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Review of Forensic Medicine and Toxicology (Including Clinical & Pathological Aspects)
Gautam Biswas
1: JURISPRUDENCE AND FORENSIC MEDICINE
CHAPTER 1:
Medical Jurisprudence and Ethics
Medical Council of India (MCI)
Schedules
FUNCTIONS of MCI
State Medical Council (SMC)
Functions of SMC
Duties of a Doctor (Flow chart 1.2)
Duties of a Doctor in General
Duties of a Doctor towards the State
Duties of a Doctor towards Patients
Duties of a Doctor in Consultation
Responsibility of Doctors towards Each Other
Privileged Communication
Medical Malpractice
Unethical Acts
Professional Misconduct (Infamous Conduct)
Erasure of Name
Rights and Privileges of Registered Medical Practitioners
Red Cross Emblem
Privileges and Rights of Patients
Types of Physician-Patient Relationship
Professional Negligence
Types (Diff. 1.2)
Civil Negligence
Criminal Negligence
Burden of Proof
Preventing Medical Litigation
Defenses Against Negligence
Doctrine of Res ipsa loquitur
Calculated Risk Doctrine
Doctrine of Common Knowledge
Doctrine of Avoidable Consequence Rule
Novus Actus Interveniens(Unrelated Intervening Action)
Contributory Negligence
Corporate Negligence
Products Liability
Medical Maloccurrence
Therapeutic Misadventure/Hazard
Vicarious Liability/Respondeat Superior
Consent
Types (Flow chart 1.4)
Doctrine of Informed Consent30
Exceptions to Informed Consent
Consenting Ages for Treatment
Reasons for Obtaining Consent
Rules of Consent
Medical Records
Malingering (Shamming)
Reasons
Euthanasia (Mercy Killing)
Arguments against Euthanasia
Reasons for Euthanasia
CHAPTER 2:
Acts Related to Medical Practice
The Transplantation of Human Organs Act, 19941 (Amendment 2011, 2014)
Donation in medico-legal cases
Duties of the Medical Practitioner Regarding Organ Transplantation
Authorization Committee
The Consumer Protection Act, 1986 (CPA) (Amendment in 1991, 1993, 2002)
Redressal Agencies (Flow chart 2.1)
CPA and Medical Services (Table 2.1)
Medical Indemnity Insurance
The Workmen's Compensation Act, 1923
The Medical Termination of Pregnancy (MTP) Act, 1971
Indications for Termination of Pregnancy13
MTP Act Rules
Place where MTP can be performed
Qualification and Experience of RMP
For RMP conducting MTP upto 12 weeks
The Pre-conception and Prenatal Diagnostic Techniques Act, 1994 (Amendment 2002)
Regulation of Prenatal Diagnostic Techniques
Maintenance and Preservation of records
Offences and Penalties
The Protection of Children from Sexual Offences (POCSO) Act, 2012
Offences and Punishments
The Mental Health Act, 1987
Restraint of an Insane
Content of Medical Certificates
Discharge of a Mentally Ill Person
CHAPTER 3:
Legal Procedure
Inquest
Types of Inquest
Police Inquest
Procedure
Magistrate Inquest
Coroner's Inquest (Diff. 3.2)
Medical Examiner System
Courts of Law
Capital Punishment
Subpoena / Summons24
Conduct Money
Medical Evidence
Documentary Evidence
Oral Evidence
Types of Witness
Types (Diff. 3.4)
Recording of Evidence
Testifying
Presentation of Evidence
Oath
Examination-in-Chief (Direct Examination)
Cross-Examination
Objectives are:
Re-Examination (Re-Direct Examination)
Objectives are:
Court Questions/Questions by the Judge
Conduct and Duties of a Doctor in the Witness Box
CHAPTER 4:
Identification I
Corpus Delicti
Race and Religion
Race
Religion
Sex
Sex Verification Tests
Nuclear Sexing
Histological Examination
Disorders of sexual development
Sex from Skeletal Remains
Age
Dentition in Determining Age
Gustafson's Method
Other Information from Teeth
Age from Ossification of Bones
Age Determination in Adults Over 25 years
Symphyseal Surface of Pubis
Skull Suture Closure (Table 4.12 and Fig. 4.17)
Age Estimation from Mandible
Sacrum
General Features in Estimation of Age
Older years
Medico-legal Importance of Age
Stature
Stature from Bones
Scars
Characteristic of Scars
Medico-legal Importance
Tattoo Marks
Classification of Tattoos
Erasure of Tattoo
Medico-legal Importance
Notes
CHAPTER 5:
Identification II
Anthropometry (Bertillon system/Bertillonage)
Dactylography (Dactyloscopy)
Fingerprint Patterns
Recording of Fingerprints
Types of Evidentiary Fingerprints
Development/Enhancement of Latent Prints
Fingerprint Development
Identification Protocol
Fingerprint Classification
Medico-legal Application
Poroscopy
Lip Prints (Cheiloscopy)
