evidence
Documentary Evidence
Documentary Evidence in Relation to Medical Practice
Medical Certificates
Dying Declaration
Dying Deposition
WITNESS
Types of Witness
Common or Ordinary Witness
Expert or Skilled Witness
OFFENCE
Types of Offence
Procedure of Attendance in the Court
Summons or Subpoena (Sub—Under, Poena—Penalty)
Conduct Money
Attending the Court
Oath Taking
Perjury (Under Section 191 IPC and 344 CrPC)
Examination in Chief
Cross Examination
Re-examination
Questions by the Court
DUTY OF A DOCTOR AS A WITNESS IN THE COURT
CHAPTER 3:
Medical Law and Ethics
MEDICAL COUNCIL OF INDIA
Structure of Medical Council of India (MCI)
Constitution and Composition of the MCI
Executive Committee
Duration of MCI
Functions of MCI
Maintenance of Indian Medical Register
Maintenance of Quality of Medical Education
Inspection of Medical Colleges
Recognition of Foreign Medical Degrees
Functions of State Medical Council
Maintenance of State Medical Register
Disciplinary Control
ETHICAL ASPECTS OF MEDICAL PRACTICE
Medical Ethics
Medical Etiquette
Duties of Doctors to Each Other (Medical Etiquette)
Declaration of Geneva
International Code of Medical Ethics
Duties of Doctors in General
Duties of Doctors to the Sick
Doctors and the Media
The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002
Code of Medical Ethics
REGISTERED MEDICAL PRACTITIONER
Rights and Privileges of Registered Medical Practitioners
Procedure of Getting Registered
Use of Generic Names of Drugs
Exposure of Unethical Conduct
Payment of Professional Services
Duties of Physicians to their Patients
Duties of Registered Medical Practitioner
Professional Secrecy and Privileged Communications
Duties of Physician in Case of Consultation
Rights and Duties of Attending Physician in Consultation
Rights of Consultant during Consultation
Procedure of Referral of Patient
Display of Registration Number
UNETHICAL ACTS
Patent and Copyrights
Running an Open Pharmacy Shop (Dispensing of Drugs and Appliances by Physician)
Rebates and Commission
Secret Remedies
Human Rights
Euthanasia
Organ Transplantation
PROFESSIONAL MISCONDUCT
LEGAL ASPECTS OF MEDICAL PRACTICE
Different Acts (Evasion of Legal Restrictions)
MCI AND MEDICAL RECORD
CONSENT
Importance of Consent
Types of Consent
Implied Consent
Informed Consent
Criteria for Consent
Consent and Age
Competency for Giving Consent
Concept of Adult, Majority or Minority
Scope of Consent
Consent of Female Patients
Consent is Not Required
Consent for Sterilization
Consent for Abortion
Doctrine of Loco Parentis
Law and Consent
Consent and Medicolegal Cases
This is Every Man's Fundamental Right
Cases of Drunkenness
Right to Refuse Consent
Only Competent Patient has a ‘Right to Refuse Treatment’
MEDICAL NEGLIGENCE
Definition and Explanation
Classification of Medical Negligence
Civil Negligence
Essential Elements of Negligence
Standard of Judgment
What is ‘Bolam Test’?
Degree of Skill and Care Required by a Medical Practitioner
Instances of Medical Negligence
Doctrine of Res Ipsa Loquitur
Examples of Res Ipsa Loquitur
Criminal Negligence and Res Ipsa Loquitur
Respondent Superior (Vicarious Liability)
Court's Views in Favor of Doctors
Loss to Society
What is the Purpose of Law for Holding a Doctor Negligent?
Negligence by Medical Professionals Calls for Treatment with a Difference
No Security of Human Life
Examples of Criminal Negligence
Doctrine of Error of Judgment
Doctrine of Calculated Risk
Doctrine of Common Knowledge
Novus Actus Interveniens
Medical Maloccurrence
Therapeutic Misadventure
Mischance or ‘Misadventure’ or an ‘Error of Judgment’ Not Negligence
Meaning of Accident
Doctrine of Respondent Superior
Contributory Negligence
Advantages of Contributory Negligence
Composite Negligence
Corporate Negligence
Product Liability
Defenses Available in Case of Medical Negligence
CONSUMER PROTECTION ACT, 1986
Consumer Redressal Forum
Salient Features of Consumer Protection Act (CPA)
BIOMEDICAL WASTE MANAGEMENT
Importance
Ethical Aspect
Reasons for Indiscriminate Management and Handling of Biomedical Waste
What is Biomedical Waste?
Who are the Generators of the Biomedical Waste?
Definition
Segregation of Biomedical Waste
Definition
Significance
Responsibility for Segregation
Emphasis on Sharps
Solution
Collection of Biomedical Waste
Containers
Labeling
Storage of Biomedical Waste
Definition
Duration
Transportation of Biomedical Waste
Definition
Type of Vehicle
Timing of Transportation
Documentation System
Treatment of Biomedical Waste
Definition
Objectives
Site
Disposal of Biomedical Waste
Definition
Site
Disposal of Solid Waste
Disposal of Liquid Waste
Duties of Biomedical Waste Management Facility Operator
Definition
Authorization
Legal Implications
Appeal against Punishment
ETHICS AND MEDICAL RESEARCH (HUMAN EXPERIMENTATION)
Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002
Research
Human Experimentation
Types of Human Experimentations
Helsinki Code
Basic Principles
Medical Research Combined with Professional Care (Clinical Research)
Non-therapeutic Biomedical Research Involving Human Subjects (Non-clinical Biomedical Research)
Salient Features of Helsinki Declaration
ICMR Guidelines for Human Research, 1995
General Principles
CHAPTER 4:
Euthanasia (Mercy Killing)
DEFINITION
HISTORY
PHYSICIAN SENTIMENT
TYPES OF EUTHANASIA
Voluntary Active Euthanasia
Involuntary Active Euthanasia
Non-voluntary Active Euthanasia
Passive Euthanasia
Physician Assisted Suicide
PROS AND CONS
MEDICOLEGAL IMPORTANCE
CHAPTER 5:
Identification
TYPES OF IDENTIFICATION
MEDICOLEGAL CIRCUMSTANCES WHERE IDENTIFICATION IS NEEDED
CORPUS DELICTI (THE ESSENCE OF CRIME)
POINTS TO BE NOTED FOR THE PURPOSE OF IDENTIFICATION
Commonly Recorded Data for both Living and Dead
Methods of Identification of Living Person
Methods of Identification of Dead Person
Identification Based on Advanced Laboratory Test
Identification: Special Techniques
DETERMINATION OF RACE
RELIGION AND CASTE
DETERMINATION OF SEX
Why Sex Determination is Important?
