The Essentials of Forensic Medicine and Toxicology K.S. Narayan Reddy, O.P. Murty
INDEX
A
Abandoning of, infants, 416
Abdomen, injuries of, 253
Abduction, 80, 275
Abortion, 374
cause of death, 383
duties of practitioners in, 382
legal aspects, 374
signs of, in the dead, 379
signs of, in the living, 379
therapeutic methods, 374, 378
Abrasions, 171
Abrasion collar, 212
Abrecation, 447
Abrus precatorius, 516
Accidental injury of childhood, 417
Accident, register, 276
Acetaminophen, 587
Acetylsalicylic acid, 586
Acid phosphatase test, 406
Aconite, poisoning by, 574
Acrodynia, 506
Activated charcoal, 480
Acts of commission, 416
Acts of omission, 416
Actus reus, 459
Acute tubular necrosis, 286
Acute yellow atrophy, 513
Addiction drugs, 27, 469
Adipocere, 162
Adultery, 362, 399
Advertising, 26, 27, 599
Affective disorder, 447
Affiliation cases, 371
Age, in identification, 55
certificate, 621
criminal responsibility, 79
estimation, 620
foetus, 80
medicolegal importance, 79
Agricultural poisons, 484
AIDS, 141
Air bags, injuries, 265
Air blast, 226
Aircraft injuries, 268
Air embolism, 104
Air guns, 216
Alcohol, ethyl, 528
methyl, 468
Alcohol gaze nystagmus, 531
Alcohol and sudden death, 540
Alcoholic anonymous, 532
Alcoholic blackout, 538
Alcoholic palimpsests, 538
Aldrich-Mees lines, 503
Algolagnia, 403
Algor mortis, 145
Alkaline diuresis, 548
Alkalis, caustic, 499
Alkaloids, 515
Aluminium phosphide, 491
Amanita muscaria, 592
Amanita phalloides, 592
Amentia, 451
American law institute test, 460
Ammonia, 499
Amnesia, following head injury, 239
Amniotic fluid embolism, 383
Amphetamine, 552
Anaesthetic deaths, 353
Analgesics, 527
Analytical methods in toxicology, 608
Anaphylactic deaths, 140
Anilingus, 404
Animal bites, 96, 124
Animals in research, 604
Anoxia, 130
Anterograde amnesia, 239
Anthropometry, 82
Antidepressants, 552
Antidotes, 480
Antihistaminics, 589
Antimony, poisoning by, 511
Antipyretics, 586
Antivenin, 527
Aorta, injuries, 264
Aphasia, 447
Appendices, 595
Arborescent markings, 312
Arc eye, 309
Arcus senilis, 78
ARDS, 343
Argemone Mexicana, 592
Arrack, 528
Arrow poisons, 467
Arsenic, poisoning by, 482
Artefacts, 436
Arteries, injuries of, 257
Artificial bruise, 179
Artificial insemination, 361
Act, 362
Asphyxia, 130
Asphyxial deaths, 472
Asphyxial stigmata, 133
Asphyxiants, 576
Aspirin, 586
Assault, 280
Assisted reproductive technique, 362
Assisted suicide, 52
Asthma, death from, 141
Atavism, 372
Athello syndrome, 448
Atomic absorption spectroscopy, 223, 503
Atropa belladonna, 558
Autoerotic deaths, 351
Autolysis, 156
Automatic weapons, 201
Automatism, 462
barbiturate, 548
CO, 577
drug, 477
post-epileptic, 452
post-traumatic, 239
Autopsy, in AIDS, 115
endoscopic technique, 114
HRC recommendations, 116
laboratory procedures, 116
medicolegal, 98
negative, 136
obscure, 137
organs, examination, 105
protocol, 100
psychological, 114
radioactive corpse, 116
virtual, 114
Avulsion, 181
B
B.A.L., 481
Baby farmer, 314
Back calculations, alcohol, 535
Back spatter, 205, 210
Bacterial food poisoning, 590
Bagging, 565
Balling of shot, 208
Ballistics, 197
Ballottement, 368
Bansdola, 335
Barberio's test, 406
Barbiturate, poisoning by, 544
Barium, poisoning by, 511
Basophilic stippling, 507
Bastard, 371
Battered baby, 417
Battered wife, 398
Beating heart donor, 129
Bee and wasp stings, 526
Benzidine test, 422
Benzodiazipines, 553
Berry aneurysms, 245
Bertillon's system, 82
Bestiality, 402
Bevelling cut, 184
Billiard ball ricochet effect, 208