Hair
Medico-legal Questions
Q. Is the material hair or some other fiber?
Q. If hair, is it human or animal hair?
Q. What could be the racial profile of the person?
Q. From what part of body has the hair originated? (Fig. 5.9)
Q. Is it male or female hair?
Q. What could be the age of the person?
Q. Has the hair being altered by dyeing, bleaching or diseased?
Q. Is the hair identical with hair of the victim or the suspect?
Q. Did the hair fall naturally or was it forcibly removed? (Fig. 5.10)
Q. What is the cause of injury? (Fig. 5.11)
Superimposition
Forensic Odontology
Identification of Human Remains
Bite Marks
Dental Profiling
Charting of Teeth
Medico-legal Application
Miscellaneous Methods of Identification
Clothes and Personal Effects
Occupational Marks
Handwriting
Speech, Voice, Ticks, Manner and Habit
CHAPTER 6:
Medico-legal Autopsy
Purpose/Objectives of Autopsy
Procedure for Medico-legal Autopsies (Flow chart 6.1)
Instruments for Autopsy Examination
External Examination
External Injuries
Internal Examination (Evisceration)
Skin Incisions
Evisceration Methods (Flow chart 6.2)
Examination Proper
Abdomen and Pelvis
Chest
Lungs
Heart
Examination of the Heart
Subendocardial or Sheehan's Hemorrhages
Neck
Skull and Brain
Delivery of the Brain
Examination of the Brain
Fixation of the Brain
Dissection of the Brain
Cerebrum
Cerebellum
Brainstem
Spinal Cord
Description of an Organ
Report
Demonstration of Pneumothorax
Demonstration of Air Embolus
Collection of Samples
Preservation of Viscera
Preservation of Samples
Procedure of Preservation
Samples for Laboratory Investigations
Obscure and Negative Autopsy
Second Autopsy
Examination of Decomposed, Mutilated and Skeletonized Remains
Definitions
Medico-legal Questions
Q. Whether the body is of human or animal?
Q. Whether it belongs to one or more bodies?
Q. What was the race of the person?
Q. Whether it is male or female?
Q. What was the age of the individual at the time of death?
Q. What was the stature of the individual?
Q. What was the identity of the individual?
Q. What was the manner of separation of parts?
Q. What was the mode and place of disposal?
Q. Whether the injuries are antemortem or postmortem in nature?
Q. What was the cause of death?
Q. What type of weapon was involved?
Q. What was the time of death?
Exhumation
Reasons
Procedure
Time limit
CHAPTER 7:
Autopsy Room Hazards
Classification of Pathogens
Commonly Acquired Infections
Transmissible spongiform encephalopathies (TSE)
Miscellaneous infections
Autopsy of Hazard Group 3 Patients
Universal Work Precautions
Autopsy of suspected TSE patient
Autopsy of Hazard Group 4 Patients
Autopsy and Disposal of Radioactive Corpse
CHAPTER 8:
Thanatology
Brain/Brainstem Death
Mechanism of Brain Death
Diagnosing Brain Death (Box 8.1)
Exclusion of Reversible Conditions
Brain Death Certification
Cause, Mechanism and Manner of Death
Cause of Death
Modes of Death (Proximate Causes of Death)
Coma
Syncope
Asphyxia
Anoxia
Sudden Death
Causes
Special Causes in Children
Coronary Atherosclerosis
Postmortem Examination
Anaphylactic Deaths
Vagal Inhibition (Vasovagal Shock/Reflex Cardiac Arrest/Nervous Apoplexy)
CHAPTER 9:
Signs of Death
Immediate Changes (Somatic Death)
Suspended Animation (Apparent Death)
Early Changes (Molecular Death)
Cooling of the Dead Body (Algor Mortis)
Factors Affecting Algor Mortis
Postmortem Caloricity
Medico-legal Importance of Algor Mortis
Postmortem Staining (Livor Mortis)
Development of PM Staining
Fixation of PM Staining
Distribution of PM Staining
Fate of PM Staining
Features Related to PM Staining
Medico-legal Importance of PM Staining14
Rigor Mortis
Muscles involved
Onset and Duration
Order of Appearance
Factors Affecting Rigor Mortis
Medico-legal Importance of Rigor Mortis
Cadaveric Spasm (Instantaneous Rigor /Rigidity, Cataleptic Rigidity)
Medico-legal Importance
Heat Stiffening
Cold Stiffening
Secondary Relaxation of Muscles
Decomposition/Putrefaction
External Signs of Decomposition
Internal Changes due to Putrefaction
Factors Affecting Putrefaction
Medico-legal Importance of Putrefaction
Decomposition of Submerged Body
Factors Influencing Decomposition in Water
Floatation of a Dead Body on Water
Factors Influencing Floatation
Entomology
Adipocere (Saponification)
Factors Influencing Adipocere Formation
Medico-legal Importance
Mummification
Salient Features
Factors Favoring Mummification
Estimation of Time Since Death (TSD) or Postmortem Interval (PMI)
Physical Changes Useful for Estimation of TSD
Preservation of Dead Bodies
Embalming or Thanatopraxia
Presumption of Survivorship
Presumption of Death
CHAPTER 10:
Asphyxia
Etiology of Asphyxia (Table 10.1)
Clinical Effects of Asphyxia
Hanging
Classification
Cause of Death
Autopsy of Neck (Asphyxial Deaths)