Identification of Sex
Determination of Sex of an Individual
Morphological Examination
Microscopic Examination
Hormonal Analysis
Gonadal Biopsy
DNA Profiling
Troubles in Sex Determination
Concealed Sex
Sex from Decomposed or Mutilated Bodies
Sex from Skeleton
Intersex State
DETERMINATION OF AGE
Age of the Fetus
Length and Weight
Rule of Haase
Physical Features
Appearances of Ossification Centers
Age from Birth till 25 Years
Physical Examination for Age Estimation
Dental Examination for Age Estimation
Radiological Examination for Age Estimation
Appearance and Fusion of Ossification Centers
Disturbance in Skeletal Growth and Maturation
Medicolegal Importance of Age
STATURE
Stature of Dismembered Body
ANTHROPOMETRY (BERTILLON SYSTEM)
Principle
FINGERPRINT SYSTEM
Definition
Principle of Use
Historical Background
Classification
Latent Prints
Patent Prints
Plastic Prints
The Individuality of Fingerprints
Mode of Production
Techniques of Fingerprints
Lifting of Fingerprints
Fingerprints in Decomposed Bodies
Mutilation of Fingerprints
Medicolegal Importance
Poroscopy (Figure 5.19)
Palm Prints
FOOTPRINTS (PODOGRAM)
LIP PRINTS (CHEILOSCOPY)
Definition
History
Features
EAR PRINTS
NOSE PRINT
RUGOSCOPY (PALATOPRINTS)
SUPERIMPOSITION (FIGURE 5.22)
Technique
Comparison Points
Computer-assisted Skull Identification Using Video Superimposition
DEFORMITIES AND BIRTHMARKS
Birthmarks
SCARS
Examination
Characters
Growth
Age of Scars
Medicolegal Importance
TATTOO MARKS
Complications
Erasures
Medicolegal Importance
DISEASE, WOUNDS AND STAINS
Disease
Wounds
Stains
OCCUPATIONAL STIGMATA
Recent and Temporary
Permanent
COMPLEXION AND FEATURES
CLOTHES AND ORNAMENTS
HAIR
Human Hair
FIBERS
Difference between Human and Animal Hair
Medicolegal Questions
Medicolegal Importance of Hair and Fiber
MISCELLANEOUS
Handwriting (Calligraphy)
Speech and Voice
Gait
Tricks of Manner and Habit
Memory and Education
CHAPTER 6:
Forensic Osteology
EXAMINATION OF SKELETAL REMAINS
Bone or Not
Human or Animal
Single or Multiple Individual
Age from Bone
Sex from Bone
Race from Bone
Stature from Bone
Personal Identity
Time since Death
Cause of Death
Nature of Death
Manner of Separation
GROWTH IN INDIVIDUAL BONES
SKULL
Sex
Stature
Race
Morphological Features
Cephalic Index
Age
Closure of Fontanelles (Figures 6.6 and 6.7)
Fusion of Bone
Suture Closure
Age of Fusion
MANDIBLE
Sex
Stature
Race
Age from Mandible
At Birth (Figure 6.10)
At 1–3 Years (Figure 6.11A)
At 6 Years (Figure 6.11B)
Adults (Figure 6.12A)
Old Age
FEMUR
Sex
Age
Examination of Ossification Centers
Radiographic Changes
Race
Structural Appearances
Bone Length
Index
Stature
TIBIA
Sex
Stature
Race
Age
FIBULA
Sex
Stature
Age
SCAPULA
Age
CLAVICLE
Sex
Age
Stature
HUMERUS
Sex
Stature
Race
Bone Length
Index
Age
RADIUS
Sex
Age
ULNA
Sex
Stature
Age
STERNUM
Sex
Age
HYOID BONE
PELVIS AND HIPBONE
Sex
Age
Ossification Centers
Pubic Symphysis Phase
Pubic Symphysis Component
Race
SACRUM
Sex
Corporo-Basal Sacral Index as a Discriminator of Sex
Age
Race
VERTEBRAE
SMALL BONES OF HAND AND FEET
Age from Small Bones of Hand
Age from Small Bones of Foot
CHAPTER 7:
Forensic Odontology
FORENSIC SIGNIFICANCE
DEFINITION
HISTORICAL EVENTS
DENTAL RECORDS
Patient Record
Maintenance of Dental Records
Management and Storage of Dental Records
Forensic Uses of Patient Records
DENTITION
About Dentition
Anatomy of the Tooth
Tooth Development
Chronology of Eruption/Emergence of the Temporary Teeth
Temporary Teeth
Mixed Dentition (5–13 Years)
Two Sets of Teeth
Permanent Teeth
Chronology of Eruption/Emergence of the Permanent Teeth
Abnormalities of Size and Number
Laboratory Methods of Approximation of Age
CHARTING OF TEETH
Universal System
Palmer Notation
Haderup System
Federation Dentaire Internationale (FDI) Two Digit System
Modified FDI System
Diagrammatic or Anatomical Chart
Gustafson's Method
Radiographic Estimation of Dental Age
DENTAL IDENTIFICATION
Factors of Dental Identification
Number of Teeth
Tooth Loss
Restorations (Figure 7.13)
Dental Prosthesis
Bony Pattern
Occlusion
Oral Pathology
Occupation, Habits and Social Position
Dental Identification Methods
Comparative Method of Dental Identification
Postmortem Dental Profiling
ROLE OF FORENSIC ODONTOLOGIST
Forensic Odontologists are Involved in Six Main Areas of Practice
Identification of Human Remains
In Mass Fatality Incidences
Bite Mark Analysis
Bite Mark Evidence
DOMESTIC VIOLENCE AND CHILD ABUSE
CIVIL CASES IN MALPRACTICE
AGE AND SEX DETERMINATION
ORGANIZATIONS IN THE FIELD OF FORENSIC ODONTOLOGY
RECENT ADVANCES IN FORENSIC ODONTOLOGY
Denture Labeling
Dental Profiling
DNA Identification
Digital Forensics
Latent Lip Prints
LIMITATIONS
DIAGNOSIS OF POISONINGS
CHAPTER 8:
Forensic DNA Typing
INTRODUCTION TO DNA
Base Pair Sequence in DNA (Figure 8.3)
Constituents of DNA
Methods of DNA Fingerprinting for Forensic Purpose
Methods Applied in DNA Fingerprinting
Factors that Influence the Applicability of DNA Technique
Collection of Samples for DNA Extraction
Blood
Other Biological Samples
USES OF DNA TYPING IN FORENSIC INVESTIGATION
Paternity Disputes
Usefulness of DNA Profiling
CHAPTER 9:
Thanatology
TYPES OF DEATH
Somatic or Clinical or Systemic Death
Molecular or Cellular Death (Few Minutes to Hours)
WHAT IS BRAIN DEATH?
Cortical Brain Death
Brainstem Death
Whole Brain Death
Diagnosis of Brainstem Death
British Code (or Harvard Criteria) for Diagnosis of Brainstem Death
Medicolegal Issues of Brain Death
Why Death Diagnosis in Time is Important?
Organ Transplantation
Persistent Vegetative State
Stupor
Beating Heart Donor
Suspended Animation
Agonal Period
DEATH CERTIFICATE
What is Death Certificate and why is it Needed?
Cause of Death
Form for Medical Certificate
Immediate Cause
Antecedent Cause
Other Significant Conditions
Format of the Certificate
Death Certification and its Significance
Physician's Responsibility
MANNER OF DEATH
MECHANISM OF DEATH
MODES OF DEATH
Syncope
Causes of Syncope
Asphyxia
Postmortem Findings
Coma
Clinical Features
Postmortem Findings
SUDDEN DEATH
Causes of Sudden Death
Cardiac Tamponade
CHANGES AFTER DEATH
Immediate (Somatic Death) Signs
Permanent Cessation of Brain Function
Entire and Permanent Cessation of Respiratory Function
Complete Cessation of Circulatory Function
Early (Cellular Death) Signs
Changes in the Skin
Changes in the Eye
Primary Flaccidity of Muscles
Cooling of the Body
Postmortem Caloricity
Cadaveric Lividity
Rigor Mortis
Late (Decomposition and Decay) Signs
What Factors Affect Decomposition and Decay?
Speeding up Decomposition
Putrefaction
Adipocere
Mummification
SUSPENDED ANIMATION (APPARENT DEATH)
POSTMORTEM INTERVAL (PMI) OR TIME SINCE DEATH (TSD)
Forensic Entomology
Condition of the Gastrointestinal and Urinary Tract
Changes in the CSF
Changes in Blood Profile
Changes in Bone Marrow
Changes in Hair Growth
Personal Effects on the Cadaver
CHAPTER 10:
Autopsy
DEFINITION
HISTORY
TYPES OF AUTOPSY1,3–6
Academic or Clinical Autopsy
Medicolegal Autopsy
Psychological Autopsy
Objectives of Medicolegal Autopsy
EXAMINATION1,3–12
External Examination
Clothing
Internal Examination
Incisions1,3–5,8–10
“I” Shaped Incision
“Y” Shaped Incision
Modified “Y” Shaped Incision
Cosmetic Incision or Dr AJ Patowary's Incision (The Fourth Incision)4,8,9
Closing of the Incisions (Figure 10.14)
Summary of the Cosmetic Autopsy Incision
VISCERA EXAMINATION TECHNIQUE1,3–6,10,11
Dissection of Different Organs
Brain (Figure 10.17)
Spinal Cord
Lungs
Heart and Great Vessels
Gastrointestinal Tract
Genitalia
FETAL AND PERINATAL AUTOPSY
SAMPLES TO BE PRESERVED
Other Body Fluids
Bone and Muscles
Hair and Nail
Maggots
Tablets, Powders and Syringes
Preservatives used for Common Visceras
Additional Samples to be Preserved Depending Upon the Circumstances
Custodial Death
CHAPTER 11:
Mechanical Injury
SOME TERMS OF MEDICOLEGAL IMPORTANCE
Injury
Wound
Trauma
Lesion
BIOPHYSICS OF INJURY
Physical Factors Affecting Injury
Biological Factors Affecting Injury
PRINCIPLES OF CELL INJURY3
TYPES OF INJURY
Medical Classification
Mechanical Injuries
Thermal Injuries
Chemical Injuries
Miscellaneous Injuries
Legal Classification
Medicolegal Classification
ABRASION
Mechanism of Abrasion
Types of Abrasion
Scratch or Linear Abrasion
Graze or Brush Abrasion
Pressure Abrasion
Imprint Abrasion
Healing of an Abrasion
Bite Marks2
Medicolegal Importance
CONTUSION
Mechanism of Contusion
Delayed Appearance
Degree of Force Enforced
Age of Contusion
Why Color Change is Not Seen in Subconjunctival Hemorrhage?