Bhang, 558
Biocremation, 120
Biomedical waste, 605
Biological tests for pregnancy, 369
Biological warfare, 582
Bite marks, identification, 95
Black eye, 228
Bladder, injuries, 256
Blank cartridge, 219
Blast lung, 226
Blistering gases, 580
Blood groups, 424
Blood groups, in tissues, 426
Blood stains, 420
Blood transfusion, hazards, 429
Blood vessels, injuries of, 235, 512
Blue vitriol, 509
Bobbit syndrome, 405
Body packer syndrome, 564
Body stuffer syndrome, 565
Bomb explosion, 225, 227
Bondage, 351, 352, 403
Bone pearls, 310
Bones, examination of, 121
Bones, fractures, 121, 286
Bones, growth, 69, 509
Bones, normal and abnormal, 87
Borrowed servant doctrine, 45
Botulism, 591
Boxing injuries, 268
Boyde's method, 69
Brain, contusions, 234
death, 128
fixation, 112
lacerations, 236
mechanism of injuries, 234
oedema, 241
p.m. examination,
Brain fingerprinting, 446
Brain mapping, 446
Brainstem death, 128, 129
Brainstem, injury, 241, 250
Breslau, second life test, 413
Bromides, 483, 549
Brown sugar, 545
Bruises, 174, 179, 329, 416
Brush burn, 172, 261
Buccal coitus, 384, 401
Buggery, 399
Bulbocavernous test, 358
Bullet graze, 218
Bullets, 203
crime, 222
explosive, 203
fingerprinting, 222
frangible, 219
piggyback, 218
plastic, 203
primary markings, 222
ricochet, 217
secondary markings, 222
souvenir, 219
tandem, 218
tumbling, 217
yawning, 217
Bumper injuries, 259
Burking, 341
Burns, 96, 170, 226, 500
Burtonian line, 507
Buttock traction test, 401, 624
C
Cadaveric alkaloids, 591
Cadaveric spasm, 154, 155, 185, 196, 345, 592
Cafe coronary, 340
Caffeine, 91, 469, 532, 545, 552, 562, 589
Caffey syndrome, 417
Calculated risk cases, 37
Calibre, of firearm, 209
Calotropis, 91, 179, 376, 378, 466, 467, 469, 495, 518,
Cannabis, poisoning by, 558
Cannelure, 202
Cantharides, poisoning by, 518
Capital punishment, 8, 459, 461
Capsicum annum, 517
Caput succedaneum, 409, 414, 415
Carbamates, 83, 91, 466, 484, 488, 528
Carbine, 199
Carbolic acid, poisoning by, 497
Carboluria, 497, 544
Carbon dioxide, poisoning by, 579
Carbon monoxide, poisoning, 544
Carbon tetrachloride, 468, 469, 474, 550, 565, 580, 589
Cardiac concussion, 252
Cardiac poisons, 572
Cardiac tamponade, 104, 252, 253, 283, 285
Carotid sleeper hold, 280, 336
Cartridges, 197, 200, 201, 202, 203, 206, 208, 219, 222, 223, 611
Carunculae hymenales, 367
Casper dictum, 161
Catamite, 399
Cause of death, from wounds, 282
Cellular death, 128, 144, 151
Centipedes, poisoning, 526
Cephalhaematoma, 414
Cephalic index, 56, 57
Cerbera odallam, 574
Cerbera thevetia, 378, 573, 574
Cerebral compression, 241, 244, 245, 283
Cerebral injury, mechanism, 234
Cerebral oedema, 108, 113, 128, 129, 235, 240, 243, 247, 268, 342, 370, 482, 490, 510, 539, 542, 578, 587, 614
Certificates and proformas
age, 621
death, 617
drunkenness, 626
exhumation, 616
fitness, 626
health and age, 627
impotency, female, 625
male, 625
leave, 626
postmortem, 612
rape, accused, 622
rape victim, 621
sodomy, accused, 623
wound, 619
Chain of custody, 12, 16, 19, 269
Chalcosis, 510
Charas, 559, 588
Charcoal haemoperfusion, 481, 548
Cheese-cutter method, 319, 324
Chelating agent, 480, 481, 482, 505
Chemical antidotes, 481
Chemical burns, 91, 265, 476, 499, 500
Chemical hydrolysis, 120
Chemical warfare, 581
Chest, injuries of, 253
Child sexual abuse, 397
Chilotic line, 63
Chloral hydrate, 118, 467, 469, 472, 481, 483, 528, 548, 549, 562, 568
Chlorate, 130, 151, 437, 468, 472, 474, 483, 484, 489, 588