External Examination
Internal Examination
Postmortem Findings in Hanging
External Findings
Internal Findings
Medico-legal Questions
Q. Whether the hanging was suicidal, homicidal or accidental?
Lynching
Judicial Hanging
Strangulation
Classification
Ligature Strangulation
Cause of death
Postmortem Examination
External Findings (Fig. 10.9)
Internal Findings
Medico-legal Questions
Q. Whether death was caused by strangulation?
Q. Whether the strangulation was suicidal, homicidal or accidental?
Pseudo or False Strangulation Groove
Throttling or Manual Strangulation
Postmortem Examination
External Findings
Internal Findings (Fig. 10.11)
Medico-legal Questions
Q. Whether death was due to throttling?
Q. Whether throttling was suicidal, homicidal or accidental?
Q. How much force an assailant could have used?
Hyoid Bone Fractures
Inward (Side-Wise) Compression Fractures
Anteroposterior Compression Fractures
Avulsion or Traction or Tug Fracture
Suffocation
Classification19
i. Smothering
ii. Choking
Café-coronary
Causes
Postmortem Findings
Medico-legal Aspects
iii. Gagging
iv. Overlaying
Traumatic or Crush Asphyxia / Perthes Syndrome
vi. Burking
Drowning
Classification (Flow chart 10.3)
I. TYPICAL OR WET DROWNING
II. ATYPICAL DROWNING
Epidemiology
Cause of Death
Postmortem Examination
External Findings
Internal Findings
Medico-legal Questions
Q. Whether death was due to drowning?
Q. Whether drowning was accidental, suicidal or homicidal?
Hyperventilation Deaths
Sexual Asphyxia (Autoerotic Asphyxia /Hypoxyphilia / Asphyxiophilia)
Methods
CHAPTER 11:
Injuries
Classification of Wounds / Injuries
Based on Causative Factors
Based on Severity of Injury (Legally)
Based on Nature of Injuries (Medico-legally)
Based on Time of Infliction
Abrasion
Types (Fig. 11.2)
Age of Abrasion
Differential Diagnosis
Circumstances of Abrasions
Medico-legal Importance
Bruise / Contusion
Causes
Classification
Factors Influencing the Bruise
Patterned Bruise
Dating/Age of Bruise
Complications
Medico-legal Importance
Lacerated Wound
Types
Characteristics (Fig. 11.8)
Dating of Laceration
Complications
Medico-legal Importance
Incised Wound (Cut / Slash / Slice)
Description of a Sharp Wound
Characteristics29
Dating of Incised Wound
Medico-legal importance
Chop Wounds
Medico-legal Importance
Stab Wound / Punctured Wound
Classification
Characteristics
Complications / Cause of Death
Medico-legal Importance
Defense Wounds
Therapeutic or Diagnostic Wounds
Fabricated / Fictitious / Forged Wounds
CHAPTER 12:
Firearm Injuries
Classification of Firearms
Rifled Firearms (Fig. 12.2)
Smooth Bore Firearms / Shotguns (Fig. 12.2)
Choking (Fig. 12.4)
Bore (Gauge / Caliber)
Bullet
Types of Bullet
Cartridge
Gunpowders (Propellant Charge)
Mechanism of Discharge of Projectile
Wound Ballistics and Mechanism of Injury
Firearm Wounds
Characteristics of Shotgun Wounds (Fig. 12.13)
Contact or Near Contact Shot
Close Range (Between contact and 3 ft)
Mid/Near Range (Upto 7 ft)
Long Range (Beyond 7 ft)
Characteristics of Rifled Firearms Wounds
Contact Shot
Close Shot (Flame Range) (Fig. 12.16)26
Near Shot (Medium-Range or Intermediate Range)
Distant Shot
Firearm Wounds on Skull (Fig. 12.17)
Exit Wounds
Shotguns
Rifled Firearms
Peculiar Effects of Firearms
Postmortem Examination
Clothing
Description of Bullet Wounds (Entry or Exit)