Differentiation from Postmortem Lividity
Types of Bruising
Patterned Intradermal Bruise
Subcutaneous Bruise
Tram-line or Rail-track Bruises
Doughnut Bruise
Counter Pressure Bruise
Kicking or Shoe Foot Bruise
Love Bite or Hickey Bruise
Black Eye or Peri-orbital Hematoma (Figure 11.22)
Medicolegal Importance
LACERATION
Characteristics Features
Types of Laceration
Split Laceration
Stretch Laceration
Avulsion Laceration
Tear Laceration
Cut Laceration
Medicolegal Importance
Clinical Importance
INCISED WOUNDS
Characteristics Features
Age of the Wound
Medicolegal Importance
Self-Inflicted or Suicidal Incised Wound
Suicidal Cut Throat (Figure 11.33)
Homicidal Cut Throat (Figure 11.34)
Other Self-inflicted Injury
Fabricated Wound
Parasuicidal Mutilation
Accidental Incisions
Defense Wounds
Chop Wound
Definition
Features
Medicolegal Importance
STAB OR PUNCTURE WOUNDS
Classification
Penetrating Wounds
Perforating or Transfixing Wound
Features of Stab Wounds
Effects of Stabbing
Puncture Wounds by Blunt Objects
Associated Internal Injuries
Concealed Punctured Wound
Medicolegal Importance
CHAPTER 12:
Firearm Injuries
TERMINOLOGIES
GENERAL MAKE UP OF FIREARM
Stock or Grip or Butt
Barrel
Breech Action
Mechanism
CLASSIFICATION OF FIREARMS
Smooth Bored or Shotgun Firearms
Types of Shotgun (Figure 12.4)
Uses of Shotgun
Bore or Caliber of Non-Rifled Weapon
Choking
Cartridge of Shotgun
WAD
Functions of the Wad
Medicolegal Importance of Wad
SMOOTH BORE FIREARM INJURY
Range of Firing
Entry Wound
Contact and Near Contact Range
Close or Contact Range Injuries to the Head
Close Range
Short Range
Intermediate Range
Distant Wounds
The Size of the Shot
The Nature of the Explosive
Type of the Gun Itself
Direction of Fire
Survivability
Balling or Welding of Shot
Billiard Ball Ricochet Effect
Country-made Firearms
RIFLED FIREARMS
Types of Rifled Firearms
Uses of Rifled Firearm
Rifling
Bore
Short Barrel or Short Rifled or Hand Guns or Hand Rest
Cartridge of Rifled Firearm
Projectile
Jacketed Bullets
RIFLED FIREARMS OR SHOTGUN INJURIES
Certain Features of Rifled Firearm Wound
Medicolegal Importance of Powder Marks
Entry Wound in Rifled Firearm
Contact Shot or Point Blank Shot
Close Shot
Intermediate Range Shot
Distant Shot
Exit Wound
Gunshot Wounds in Bone
Unusual Effect of Rifled Firearm
Position of the Assailant
Factors Affecting the Appearance of the Entry
IDENTIFICATION OF THE WEAPON
Weapon
The Missile
Gunshot Wound Imaging
Patterns of Gunshot Injuries
ROLE OF PHYSICIAN IN FIREARM INJURIES
Do's
Don'ts
CHAPTER 13:
Regional Injuries
BRIEF ANATOMICAL REVIEW OF HEAD
Scalp
Skull
Brain
Parts of the Brain
HEAD INJURY
External Injuries on the Head and the Face
Specific Features and Peculiarities of Blunt Force Injuries on the Head and the Face
Periorbital Hematoma
INJURY TO THE BONES OF THE HEAD
Fractures of Skull
Fissured or Linear Fracture
Comminuted Fracture
Depressed Fractures
Pond or Indented Fracture
Penetrating Fracture
Gutter Fracture
Ring Fracture
Hinge Fracture
Cut Fracture
Suture Fracture or Sutural Separation
Crush Fracture
Heat Fracture
Contrecoup Fracture
Mechanism of Fracture of Skull (Figure 13.15)
At the Base of the Skull
Fracture on the Anterior Fossa
Fracture of the Middle Fossa
Fracture of the Posterior Fossa
Brain Injury
Types of Traumatic Brain Lesions (Table 13.1)
Cerebral Concussion
Cerebral Contusion
Cerebral Laceration
Cerebral Edema
Cerebral Hemorrhage
Diffuse Neuronal Injury (Axonal Injury)
Cerebral Compression
Cerebral Irritation
INTRACRANIAL HEMORRHAGES
Extradural Hemorrhage (Figure 13.16)
Mechanism
Fate of EDH
Medicolegal Importance
Subdural Hemorrhage
Causes of Subdural Hemorrhage (SDH)
Classification
Primary or Acute SDH
Subacute SDH
Chronic SDH
Fate of SDH
Medicolegal Importance
Subarachnoid Hemorrhage
Intracerebral Hemorrhage
Intraventricular Hemorrhages
Causes
Medicolegal Importance
Other Injuries of the Brain
Complications of the Intracranial Injuries
Age of the Intracranial Injuries
HEAD INJURY AND LEGAL RESPONSIBILITY
Lucid Interval in Head Injury Cases
Punch Drunk
Vertebrobasilar Artery Injury
INJURY TO NECK
INJURIES ON THE CHEST
ABDOMINAL INJURIES
INJURIES ON LIMBS
INJURIES TO PRIVATE PARTS
INJURIES TO THE SPINAL CORD
Whiplash Injury
Rabbit Punch
Jefferson Fracture
Hangman's Fracture
Pithing
CHAPTER 14:
Road Traffic Injuries
DEFINITION
BRIEF REVIEW OF ROAD TRAFFIC ACCIDENT
MECHANISM OF INJURY PRODUCTION
PATTERN OF ROAD TRAFFIC INJURIES
Injuries to the Pedestrians
Primary Impact Injuries
Secondary Impact Injuries
Secondary Injuries
Injuries to the Vehicle Occupants
Whiplash Injury
Seat Belt Injuries
Airbags Injury
SAFETY DEVICES
Seat Belts
Other Safety Features
INJURIES OF MOTORCYCLISTS
Causes of Motorcycle Accident
ACCIDENT PREVENTION
RTA Reconstruction
Contributory Factors in Crashes
Preventive Measures
Traffic Rules
CHAPTER 15:
Thermal Injuries
BRIEF REVIEW OF BURNS
CLASSIFICATION OF THERMAL INJURIES
Injuries Due to High Temperature (Heat)
Injuries Due to Low Temperature (Cold)
INJURIES DUE TO HIGH TEMPERATURE (HEAT)
Generalized Effects of Heat
Heat Stroke
Heat Hyperpyrexia
Heat Cramps
Heat Exhaustion
Localized Effects of Heat
Burns
Classification of Burns
Factors Affecting Prognosis of Burns
Cause of Death in Burn Injuries
Postmortem Findings
Heat Ruptures
Heat Hematoma
SCALD
Characteristics
Medicolegal Importance
INJURIES DUE TO LOW TEMPERATURE (COLD)
Generalized Effects of Cold
Hypothermia
Localized Effects of Cold
Chilblains (Pernio)
Frostbite
Trench Foot or Immersion Foot
ELECTRICAL INJURIES
Severity of Tissue Damage
Intensity of Current
Type of Current
Pathway of the Current
Resistance of Tissues
Duration of Exposure
Types of Electrical Injuries
Contact Injury
Spark Burn
Flash Burn
Cause of Death in Electrocution
LIGHTNING
Lightning Injuries
Linear Lightning Burn Injury
Arborescent Marks
Surface Burns
Complications
CHAPTER 16:
Medicolegal Aspects of Injuries
INJURY
OFFENCE
Classification of Offence
Bailable Offences
Non-bailable Offences
Cognizable Offence and Case
Non-cognizable Offence and Case
Compoundable Offences
Non-compoundable: 302, 304B, 307, 324, 326 IPC
TYPES OF WEAPON
Dangerous Weapon
LEGAL ISSUES OF INJURIES
Assault
Hurt
Grievous Hurt
Voluntarily Causing Hurt
Voluntarily Causing Grievous Hurt
Punishment for Voluntarily Causing Hurt
Voluntarily Causing Hurt by Dangerous Weapons or Means
Punishment for Voluntarily Causing Grievous Hurt
Voluntarily Causing Grievous Hurt by Dangerous Weapons or Means
Voluntarily Causing Grievous Hurt by Use of Acids, etc.
Voluntarily Throwing or Attempting to Throw Acid
HOMICIDE
Classification of Homicide (Figure 16.2)
Lawful Homicide
Unlawful Homicide
Culpable Homicide
Illustrations
Murder
Murder Distinguished from Culpable Homicide
Punishment for Murder by Life Convict
Punishment for Culpable Homicide Not Amounting to Murder
SOME IMPORTANT IPC
Causing Death by Negligence
Dowry Death
Abetment of Suicide of Child or Insane Person
Abetment of Suicide
Attempt to Murder
Illustrations
Attempt to Commit Culpable Homicide
Illustration
Attempt to Commit Suicide
Voluntarily Causing Hurt on Provocation
Voluntarily Causing Grievous Hurt on Provocation
Act Endangering Life or Personal Safety of Others
Causing Hurt by Act Endangering Life or Personal Safety of Others
Illustration
Causing Grievous Hurt by Act Endangering Life or Personal Safety of Others
Illustration
MANNER, MODE AND MECHANISM OF DEATH
Manner of Death
Modes of Death
Mechanism of Death
INJURY CERTIFICATE/REPORT
Data for Injury Certificate
CHAPTER 17:
Asphyxial Deaths
DEFINITION OF ASPHYXIA
GORDON'S CLASSIFICATION OF DEATH
Asphyxia Begets Asphyxia
CLASSICAL SIGNS OF ASPHYXIA
Cyanosis
Congestion
Fluidity of Blood
Petechial Hemorrhages
Pharyngeal Hemorrhage
CLASSIFICATION OF ASPHYXIA (FIGURE 17.2)
Non-mechanical
Mechanical
HANGING
Definition
The Ligature Material
Examination of Ligature Material
Mechanism of Neck Constriction
Sequence of Events in Hanging
Loss of Consciousness
Stage of Convulsion
Causes of Death in Hanging
Fatal Period
Postmortem Findings
General External Findings
Local External Findings
General Internal Findings
Local Internal Findings
Medicolegal Questions Related to Hanging
Whether the Hanging was Antemortem or Postmortem?
Whether the Hanging was Suicidal, Homicidal or Accidental?
Lynching
Sexual Asphyxia
STRANGULATION
Definition
Types of Strangulation
Causes of Death in Strangulation
Postmortem Findings
External Findings
Internal Findings
Medicolegal Questions Related to Strangulation
Whether Death was due to Strangulation?
Whether Strangulation was Suicidal, Homicidal or Accidental?
SUFFOCATION
Definition
Smothering
Choking
Traumatic Asphyxia
Inhalation of Irrespirable Gases
Gagging
Burking
DROWNING
Definition
Types of Drowning
The Event of Drowning
Causes of Death in Drowning
Fatal Period
Treatment
Postmortem Appearance
External Findings
Internal Findings
Histological Examination
Tests for Drowning
Gettler's Test
Diatom Test
Medicolegal Questions in Case of Drowning
Whether Death was Caused due to Drowning?
Whether Drowning was Suicidal, Homicidal or Accidental?
How long was the Body in Water?
CHAPTER 18:
Anesthetic Procedures and Death
BRIEF REVIEW
CLASSIFICATION OF ANESTHETIC DEATHS
TYPES OF ANESTHESIA USED IN SURGICAL PROCEDURE6
Preanesthetic Medication
Mechanism of Action
Muscle Relaxant Used for Intubation6
CAUSES OF DEATH DUE TO GENERAL ANESTHESIA
Medicolegal Approach in a Case of “Death on Table”
Clinical Records
Autopsy Examination
Preservation of Viscera and Other Materials for Analysis
Precautions during Collection of Blood Samples
Interpretation and Opinion
CHAPTER 19:
Starvation Death
DEFINITION
TYPES OF STARVATION
Acute Starvation
Chronic Starvation
Fatal Period
Factors Influencing the Fatal Period
CLINICAL FEATURES
Acute Starvation
Chronic Starvation
CAUSES OF STARVATION
Causes of Death
POSTMORTEM FINDINGS
External Examination
Internal Examination
MEDICOLEGAL IMPORTANCE
CHAPTER 20:
Impotence, Frigidity and Sterility
MALE IMPOTENCE
Types of Impotence
Causes of Impotence
Premature Ejaculation
Examination of a Case of Impotency
Medicolegal Importance
POTENCY TEST
FRIGIDITY
Types
Causes of Frigidity
Medicolegal Importance
STERILITY
Types of Sterility or Infertility
Primary Infertility
Secondary Infertility
Causes of Sterility
Causes of Male Sterility
Causes of Female Sterility
Medicolegal Importance
STERILIZATION
Types
Voluntary Sterilization
Compulsory Sterilization
Methods
Medicolegal Importance
ARTIFICIAL INSEMINATION
Types
Indications of Artificial Insemination
Legal Precautions of Artificial Insemination Donor (AID)
Medicolegal Importance
SURROGATE MOTHER
CHAPTER 21:
Pregnancy, Delivery, Legitimacy and Paternity
PREGNANCY
When a Female is examined for Signs of Pregnancy or Delivery?
DIAGNOSIS OF PREGNANCY IN LIVING WOMEN
The Presumptive Signs
The Probable Signs
Positive Signs or Sure Signs
SIGNS OF PREGNANCY IN THE DEAD
GESTATIONAL PERIOD
CERTAIN MEDICOLEGAL TERM
Posthumous Child
Super Fecundation
Superfetation
Pseudocyesis (Spurious or Phantom Pregnancy)
Suppositious Child
Birth in Helmeted (CAUL) Head
DELIVERY
Signs of 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
LEGITIMACY AND PATERNITY
When Question of Legitimacy Arises?
CHAPTER 22:
Abortion and MTP Act
DEFINITION OF ABORTION
INCIDENCE
CLASSIFICATION OF ABORTION
Spontaneous (Natural) Abortion
Complete Abortion
Incomplete Abortion
Threatened Abortion
Inevitable Abortion
Missed Abortion
Septic Abortion
Artificial or Induced Abortion
Therapeutic or Justifiable or Legal
Rules for Doing MTP
Methods for Induction of MTP
Criminal Abortions
Motives for Criminal Abortion
Legal Bearing
Methods for Inducing Criminal Abortion
Legal Status of Criminal Abortion
Complication of MTP
Evidences of Abortion
Evidences during Life
Evidences after Death
Fabricated Abortion
CHAPTER 23:
Infanticide
DEFINITION
MOTIVE FOR INFANTICIDE
Feticide
Neonaticide
MEDICOLEGAL QUERIES
Is the Infant Born is a Stillborn or Dead born?