Preservation and Marking of Exhibits
Medico-legal Questions
Q. Is the injury caused by firearm?
Q. From what distance was the shot fired?
Q. From which direction was the shot fired?
Q. What kind of weapon fired the shot?
Q. Is it possible to identify the victim/assailant from a recovered bullet?
Q. If multiple wounds of entrance and exit are present, could a single bullet have produced them?
Q. If multiple wounds are present, were they produced from the same or different weapons?
Q. When was the firearm discharged?
Q. How long did the victim survive after the injury?
Q. How much activity could the victim perform following the injury?
Q. Is it a case of suicide, accident or homicide?
Q. Can there be multiple wounds of entry and exit from a single shot?
Q. Is it possible that entry wound is present but the bullet is not found in the body?
Detection of Gunshot Residues (GSR)
Notes
CHAPTER 13:
Regional Injuries
Craniocerebral Injuries
Biomechanics of Head Injury
Soft Tissue Injury
Skull Fractures
Types (Fig. 13.3)1
Complications of Skull Fractures
Brain Injury
Cerebral Concussion
Signs and Symptoms
Diffuse Axonal Injury (DAI)
Autopsy Findings
Cerebral Contusion and Laceration
Autopsy Findings
Coup and Contrecoup Injury
Mechanism
Site
Medico-legal Importance
Intracranial Hematoma
Extradural/Epidural Hematoma (EDH)
Causes
Salient Features
Site and Vessels Involved
Types
Clinical Features31,32
Autopsy Findings
Medico-legal Aspects
Subdural Hematoma (SDH)
Cause
Salient Features
Vessels Involved
Site
Types
Age of Subdural Hematoma
Autopsy findings
Medico-legal aspects
Subdural Hygroma
Subarachnoid Hematoma (SAH)
Causes
Salient Features
Site
Types
Clinical Features39
Medico-legal Aspects
Intracerebral Hematoma (ICH)
Causes
Salient Features
Sites
Clinical Features
Diffuse Injury to the Brain
Diffuse Ischemic Injury
Diffuse Vascular Injury
Brain Swelling
Facial Injuries
Spinal Cord
Whiplash Injury
Concussion of Spinal Cord (Railway Spine)
Neck
Vertebral Column
Chest
Ribs
Lungs
Heart
Abdomen
Spleen
Liver
Kidneys
Bladder
Reproductive Organs
Bones and Joints
Healing of Fracture
Antemortem or Postmortem Fracture
CHAPTER 14:
Thermal Injuries
Cold Injury
Hypothermia
Clinical features
Chilblain (Erythema Pernio)
Immersion Syndrome (Trench / Immersion Foot)
Frostbite
Heat Injury
Heat Cramps (Miner's / Stoker's / Fireman's Cramps)6
Heat Exhaustion
Heat Hyperpyrexia / Heat Stroke
Predisposing factors
Clinical Features (Fig. 14.2)
Treatment
Postmortem Findings
Heat Prostration (Heat Syncope / Collapse)
Burns
Characteristics / Types of Burns
Classification
Effect of Burns
Cause of Death
Remote cause
Postmortem Examination
External Findings
Internal Findings
Medico-legal Questions
Scalds
Types
Medico-legal Aspects
Electrical Injuries (Electrocution)
Effects due to Passage of Electricity
Characteristics of Injuries
Postmortem Findings
Medico-legal Aspects
Judicial Electrocution
Lightning Stroke
Lichtenberg Flowers/Arborescent Markings
Other features of lightning
CHAPTER 15:
Transportation Injuries
Pedestrian Injuries
Primary Impact Injuries
Secondary Impact Injuries
Secondary Injuries/Tertiary Impact Injuries
Injuries Sustained by Vehicle Occupants
Front Impact Crash
Rear Impact Crash
Side Impact Crash
Roll-over Crash
Role of Seat Belts and Air Bags
Motorcycle and Cycle Injuries
Postmortem Examination
History
Clothing
Injuries
Laboratory Specimens
Medico-legal Issues
Alcohol, Drugs and Trauma
Railway Injuries
CHAPTER 16:
Explosion Injuries and Fall from Height
Explosion Injuries
Definitions
Mechanism of Action
Classification of Injuries
Work up
Medico-legal Aspects
Fall from Height
Introduction
Investigation of the Scene
Injury Patterns
External Examination
Internal Examination
Cause of Death
CHAPTER 17:
Medico-legal Aspects of Injuries
Grievous Hurt / Injury
Punishments
Causes of Death from Wounds
Immediate Causes
Remote Causes
Medico-legal Questions
Injury Report
Salient Features
Preliminary Particulars
Findings/Observations
Opinion
Handing Over the Report
CHAPTER 18:
Decompression, Radiation and Altitude Sickness
Decompression Sickness
Definitions
Signs and Symptoms
Treatment
Autopsy in Decompression Sickness
Ionizing Radiation Reactions
Acute (Immediate) Ionizing Radiation Effects
Systemic Reactions (Radiation Sickness)
Nuclear Terrorism
Treatment
Altitude Illness
Acute Mountain Sickness (AMS)
Treatment
CHAPTER 19:
Starvation Deaths
Mode of Starvation
Failure of Taking Food
Refusal to Take Food
Pathophysiology
Signs and Symptoms
Acute Starvation
Characteristic Findings
Chronic Starvation
Fatal period
Postmortem Findings
Medico-legal Questions
CHAPTER 20:
Anesthetic Deaths