Stillborn
Dead Born
Has the Infant Attained Age of Viability or Not?
Definition
Signs of Maturity of a Fetus
Was the Infant Born Alive?
Postmortem Findings
Some Other Useful Tests
Observation and Conclusion
Fallacies of this Test
If the Infant was Born Alive, how long did the Infant Survive?
What was the Cause of Death of the Infant?
Natural Causes
Accidental Causes
Criminal Causes
BATTERED BABY SYNDROME
Definition
Features
Examination Findings
SHAKEN BABY SYNDROME
History
Features
MUNCHAUSEN'S SYNDROME
Munchausen's Syndrome by Proxy
Treatment
SUDDEN INFANT DEATH SYNDROME
Definition
Risk Factors
Etiology
Autopsy Findings
FEMALE FETICIDE
Objective of PC and PNDT Act 1996
PCPNDT Act 200321
Features of PCPNDT Act
Pre-requisite for Doing PCPNDT
Indications
CHAPTER 24:
Virginity, Sexual Offences and Perversions
VIRGINITY
Signs of Virginity
Breast Signs
Genital Signs
HYMEN
What is Hymen?
What is the Hymen for?
Types of Hymen
Rupture of Hymen
Causes of Rupture of Hymen Other than Sexual Intercourse
Medicolegal Importance of Virginity
SEXUAL OFFENCES
Classification of Sexual Offences (Figure 24.5)
Natural Offences
Unnatural Offences
Sexual Perversions
Sex-linked Offences
INDECENT ASSAULT (MOLESTATION), SEXUAL HARASSMENT AND PUNISHMENT
Indecent Assault/Molestation (Section 354 IPC)
Sexual Harassment (Section 354A, IPC)
Assault or Use of Criminal Force to Woman with Intent to Disrobe (Section 354B, IPC)
Voyeurism (354C, IPC)
Stalking (354D, IPC)
Natural Offences
RAPE
Substitution of New Sections for Sections 375, 376, 376A, 376B, 376C and 376D
375 IPC
Punishment for Rape (Section 376 IPC and Other after Criminal Law Amendment, 2013)1
376 IPC
Punishment for Causing Death or Resulting in Persistent Vegetative State of the Victim
376A, IPC
Rape by Husband upon his Wife during Separation [Punishment Increased from Minimum 2 Years to 7 Years]
376B, IPC
Sexual Intercourse by a Person in Authority
376C, IPC
376D, IPC
376E, IPC
Types of Rape
Date Rape
Spouse Rape
Gang Rape
Incestual Rape
Protection of Children from Sexual Offences Act, 2012
Statutory Rape
Examination of a Rape Victim
Different Objectives
Procedures
Step of Examination
Examination Proper
Cytological Detection of Spermatozoa
Specimens to Be Collected from Victim
Objectives
Things are to Be Preserved
Evidence of Rape
Rape Trauma Syndrome
Medical Examination of the Accused
Specimen to be Collected from Accused
Legal Procedure for Medical Examination
INCEST
ADULTERY
UNNATURAL SEXUAL OFFENCES
Sodomy
Examination of Victim
Tribadism or Lesbianism
Bestiality
Buccal Coitus
Delhi High Court Ruling on Section 377 IPC
SEXUAL PERVERSIONS/PARAPHILIAS
Sadism
Lust Murder
Masochism
Necrophilia (Phila – to defile or foul)
Fetishism
Transvestism
Exhibitionism
Masturbation
Voyeurism or Scoptophilia
Frotteurism
Undinism
SEMINAL FLUID
CHAPTER 25:
Forensic Psychiatry
CLASSIFICATION OF MENTAL HEALTH DISORDERS1
DISTURBANCES OF PERCEPTION
Hallucination
Types of Hallucination
Illusion2
Types of Illusion
DISORDERS OF THOUGHT AND SPEECH
Derailment
Loosening of Association
Delusion
Types of Delusion Depending on the Content
Echolalia
Circumstantiality
Flight of Ideas
Word Salad
Formal Thought Disorder
COMMONLY USED TERMS IN FORENSIC PSYCHIATRY PRACTICE
Abreaction
Affect
Euphoria
Enuresis
Aggression
Hypersomnia
Agitation
Ambivalence
Aphasia
Compulsion
Coprolalia
Insight
PSYCHIATRIC DISORDERS OF MEDICOLEGAL IMPORTANCE
Schizophrenia
Schizophrenia and Offence
Bipolar Mood Disorder
Mania
Dementia
Types of Dementia
Disorders of Consciousness and Other Higher Functions of Brain
Amnesia
Lucid Interval
Somnambulism
Narcolepsy
Obsessive–Compulsive Disorder
Obsession
Compulsion
Mental Retardation
Some Old Terms for Mental Retardation
Impulse Control Disorders
Types of Impulse Control Disorder
Disorders of Anxiety
Phobia
Types of Phobia
Feigned Mental Illness
Malingering
PSYCHOSIS AND NEUROSIS
Psychosis
Neurosis
Causes of Mental Illnesses3
Diagnosis of Mental Illness
MENTAL HEALTH ACT 1987
Restraining of Mentally Ill
Escape and Recapture of Mentally ill
JUDICIAL RESPONSIBILITY OF INSANE OFFENDERS
CRIMINAL RESPONSIBILITY
Different Degrees of Mental Element or ‘Mens Rea’9
Not Guilty by Reason of Insanity
McNaghten Rule (Not Guilty by Reason of Insanity)
INSANITY IN INDIAN PERSPECTIVE
Medical Insanity vs Legal Insanity
Diminished Responsibility
Automatism
Intoxication
Fitness to Stand Trial or Plead
Restoration of Competency to Plead Trial
CIVIL RESPONSIBILITIES OF INSANE
Marriage and Mental Health Problems
Testamentary Capacity21
Common Grounds for Invalid Testamentary Capacity
Responsibility in Disorders of Body Functions
Hypnotism: Hypnosis and Crime
CHAPTER 26:
Postmortem Artefacts
DEFINITION
TYPES OF ARTEFACT
Agonal Artefacts
Artefact Related to Changes after Death1
Artefacts Related to Rigor Mortis
Artefacts Related to Postmortem Lividity
Artefacts of Brain
Artefacts of Liver
Artefact of Postmortem Hemorrhage
Artefacts of Hair
Artefacts of Decomposition
Third-party Artefact
Artefacts of Emergency Intervention
Artefacts Induced in Firearm Wounds
Artefacts of Animal and Insect Bites
Artefacts Induced at the Time of Handling of the Cadaver
Artefact of Embalming
Artefact of Exhumation
Artefacts in Toxicological Analysis
Artefact acquired during Autopsy
Artefact of Environment
Freezing of Cadaver
Artefacts Due to Burns
MEDICOLEGAL IMPORTANCE
Case Report No: 1
Case Report No: 2
CHAPTER 27:
Forensic Serology
BLOOD
Information to be Determined
Blood Spatter Stains
Classes of Blood Stains
Evaluation of Blood
Presumptive/Catalytic Tests
Confirmatory/Crystal Tests
Individualization
Naked-Eye or Visual Examination
Stains Resembling Blood
Blood Stain and Sources
Age of Blood Stain
Microscopic Examination
Species Origin
Blood Grouping
Secretors
Rh System
DNA Typing
Medicolegal Importance of Examination of Blood
Civil Importance
Criminal Importance
SEMEN
Collection of Material
Physical Examination
Microscopic Examination
Chemical Examination
VAGINAL FLUIDS
SALIVA
CHAPTER 28:
Crime Scene Investigation
WHAT IS CRIME SCENE?
Purpose
How It Should Be Done
First Responders
Investigating Police Officer
EXAMINATION OF THE CRIME SCENE
Identification of Evidence
Collection of the Evidence
Preserving the Evidence
Sending Evidence to the Proper Agency
Maintaining Chain of Evidence
Documentation of the Whole Process
Final Survey of Crime Scene
Precautions
MUST FOR CRIME SCENE INVESTIGATIONS
DO NOT'S OF CRIME SCENE INVESTIGATIONS
A Case Report
CHAPTER 29:
Medicolegal Importance of People Living with HIV/AIDS
HISTORY
BRIEF REVIEW
MODES OF TRANSMISSION
RIGHTS AND PRIVILEGES FOR PATIENTS LIVING WITH HIV/AIDS UNDER INDIAN LEGAL SYSTEM
Individual Rights
Informed Consent
Confidentiality and Privacy
Court Case
Case Law4 on HIV Positive Patient's Disclosure to Interested Parties
Questions Related to Practical Difficulties in Disclosure
Employment and Discrimination
Discrimination in Health Care
Personal Liberty
Public Health Matters
Considering the Public Health Matter
The Constitution of India Grants
SOME LEGISLATIONS FOR CONTROL OF HIV
DECLARING HIV STATUS OF POSITIVE INDIVIDUALS IN DEATH CERTIFICATE
OFFENCES, PENALTIES AS LAID UNDER “THE DRUGS AND COSMETIC ACT, 1940”
Notation to be used in Case Sheets
AN APPROACH TO MEDICOLEGAL AUTOPSY OF HIV INFECTED CASE
UNIVERSAL PRECAUTIONS
CHAPTER 30:
Human Rights, Custodial Torture and Deaths
SOME IMPORTANT TERMINOLOGIES
Custody
Arrest
Police Custody
Detention
Imprisonment/Incarceration
Deaths during Police Action
TORTURE
Laws against Torture
History of Torture
Purpose of Torture
Who are the Perpetrators?
Where it Occurs?
Types of Torture
Physical Torture
Rape or Other Sexual Torture
Psychological Torture
Pharmacological Torture
Torture-Murder
Role of Medical Professionals in Tackling Torture Menace
Ethics and Medical Profession
CUSTODIAL DEATH INVESTIGATIONS: NHRC GUIDELINES
Some Statutory Safeguards
Indian Evidence Act, 1872
Code of Criminal Procedure, 1973
Indian Police Act
Alleged Victim of Custodial Torture: Photographic Documentation of Injuries
CHAPTER 31:
Techniques in Museum
FUNCTIONS OF A WELL-ORGANIZED MUSEUM
BASIC MUSEUM TECHNIQUES
Reception
Preparation
Fixation, Restoration and Preservation
Kaiserling's Solution
Pulvertaft: Kaiserling Method
Lundquist: Kaiserling Method
Additional Points in the Fixing of Museum Specimens
Specimen Containers
Construction of the Jar
Mounting of the Specimen
Labeling of the Specimen
SPECIAL MUSEUM TECHNIQUES
Gross Staining
Bones
Photography
Other Techniques
Organization of Specimens
VIRTUAL MUSEUMS
CHAPTER 32:
Forensic Science Laboratory
FORENSIC SCIENCE IN INDIA
The Chronological Order of Few Events Related to Forensic Science in India is as below2 (Table 32.1)
FORENSIC SCIENCE LABORATORY
Common Types of Physical Exhibits Encountered in FSL
THE ORGANIZATIONAL SET UP OF FORENSIC SCIENCE LABORATORY
A BRIEF ACCOUNT OF SOME OF THE TOOLS AND TECHNIQUES USED IN FSL
Photography
Microscopy
Chromatography
Electrophoresis
Spectrophotometry and Colorimetry
Neutron Activation Analysis
Narco Analysis
Brain Mapping
Polygraph (Lie Detector)
Pre-test Interview
In Test
Response Recording
Subjects Unsuitable
How to Trick the Device?
Illustration
DNA Profiling
SECTION 2: TOXICOLOGY
CHAPTER 33:
General Consideration of Toxicology
WHAT IS TOXICOLOGY?
DEFINITION OF POISON
NATURE OF POISONING IN INDIA1–4
Homicidal Poisoning
Suicidal Poisoning
Accidental Poisoning
Cattle and Animal Poisoning
Stupefying Poisoning
ACTION OF POISON
Fate of Poisons in the Body
Diagnosis of Poison
In Living
In Dead Body
Factors Modifying Action of Poison1–8
Toxicity Rating of Poison (TRP)
CLASSIFICATION OF POISONS5,7
Corrosive Poisons
Irritants Poisons
Systemic Poisons
Miscellaneous
General Line of Treatment1–6
Evaluation and Stabilization
DECONTAMINATION
Removal of the Patient from Poisoned Environment
Emetics
Cathartics and Whole Bowel Irrigation
Gastric Lavage
Activated Charcoal
Elimination of the Absorbed Poison
Clinical Diagnosis
Signs and Symptoms1
Diagnostic Tests
Poison Research Center/Poison Laboratory/Poison Information Center
ANTIDOTE THERAPY
Mode of Action of the Antidotes
Types of Antidotes
Physical or Mechanical Antidotes
Chemical Antidotes
Physiological Antidotes
Universal Antidotes
Some of the Antidotes and their Uses
Activated Charcoal
Atropine
Pralidoxime (2-PAM)
British Anti Lewisite (BAL)
Dimercaptosuccinic Acid
Ethylenediaminetetraacetic Acid (EDTA), Edetate Disodium
Dimercaptopropane Sulfonate (DMPS)
Penicillamine (D-Penicillamine)
Desferrioxamine
CHAPTER 34:
Medicolegal Aspect of Toxicology
BRIEF STATISTICAL REVIEW OF THE POISONING CASES
ROLE OF A DOCTOR IN DEALING WITH POISONING CASE
Other Formalities
OPINION ON POISONING CASES
LAWS RELATING TO POISON IN INDIA
Poison Act (Act 1 of 1904)
The Poison Act, 1919
Dangerous Drug Act (Act II of 1930)
Drug Act (Act 23 of 1940)
The Drugs and Cosmetic Act, 1940
The Drugs and Cosmetics Rules, 1945
The Drugs (Control) Act, 1950
The Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954
The Insecticides Act, 1968
Insecticides Rules, 1971
The Narcotic Drugs and Psychotropic Substance Act, 1985 (NDPS Act)
Some Other Relevant Acts and Rules
POISONS AND RELATED INDIAN PENAL CODES
Suicide
CHAPTER 35:
Corrosive Poisons
DEFINITION
Different Corrosive Poisons
INORGANIC ACIDS
Sulfuric Acid
Properties
Uses
Mode of Action
Clinical Features
Diagnosis
Management
Postmortem Findings
Medicolegal Importance
Nitric Acid (HNO3)
Properties
Uses
Clinical Features
Postmortem Findings
Hydrochloric Acid (HCl)
Properties
Uses
Oxalic Acid
Properties
Source
Uses
Criminal Use
Mode of Action
Differential Diagnosis (Table 35.2)
Clinical Features
Management
Postmortem Findings
Medicolegal Importance
Carbolic Acid
Properties
Commercial Uses
Mode of Action
Absorption
Clinical Features
Management
Postmortem Findings
Medicolegal Importance
ACID THROWING
CORROSIVE ALKALIS
Properties
Uses
Action
Clinical Features
Management
Postmortem Findings
Medicolegal Importance
AMMONIA
Properties
Clinical Features of Poisoning
Management
CHAPTER 36:
Inorganic Irritants: Non-metallic Poisons
INORGANIC IRRITANT POISONS
IODINE
Features
Uses of Iodine
Mechanism of Action
Clinical Features
Acute Poisoning
Chronic Poisoning
Medicolegal Importance
PHOSPHORUS
Types of Phosphorus
Uses
Mechanism of Action
Absorption, Metabolism and Excretion
Clinical Features
Acute Poisoning
Chronic Poisoning
Medicolegal Importance
CHAPTER 37:
Inorganic Irritants: Metallic Poisons
METALLIC POISON
ARSENIC (AS)
Properties
Inorganic Compounds
Organic Compounds (Used in Medical Idiom)
Common Use
Abuses
Mechanism of Action
Acute Arsenic Poisoning
Clinical Features
Differential Diagnosis
Management
Postmortem Findings
Preservation of Tissues for Chemical Analysis
Subacute Arsenic Poisoning
Chronic Arsenic Poisoning
Management
Diagnosis (Chemical Tests)
Medicolegal Importance
LEAD (PB)
Properties
Toxic Compounds
Commercial Uses
Mechanism of Action
Pharmacokinetics
Acute Lead Poisoning
Management
Postmortem Findings
Chronic Lead Poisoning
Clinical Features
Diagnosis
Management
Medicolegal Importance
MERCURY (Hg)
Properties
Organic Compounds
Common Use
Acute Poisoning
Clinical Features
Management
Postmortem Findings
Chronic Poisoning
Clinical Features
Diagnosis
Management
Medicolegal Importance
COPPER (CU)
Toxic Compounds
Common Use
Medical Use
Acute Poisoning
Clinical Features
Management
Postmortem Findings
Chronic Poisoning
Clinical Features
Treatment
Medicolegal Importance
SILVER (Ag)
Properties
Uses
Management
Postmortem Findings
GOLD (Au)
Properties
Uses
Clinical Features
Treatment
Postmortem Findings
THALLIUM (TI)
Properties
Toxic Compounds of Thallium
Uses
Source
Clinical Feature
Treatment
Postmortem Findings
Medicolegal Importance
IRON (Fe)
Toxic Iron Salts
What is the Risk of Iron Toxicity?