Death during Administration of Anesthesia (not due to anesthesia)
Deaths Directly Related to Administration of an Anesthetic
Complications of Anesthesia
Medico-legal Issues of Death in Operation Theater
Postmortem Examination
Anesthetic Drugs and Suicide
CHAPTER 21:
Infanticide and Child Abuse
Postmortem Examination of Infants
External Examination
Internal Examination
Age of Fetus
Rule of Hasse
Demonstration of Centers of Ossification
Diagnosis of Fetal Death
Viability of Fetus/Infant
Live-Born / Dead-Born / Stillborn
Signs of Live Birth
Postmortem Findings
External Findings
Internal Findings
Signs of Dead-born Fetus
Signs of Stillborn Fetus
Infant Death (Flow chart 21.1)
a. Natural Causes
b. Unnatural Causes
Abandoning of Children
Concealment of Birth by Secret Disposal of Dead Body
Battered Baby Syndrome
Features
Features Arising Suspicion of Abuse
Injuries
Diagnosis
Sudden Infant Death Syndrome [SIDS, Cot Death (UK) or Crib Death (US)]
Features
Cause
Postmortem Findings
Medico-legal Aspects
CHAPTER 22:
Abortion
Classification of Abortion (Flow chart 22.1)
Natural or Spontaneous Abortion
Causes
Artificial or Induced Abortion
Criminal Abortion
Methods for Inducing Criminal Abortion (Fig.22.1)
Intentional
Complications of Criminal Abortion
Septic Abortion
Amniotic Fluid Embolism
Medico-legal Aspects
Medico-legal Importance of Placenta
Duties of a Doctor in Suspected Criminal Abortion
Examination of a Woman with Alleged History of Abortion
Examination of a Living Individual
Clinical examination
Local examination
Examination of a Dead Body
Postmortem Examination
Trauma and Abortion
CHAPTER 23:
Impotence and Sterility
Causes of Impotence and Sterility in Males
Causes of Impotence and Sterility in Females
Examination of a Person in an Alleged Case of Impotence and Sterility
Examination of a Male
Laboratory examination
Examination of a Female
Opinion
Sterilization
Methods (Flow chart 23.2)
Permanent
Temporary
Medico-legal Aspects
Artificial Insemination (AI)
Types (Diff. 23.1)
Medico-legal Aspects
Surrogate Mother
CHAPTER 24:
Virginity, Pregnancy and Delivery
Normal Female Anatomy (in Virgins) (Fig. 24.1)
Types of Hymen (Fig. 24.2)
Causes of Rupture of Hymen
Medico-legal Aspects
Pregnancy
Diagnosis of Pregnancy in the Living(Flow chart 24.1)
Presumptive Signs/Symptoms
Probable Signs of Pregnancy
Positive/Conclusive Signs of Pregnancy
Maximum and Minimum Period of Gestation
Diagnosis of Pregnancy in the Dead
Pseudocyesis (Spurious/False/Phantom Pregnancy)
Superfecundation
Superfetation
Legitimacy and Paternity
Definitions
Signs and Symptoms of Recent Delivery in Living
Symptoms
Signs
Signs of Recent Delivery in Dead
Signs of Remote Delivery in Living
Signs of Remote Delivery in Dead
Medico-legal Aspects of Pregnancy and Delivery
Nullity of Marriage and Divorce
CHAPTER 25:
Sexual Offences I
Rape
Exceptions
Explanations
Punishment for Rape
Consent
Medico-legal Aspects of Definition of Rape
Duties of a Doctor in case of an Alleged Survivor/Victim of Rape12
Examination of the Rape Survivor/Victim
Rape Kit
Facilitating Procedures
Examination Procedure
Preliminary Data
Examination
Physical Examination
Local Examination
Specimens Preserved for Laboratory Examination
Collection of Samples for Forensic Science Laboratory (FSL)
Genital and Anal Evidence
Opinion
Corroborative Signs of Rape
Evidence from Seminal Fluid
Evidence from Vaginal Discharge
Evidence of Struggle
Time of Assault
Rape on Deflorate/Sexually Active Woman
Rape on Children
Examination
Medico-legal Questions
False Allegations
Indicators of Sexual Abuse
Rape Trauma Syndrome
Intra-marital Rape
Battered Wife Syndrome
Examination of Rape Accused
Preliminary Data
Local Examination
Incest
Medico-legal Aspects
Adultery
Legal Aspects
CHAPTER 26:
Sexual Offences II
Sodomy
Examination of Passive Agent of Sodomy
Pre-requisites and Preliminary Particulars
Local Examination (in knee-elbow position) (Fig. 26.1)
Opinion
Examination of Active Agent of Sodomy
Examination
Medico-legal Aspects
Tribadism/Lesbianism
Features
Bestiality/Zoophilia
Buccal Coitus
Medico-legal Aspects
CHAPTER 27:
Sexual Offences III
Sadism/Algolagnia
Lust Murder
Masochism/Passive Algolagnia
Transvestic Fetishism/Eonism
Voyeurism/Scoptophilia7
Exhibitionism
Fetishism
Frotteurism/Toucherism
Pedophilia
Masturbation/Onanism
Uranism
Urolagnia (Urophilia, Undinism)
Coprophilia
Indecent Assault
Allegations Against Doctors
CHAPTER 28:
Postmortem Artifacts
Artifacts due to Postmortem Changes
Third Party Artifacts
Artifacts due to Animal and Insect Activity
Therapeutic Artifacts
Deliberate Mutilation, Dismemberment
Embalming Artifacts
Autopsy Surgeon Induced Artifacts