Clinical Features
Treatment
Postmortem Findings
Medicolegal Importance
METAL FUME FEVER
Occupations Affected
Metals Involved
Clinical Features
CHAPTER 38:
Organic Irritants of Plants and Vegetables Origin
TOXIC PRINCIPLE IN PLANT
ABRUS
Features
Toxic Part of the Plant
Active Principle
Mechanism of Action
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
CASTOR
Medicinal Uses
Features
Active Principle
Mechanism of Action
Clinical Features
Diagnosis
Management
Autopsy Findings
Medicolegal Importance
CROTON
Features
Medicinal Uses
Toxic Part of the Plant
Active Principle
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
CAPSICUM
Varieties of Species
Features
Active Principle
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
CALOTROPIS
Varieties
Features
Medicinal Uses
Toxic Principles
Toxicity
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
MARKING NUT
Features
Common Use
Medicinal Uses
Active Principle
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
PLUMBAGO
Varieties
Features
Active Principle
Medicinal Use
Clinical Features
Management
Medicolegal Importance
COLOCYNTH
Features
Active Principle
Medicinal Uses
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
ERGOT ON RYE
Alkaloids of Ergot
Current Uses of Ergot
Clinical Feature
Management
Medicolegal Importance
CHAPTER 39:
Organic Irritants of Animal Origin
ORGANIC IRRITANTS OF ANIMAL ORIGIN
SNAKES
Classification of Snakes4
THE BIG FOUR (IN INDIA)5,6
Common Cobra (Naja Naja)
Common Krait (Bungarus Caeruleus)
Russell's Viper (Vipera Russelli/Daboia Russelli)
Saw-Scaled Viper (Echis Carinata)
RELEVANT ANATOMY
Venom Delivery Apparatus4,6
IDENTIFICATION OF POISONOUS AND NON-POISONOUS SNAKES7
Snake Venom4,5
Polypeptide Toxins
SNAKE BITE
Clinical Features5,8,9
Fang Marks5
General Signs and Symptoms of Viperine Envenomations
General Signs and Symptoms of Elapid Envenomations
MANAGEMENT OF SNAKE BITE3,9,10
“Do it RIGHT”
Traditional Methods to be Discarded
Tourniquets
Cutting and Suction
Washing the Wound
Electrical Therapy and Cryotherapy
Newer Methods Considered Inapplicable in the Indian Context
Snake Bite Treatment Protocol3,5,9,10
Patient Assessment Phase
Diagnosis Phase (General Principles)
Diagnosis Phase: Investigations
Other Useful Tests Depending on Availability
Diagnosis Phase: Symptoms (Table 39.2)
ANTI-SNAKE VENOM (ASV) SERUM POLYVALENT
ASV Administration Criteria
Primary Determinants (Table 39.3)
Systemic Envenomations
Local Envenomations (Severe Current)
Prevention of ASV Reactions
ASV Administration
ASV Reactions
Neurotoxic Envenomations
Recovery Phase
Repeat Doses: Antihemostatic
Repeat Doses: Neurotoxic
Treatment of Other Symptoms
Pain
For Hypotension
Surgical Intervention
Renal Failure
Autopsy Findings
External
Internal
OTHER SIGNIFICANT BITES AND STINGS IN INDIAN SCENARIO
Wasp and Bee Sting5
Clinical Features
Management
Scorpion Stings5
Venom
Clinical Features
Management
CANTHARIDES
CHAPTER 40:
Mechanical Irritants
MECHANICAL IRRITANT
Powdered Glass or Broken Pieces
Clinical Features
Management
Postmortem Findings
Medicolegal Importance
Diamond Powder
Management
Needles and Pins
Management
Medicolegal Importance
Chopped Animal Hairs
Vegetable Hairs
Management
Medicolegal Importance
CHAPTER 41:
Somniferous Poisons
WHAT ARE ALKALOIDS?
OPIUM OR AFIM
Classifications of Opium Alkaloids
Pharmacokinetics
Mechanism of Action
Fatal Dose and Fatal Period
Elimination and Detection
Criminal Uses
Clinical Features
Acute Opium Poisoning
Differential Diagnosis
Tests for Morphine
Management
Postmortem Findings
HEROIN (DIACETYLMORPHINE)
CODEINE (3 METHYLMORPHINE)
THEBAINE AND PAPAVERINE
CHAPTER 42:
Alcohol and Alcoholism
HISTORICAL PERSPECTIVE
INTRODUCTION
ETHYL ALCOHOL (ETHANOL)
Mechanism of Production
Types of Alcoholic Beverages
Standard Type Alcoholic Beverages
Some Indigenous Beverages
Country Liquor
Illicit Liquor
Standard Drink
One Drink Equals
Absorption
Distribution
Metabolism and Elimination
Step – I
Step – II
Mode of Action of Ethanol
Tolerance
Dependence
Fatal Dose
Fatal Period
Effects of Ethanol Consumption
Acute Alcohol Intoxication
Signs and Symptoms
Blood Alcohol Concentration and Behavior
Management
Prognosis
Postmortem Appearance in Case of Death12
Alcoholism and Chronic Alcohol Poisoning
Management
Psychotherapy
Postmortem Findings in Case of Death
DRUNKENNESS
Examination of an Alleged Case of Drunkenness and its Reporting
Procedure
Consent
Procedure Proper
Postmortem Alcohol Estimation
Medicolegal Aspect of Alcohol Intoxication
AGENCIES WORKING FOR CURBING ALCOHOLISM
METHYL ALCOHOL
Uses
Clinical Features (12–24 Hours)
Diagnosis
Management
Postmortem Appearance
CHAPTER 43:
Agricultural Poisons
CLASSIFICATION
ORGANOPHOSPHATES
Classification
Uses of Organophosphates
Toxicokinetics
Mode of Action
Mechanism of Action
Fatal Dose8
Toxicity Rating
Clinical Features
Acute Poisoning
Nicotinic Manifestations
CNS Manifestations
Muscarinic Manifestations
Chronic Poisoning
Diagnosis4,8
Management
Postmortem Findings
External
Internal
Medicolegal Importance
ORGANOCHLORINES
Classification
Absorption and Metabolism
Mode of Action
Other Effects
Fatal Dose19
Clinical Features
Acute Poisoning
Chronic Poisoning
Diagnosis
Management
Medicolegal Importance
CARBAMATES
Toxicity Rating
Mode of Action
Clinical Features
Management
Postmortem Findings
Medicolegal Importance
PYRETHRUM, PYRETHRINS AND PYRETHROIDS
Clinical Features19
Management
Decontamination
Supportive Treatment
Postmortem Findings
Medicolegal Importance
PARAQUAT POISONING
Clinical Features
Diagnosis
Management
Decontamination
Supportive Treatment
Postmortem Findings
Medicolegal Importance
HAZARDS OF PESTICIDES
CHAPTER 44:
Cardiac Poisons
DIGITALIS (CARDIAC GLYCOSIDE)
Clinical Features of Poisoning
Fatal Dose and Fatal Period
Factors Predisposing to Digitalis Toxicity
Management
Autopsy Findings
Medicolegal Importance
TOBACCO
Active Principles
Uses
Mechanism of Action
Pharmacokinetics
Fatal Dose and Fatal Period
Acute Poisoning
Clinical Features
Chronic Poisoning
Withdrawal Symptoms
Complications
Cause of Death
Management
Autopsy Findings
Medicolegal Importance
COMMON OLEANDER
Active Principles
Uses
Mechanism of Action
Fatal Dose and Fatal Period
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
YELLOW OLEANDER
Active Principles
Fatal Dose and Fatal Period
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
ACONITE
Features
Active Principles
Uses
Mechanism of Action
Fatal Dose and Fatal Period
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
HYDROCYANIC ACID
Appearance
Source
Uses
Pharmacokinetics
Mechanism of Action
Fatal Dose
Clinical Features
Acute Exposure
Chronic Exposure
Management
Autopsy Findings
Medicolegal Importance
CHAPTER 45:
Deliriants and Psychotropic Poisons
DATURA (ANTICHOLINERGICS)
Active Principle
Medical Uses
Fatal Dose and Fatal Period
Mechanism of Action
Clinical Features
Management
Postmortem Findings
Medicolegal Importance
CANNABIS
Forms in which Consumed
Uses
Active Principle
Fatal Dose and Fatal Period
Mechanism of Action
Acute Poisoning
Clinical Features
Stage of Inebriation and Release of Inhibition
Stage of Narcosis
Management
Chronic Poisoning
Psychiatric Toxicity
Cannabis Psychosis
Cardiovascular Toxicity
Respiratory Toxicity
Others
Detection
Medicolegal Importance
Postmortem Findings
COCAINE
Preparation
Routes of Administration
Medical Usage
Mechanism of Action
Absorption, Metabolism and Excretion
Fatal Dose
Acute Poisoning
Clinical Features
Management
Postmortem Findings
Samples to be Preserved
Cocainisim or Chronic Cocaine Poisoning
Clinical Features
Cocaine Bug or Magnan's Syndrome
Medicolegal Importance
CHAPTER 46:
Spinal Poisons
SPINAL POISON
STRYCHNINE
Alkaloids
Medical Use
Pharmacokinetics
Fatal Dose
Mechanism of Action
Clinical Manifestations
Differential Diagnosis
Management
Postmortem Findings
The Circumstances of Poisoning
CHAPTER 47:
Peripheral Nerve Poison
CURARE
Medicinal Uses
Mechanism of Action
Absorption, Metabolism and Excretion
Clinical Features
Management
Medicolegal Importance
CONIUM MACULATUM (FIGURE 47.2)
Medicinal Uses
Mechanism of Action
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
CHAPTER 48:
Asphyxiants (Toxic Gases)
CLASSIFICATION OF ASPHYXIANTS OR TOXIC GASES
Simple Asphyxiants
Respiratory Irritants
Systemic Asphyxiants
Volatile Compounds
CARBON DIOXIDE (CO2)
Properties
Sources
Action
Uses
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
CARBON MONOXIDE (CO)
Properties
Actions
Sources
Clinical Features
Acute Poisoning
Chronic Exposure
Diagnosis
Management
Autopsy Findings
Medicolegal Importance
HYDROGEN SULFIDE (H2S)
Properties
Sources
Actions
Clinical Features
Management
Autopsy Findings
Medicolegal Importance
PHOSPHINE
Management
Autopsy Findings
Medicolegal Importance
CHAPTER 49:
Paracetamol and Salicylates
SALICYLATES
Appearance
Uses
Pharmacokinetics
Clinical Features
Acute Poisoning
Chronic Poisoning (Salicylism)
Diagnosis
Bedside Tests
Management
Postmortem Findings
Medicolegal Importance
PARACETAMOL
Physical Appearance
Uses
Pharmacokinetics
Clinical Features
Acute Toxicity
Chronic Toxicity
Fatal Dose
Diagnosis
Detection in Body Fluids
Management
Postmortem Findings
Medicolegal Importance
CHAPTER 50:
Food Poisoning
WHAT IS FOOD POISONING?
Classification of Food Poisoning
BACTERIA
Botulism (Caused by Clostridium botulinum)
Food-borne
Wound Botulism
Infant Botulism
Diagnosis
Treatment
Medicolegal Importance
Other Bacterial Agents
Staphylococcus aureus
Bacillus cereus
Salmonella
Enterotoxigenic E. coli (ETEC)
Pathogenesis
Enterohemorrhagic E. coli (EHEC)
Vibrio parahaemolyticus
Salmonella enteritidis
Yersinia enterocolitica
Clostridium perfringens
VIRAL AGENTS
PROTOZOAL AGENTS
FUNGAL (MUSHROOM POISONING)
Cyclopeptide Containing Mushrooms
Clinical Features
Diagnosis
Management
Autopsy Findings
PLANTS
Mexican Poppy or Argemone Mexicana or Prickly Poppy
Management
Medicolegal Importance
CHEMICALS
MSG (Monosodium Glutamate)
Lathyrus Sativus
Clinical Features
POISONING BY FISH AND MARINE ORGANISMS
CHAPTER 51:
Substance Abuse
BRIEF OVERVIEW OF SUBSTANCE ABUSE
DEFINITIONS
SOME COMMONLY ABUSED SUBSTANCES AND THEIR EFFECTS
Alcohol
Sedatives and Hypnotics
Cannabis
Opiates and Other Opioids
Hallucinogens
Tobacco
Amphetamines and Related Drugs
Cocaine
Inhalants
Miscellaneous Including Prescription Medications
Distribution, Causes and Risk Factors
Drug-related Harms
Modes of Trafficking
Investigation of Drug-abuse Death
Legal Issues of Substance Abuse
Management
CHAPTER 52:
Weapons of Mass Destruction
WEAPON OF MASS DESTRUCTION
CHEMICAL WARFARE OR WEAPON
Classes of CW Agents5,6
Nerve Agent
Asphyxiant/Blood Agent
Vesicant/Blistering Agent
Chocking/Pulmonary Agent
Lesser CW Agents
Examples of CW
Agent Orange
Pepper Spray
BIOLOGICAL WEAPONS (POOR MAN'S WMD)
Introduction7
History
Types10
Advantages11
Disadvantages11
Characteristics of Ideal Biological Weapon11
RADIOLOGICAL WEAPON
Autopsy on a Radioactive Body
NUCLEAR WEAPON
MASS DISASTER MANAGEMENT (FOCUS ON ROLE OF MEDICOLEGAL EXPERT)
SECTION 3: ANNEXURES
ANNEXURE 1:
PROFORMA FOR AGE CERTIFICATION
ANNEXURE 2:
PROFORMA FOR INJURY CERTIFICATE
ANNEXURE 3:
PROFORMA FOR EXAMINATION OF A SEX CRIME (VICTIM)
ANNEXURE 4:
PROFORMA FOR EXAMINATION OF AN ACCUSED OF SEXUAL OFFENCE
ANNEXURE 5:
PROFORMA FOR EXAMINATION OF A SODOMY CASE
ANNEXURE 6:
REQUISITION FOR RADIOLOGICAL INVESTIGATION
ANNEXURE 7:
LETTER FOR PERMISSION FOR ANALYSIS OF VISCERA, BLOOD, ETC. AT STATE FORENSIC SCIENCE LABORATORY
ANNEXURE 8:
VISCERA LABELING FORM
ANNEXURE 9:
FINAL OPINION FORM AFTER CHEMICAL ANALYSIS OF VISCERA OR HISTOPATHOLOGICAL EXAMINATION OF TISSUE
ANNEXURE 10:
DEAD BODY DISPOSAL CERTIFICATE AFTER AUTOPSY
ANNEXURE 11:
FIRST INFORMATION REPORT
ANNEXURE 12:
FORM FOR DESPATCHING VISCERA/ BODY FLUIDS FOR CHEMICAL EXAMINATION
ANNEXURE 13:
EXAMINATION OF A CASE OF DRUNKENNESS
ANNEXURE 14:
Fetal and Perinatal Autopsy—A Holistic Approach
PRE-REQUISITE
PRECAUTIONS
CASE REPORTS
CONCLUSION
INDEX
TOC
Index
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