Environmental Artifacts
Heat Effects
Postmortem Corrosion
Postmortem Maceration
Other Artifacts
Artifacts due to Refrigeration
Artifacts due to Mishandling of the Body
Exhumation Artifacts
Artifacts due to Delay in Autopsy
CHAPTER 29:
Forensic Psychiatry
Delusion
Types
Hallucination
Types
Illusion
Impulse
Types
Obsession
Neurosis and Psychosis
Lucid Interval
Some More Definitions
Role of Forensic Psychiatrist
Criminal Cases
Civil Cases
Psychiatric Assessment
Classification of Mental and Behavioral Disorders (ICD-10)
Organic Mental Disorders
Delirium
Dementia
Organic Amnestic Syndrome
Psychoactive Substance use Disorders
Schizophrenia
Types of Schizophrenia
Mood (Affective) Disorders51
Other Psychotic Disorders
Neurotic and Somatoform Disorders
Behavioral Syndromes
Mental Retardation
Disorders of Adult Personality and Behavior
Disorders of Psychological Development
Behavioral and Emotional Disorders in Childhood and Adolescence
Mental Disorder and Responsibility
Civil Responsibility
Criminal Responsibility
Comments
CHAPTER 30:
Bloodstain Analysis
Bloodstain Pattern Analysis
Presumptive Tests for Blood
Catalytic Color Tests1,2
Other Tests
Microscopic Examination
Confirmatory Tests for Blood
Crystal Tests
Species Identification
Electrophoretic Methods
Precipitin Methods
Other Methods
Genetic Markers in Blood
Antigen-based markers: Blood Groups
Secretors
Medico-legal Aspects of Blood Groups
Exclusion of Paternity
Medico-legal Application of Blood (Groups)
Civil Cases
Criminal Cases
Medico-legal Questions
CHAPTER 31:
Seminal Stains and Other Biological Samples
Purpose of Seminal Identification
Collection of Material
Examination of Seminal Stains
Screening Tests
Presumptive Chemical Examination
Confirmatory Tests
Microscopic Examination
Motility of Sperms
Non-cellular Semen Markers
Identification of Species Origin
Individualization of Seminal Stains
Medico-legal Questions
Identification of Biological Samples and Body Fluids
CHAPTER 32:
DNA Fingerprinting
RFLP
Procedure (Fig. 32.1)
Limitations
PCR
Specimen Selection and Preservation
Samples Collected from Living Subjects
Samples Collected from Dead Bodies (Flow chart 32.1)
Samples Encountered in Forensic Practice
DNA Storage and FTA Card
Uses of DNA Fingerprinting
Limitations of DNA Testing
CHAPTER 33:
Torture and Custodial Deaths
Types of Torture
Physical Torture
Psychological Torture
Pharmacological Torture
Sexual Torture
Sequelae of Torture
Medical Practitioner and Torture
Custodial Deaths
CHAPTER 34:
Medico-legal Aspects of HIV
HIV Testing Policy
National AIDS Control Organization (NACO) Guidelines
HIV Testing
Health Care Workers and HIV Infection
Partner Notification (Contact Tracing, Partner Counseling)
Clinical Trials and HIV
Blood Donation and HIV
Legal Aspects
CHAPTER 35:
Newer Techniques and Recent Advances
Polygraph
Procedure
Accuracy
Admissibility of Polygraphs in the Court
Brain Fingerprinting (Brain Mapping)
Procedure
Principle
Uses
Drawbacks
Brain Fingerprinting vs Polygraph
Legal Aspects
Narco-Analysis
Other Methods
Legal Aspects
Question Bank-I
2: TOXICOLOGY
CHAPTER 36:
General Toxicology
Medico-legal Aspects of Poisons
Classification of Poisons
Factors Modifying the Action of Poisons
Action of Poison
Poisoning in the Living
Symptoms Suggestive of Poisoning
Features indicative of Chronic poisoning
Diagnosis of Poisoning in Dead
Postmortem Examination
Chemical Analysis
Experiments on Animals
Circumstantial Evidence
Failure to Detect Poison
Duties of a Doctor in a Case of Suspected Poisoning
Management of Poisoning Cases
Emergency Management of Symptomatic Patient
Removal of Unabsorbed Poison
Ingested Poisons (Gastric Decontamination)
Administration of Antidotes
Mechanical / Physical Antidotes
Chemical Antidotes
Physiological / Pharmacological Antidotes
Chelating Agents
Elimination of Poison by Excretion
Indications
Methods
Symptomatic Treatment
Maintenance of Patient's General Condition
Samples Preserved for Toxicological Analysis
Collection of Specimens
Notes
CHAPTER 37:
Corrosive Poisons
Mineral / Inorganic Acids
Introduction
Treatment
Vitriolage (Vitriol Throwing)
Characteristics of Burns
Treatment
Medico-legal Aspects
Chemical colitis
ORGANIC ACIDS
Oxalic Acid (Acid of Sugar, C2H2O4)
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Carbolic Acid (Phenol, C6H4OH)
Metabolism and Excretion
Signs and Symptoms
Treatment
Postmortem Findings
Internal
Medico-legal Aspects
Strong Alkalis (Caustic Alkalis)
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 38:
Inorganic Metallic Irritants—Arsenic
Signs and Symptoms (Acute Poisoning)
Laboratory Investigations
Treatment
Postmortem Findings
Chronic Arsenic Poisoning (Arsenicosis /Arsenicism)
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Postmortem Imbibition of Arsenic
CHAPTER 39:
Inorganic Metallic Irritants—Mercury
Signs and Symptoms (Acute Poisoning)
Treatment
Postmortem Findings
Chronic Mercury Poisoning (Hydrargyrism)
Signs and Symptoms
Specific Features / Diseases
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 40:
Inorganic Metallic Irritants—Lead
Chronic Lead Poisoning (Plumbism/Saturnism)1
Causes
Signs and Symptoms
Diagnosis
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 41:
Inorganic Metallic Irritants—Copper
Signs and Symptoms (Acute Poisoning)
Treatment
Postmortem Findings
Chronic Copper Poisoning
Cause
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 42:
Inorganic Metallic Irritants—Thallium
Signs and Symptoms (Acute poisoning)
Laboratory Investigations
Diagnosis
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 43:
Other Inorganic Metallic Irritants
Cadmium
Action
Absorption and Metabolism
Signs and Symptoms
Treatment
Postmortem Findings
Barium
Absorption
Signs and Symptoms
Treatment
Medico-legal Aspects
Zinc
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Metal Fume Fever (MFF)
Methemoglobinemia inducing Agents
Signs and Symptoms
Treatment
CHAPTER 44:
Non-Metallic and Mechanical Irritants
Phosphorus
Signs and Symptoms (Acute Poisoning)
Treatment
Postmortem Findings
Medico-legal Aspects
Chronic Phosphorus Poisoning
Mechanical Irritants
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 45:
Organic Irritants—Plant
Ricinus Communis (Castor)
Identification of Seeds (Fig. 45.1)
Active Principle
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Croton Tiglium (Jamalgota)
Identification of Seeds (Fig. 45.2)
Active Principles
Signs and Symptoms
Treatment
Medico-legal Aspects
Abrus Precatorius (Rati, Gunchi, Jequirity)
Identification of Seeds (Fig. 45.3)
Active Principles
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Suis
Semecarpus Anacardium
Identification of Seeds (Fig. 45.4)
Active Principles
Signs and Symptoms
Postmortem Findings
Medico-legal Aspects
Capsicum Annuum
Active Principles
Signs and Symptoms
Treatment
Medico-legal Aspects
Calotropis (‘Rubber bush’)
Active Principles
Signs and Symptoms
Postmortem Findings
Medico-legal Aspects
Ergot
Active Principles
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 46:
Organic Irritants—Animal
Snakes
Nomenclature
Classification of Snakes (Diff.46.1)
Features of Common Poisonous Snakes
Signs and Symptoms of Ophitoxemia
Cobra (Diff. 46.4)
Viper (Diff. 46.4)
Sea snake
Snake venom ophthalmia
Diagnosis
Management
Prevention of Spread of Venom
Antivenom Treatment
Supportive Treatment
Postmortem Findings
Medico-legal Aspects
Cantharides (Spanish Fly)
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Scorpions
Signs and Symptoms
Treatment
Postmortem Findings
Bees and Wasps
Signs and Symptoms
Treatment
CHAPTER 47:
Somniferous Poisons (Narcotic Poisons)
Opium
Active Principles
Action
Metabolism
CLINICAL TOXIDROME
Signs and Symptoms
Differential Diagnosis
Treatment
Detection
Postmortem Findings
Medico-legal Aspects
Body Packers
Chasing the Dragon
Chronic Morphine Poisoning (Morphinism)
Fentanyl
CHAPTER 48:
Inebriants—Alcohol
Introduction
Commercial Preparations of Alcohol
Action
Metabolism
Distribution
Detoxification
Signs and Symptoms (Acute Poisoning)
Treatment
Complications
Postmortem Findings
Medico-legal Aspects
Chronic Alcoholism (Systemic Effects)
Treatment
Withdrawal Symptoms
Delirium Tremens
Causes
Signs and Symptoms11
Treatment
Medico-legal Aspects
Alcoholic Hallucinosis
Wernicke's Encephalopathy
Signs and Symptoms14
Korsakoff's Psychosis
Signs and Symptoms
Treatment
Drunkenness
Consent for Examination
Diagnosing a Case of Drunkenness
Exclusion of Injuries and Pathological Conditions
Clinical Examination
General examination
Specific physical examination
Opinion
Diagnosis of Intoxication
Medico-legal Aspects
Laboratory Investigations
Measurement of Alcohol
Collection of Samples in the Living
Postmortem Samples
Methyl Alcohol (Methanol)
Absorption and Excretion
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Isopropyl Alcohol
Signs and Symptoms
Postmortem Findings
Ethylene Glycol
Signs and Symptoms
Postmortem Findings
CHAPTER 49:
Sedative-hypnotic—Barbiturates
Signs and Symptoms
Management
History
Diagnosis
Treatment
Postmortem Findings
External
Medico-legal Aspects
Barbiturate Automatism (Self-poisoning)
CHAPTER 50:
Deliriants—Dhatura/Datura
Dhatura/Datura
Active Principles1
Action
Absorption and Excretion
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Atropa belladonna
Hyoscyamus niger
CHAPTER 51:
Deliriants—Cannabis
Signs and Symptoms
Treatment
Medico-legal Aspects
Run-amok
CHAPTER 52:
Deliriants—Cocaine
Signs and Symptoms
Treatment
Complications
Postmortem findings
Medico-legal Aspects
Cocainism (Cocainomania / Cocainophagia)
Magnan's Syndrome / Cocaine Bugs4,5
CHAPTER 53:
Spinal and Peripheral Nerve Poisons
Strychnos nux-vomica (Kuchila)
Identification of Seeds
Active Principles
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Peripheral Nerve Poisons
Curare
Signs and Symptoms
Treatment
Conium maculatum (Hemlock)
Signs and Symptoms
Treatment
CHAPTER 54:
Cardiac Poisons
Aconite
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Nicotiana Tabacum (Tobacco)
Introduction
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Digitalis Purpurea (Foxglove)
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Oleander (Kaner)
Nerium Odorum (White Oleander, Kaner)
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Cerbera Thevetia (Yellow Oleander, Pila Kaner)
Signs and Symptoms
Treatment
Postmortem Findings
Quinine
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 55:
Hydrocyanic Acid
Signs and Symptoms
Treatment
Antidotal therapy
Postmortem Findings
Medico-legal Aspects
Judicial Execution
Procedure
CHAPTER 56:
Asphyxiants
Carbon Monoxide (CO)
Properties
Sources
Action
Signs and Symptoms
Severity of CO poisoning
Differential Diagnosis
Treatment
Postmortem Findings
Medico-legal Aspects
Carbon Dioxide (CO2)
Properties
Sources
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Hydrogen Sulfide (H2S)
Properties
Sources
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 57:
War Gases and Biological Weapons
War Gases
Types of Chemical Warfare Agents (CWAs)
Asphyxiants / Lung Irritants / Choking Gases
Vesicants / Blister Gases
Symptoms
Treatment
Lacrimators / Tear Gases
Sternutators / Nasal Irritants / Vomiting Gases
Nerve Gases
Paralysants
Miscellaneous
Biological Weapons
Definitions
Types of Biological Warfare Agents
CHAPTER 58:
Agricultural Poisons
Organophosphorus Compounds (OPCs)
Classification
Action
Signs and Symptoms
Laboratory Diagnosis
Differential Diagnosis
Treatment
Complications
Postmortem Findings
Medico-legal Aspects
Chlorinated Hydrocarbons
Endrin
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Naphthalene
Action
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
Paraquat
Action
Signs and Symptoms
Treatment
Postmortem Findings
Pyrethrins and Pyrethroids
Signs and Symptoms
Treatment
CHAPTER 59:
Alphos (Aluminum Phosphide)
Signs and Symptoms
On Ingestion
On Inhalation
Laboratory Findings
Laboratory Diagnosis
Treatment (Flow chart 59.1)
Stabilization
Decontamination
Combating Shock
Correction of Acidosis
Reduction of Toxicity
Complications
Postmortem Findings
Medico-legal Aspects
CHAPTER 60:
Medicinal Poisons
Paracetamol (Acetaminophen)
Action
Signs and Symptoms
Diagnosis
Treatment
Postmortem Findings
Iron
Signs and Symptoms
Investigations
Treatment
Postmortem Findings
Antipsychotic Drugs (Tranquilizers)
Classification
Signs and Symptoms
Treatment
Antihistamines
Signs and Symptoms
Treatment
Tricyclic Antidepressants (TCAs)
Signs and Symptoms
Treatment5
Benzodiazepines (BZDs)
Signs and Symptoms
Treatment
Medico-legal aspects
Signs and Symptoms of Chronic Poisoning
Acetylsalicylic Acid (Aspirin)
Action
Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Postmortem Findings
Chloral Hydrate
Signs and Symptoms
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 61:
Drug Dependence and Date Rape Drugs
Patterns of Drug Use Disorders
DSM-IV Criteria for Diagnosis of Substance Dependence
Psychoactive Substances
Alcohol
Opioids
Cocaine
Cannabis
Barbiturates
Amphetamines
HALLUCINOGENS
Lysergic Acid Diethylamide (LSD)
Methylene-dioxy-methamphetamine (MDMA)
Inhalants
Nicotine
Complications of Drug Abuse
Postmortem Findings
Internal
Date Rape Drugs
CHAPTER 62:
Kerosene Oil Poisoning
Signs and Symptoms
On ingestion
Investigations
Treatment
Postmortem Findings
Medico-legal Aspects
CHAPTER 63:
Food Poisoning
Bacterial Food Poisoning
Treatment
Postmortem Findings
Botulism (Allantiasis)
Action
Signs and Symptoms11
Differential Diagnosis
Treatment
Postmortem Findings
Medico-legal Aspects
POISONOUS FOODS
Lathyrus Sativus (‘Kesari Dhal’)
Active Principle
Signs and Symptoms
Treatment
Mushrooms
Active Principles and Action
Signs and Symptoms
Treatment
Postmortem Findings
Argemone Mexicana (Prickly Poppy)
Active Principles
Signs and Symptoms
Food Allergy
Question Bank-II
General Toxicology
Alcohol
Rest of the Poisons
Differentiation
LQ
DESIRABLE TO KNOW
LQ
SN and Viva
INDEX
TOC
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