Chlorinated compounds, 488
Chlorine, 466, 469, 514, 576, 580, 581
Chloroform, poisoning by, 469
Chlorophenoxyacetates, 489
Choke hold, 336
Choking, 339
Choking of guns, 199
Chop wounds, 170, 186, 196
Chromatography, 289, 426, 475, 536, 548, 566, 567, 579, 608, 609, 610
Chromodachryorrhoea, 486
Circumstantial evidence, 9, 477
Civil negligence, 34
Cleavage lines of Langer, 189, 190
Cleistanthus Collinus,
Clothes and ornaments, 97
Cobra, poisoning by, 519
Cocaine bugs, 561
Cocaine, poisoning by, 559, 561
Code of medical ethics, 599
Cognisable offence, 8, 595
Coitus per os, 401
Cold, death from, 295
Cold stiffening, 154
Colostrum, 368, 372
Colour markings on dead body, 151
Coma, 128, 130, 135, 148, 538
Coma cocktail, 545
Coma, diagnosis of, 544
Commando punch, 333
Common knowledge doctrine, 37
Common witness, 12, 13
Commorientes, 169
Comparison microscopes, 611
Complexion, in identity, 90
Compression of the neck, 329, 336
Computer superimposition, 86
Concealed puncture wounds, 191
Concealed sex, 57, 58
Concealment of birth, 367, 372, 416
Concussion of brain, 238
of heart, 252
of spinal cord, 251
syndrome, 239
Conditioned reflex treatment, 532
Conduct money, 9
Conium maculatum, 571
Consent in medical practice, 48
Consumer's Protection Act, 602
Contact pallor, 149
Contempt of court, 9, 33
Contrecoup injury, 235, 237, 238
Contributory negligence, 38
Contusions, 174
Contusion collar, 213
Cooling, of body after death, 145
Copper, poisoning by, 509
Corona, 205, 210, 220, 398, 622
Coroner's inquest, 7
Corporate negligence, 40
Corpus delicti, 17, 55
Corrosive poisons, 119, 473, 493, 496
Cot, or crib death, 418
Courts of law, 1, 4, 7, 32
Covering, 27, 86, 124, 140, 146, 147, 171, 194, 229, 240, 245, 305, 337, 352, 369, 373, 514
Crash helmet, 265
Creatine phosphokinase, 354, 406, 408
Crime scene, 17, 85, 395, 396, 443, 446
Criminal investigation, 442, 443
Criminal Procedure Code, 6
Criminal, responsibility in
insanity,
Criminal abortion, 18, 20, 30, 33, 39, 51, 80, 119, 126, 140, 254, 256, 286, 374, 376
Criminal negligence, 37, 39, 40, 126, 416
Criminal trial, 13, 19, 461
Crocodile flash burns, 309
Cross-examination, 2, 14, 15, 17, 436
Croton, poisoning by, 516
Crush syndrome, 286
Culpable homicide, 39, 271, 272, 275, 286, 374, 462, 465
Cunnilingus, 404
Cupping, in abortion, 377
Curare, 353, 467, 469, 520, 522, 570, 571, 594
Curren's rule, 460
Current pearls, 310
Custodial rape, 388
Custody, deaths, 279
Cutis anserina, 153, 344, 347
Cut-throat wounds, 185, 337
Cyanide, poisoning by, 130
Cyanosis, 102, 132, 133, 141, 148, 151, 283, 288, 296, 324, 326, 337, 341
Cyclists, injuries, 265
D
Danbury tremors, 505
Dactylography, 82
Dangerous injuries, 274
Dangerous lunatic, 314, 339, 454
Dangerous weapons, 275
Date rape, 387
Datura, poisoning by, 91
Deadborn child, 409
Death,
brain stem, 128
cause of, 129
Harvard criteria, 129
in custody, 279
immediate causes, 282
modes of, 130
molecular, 130
moment of, 154
remote causes, 285
somatic, 128
sudden, 252
time of, 135
Deciduous teeth, 63, 66, 67, 68, 94, 96
Declaration of Geneva, 25, 278, 599, 600
Declaration of Helsinki, 600
Declaration of Oslo, 374, 600
Declaration of Tokyo, 278, 600
Decomposition, 55, 57, 82, 88, 94, 104, 114, 117, 120, 124, 151
DDT, 480, 484, 488, 489
Defence wounds, 194
Defensive medicine, 41
Defloration, 364, 367
Deformities, 88
Deliriant poisons, 556
Delirium, 282, 447
Delirium tremens, 539, 554
Delivery, 364, 372
Delusions, 447, 448
Dementia, 451
Demulcents, 480, 498, 499, 502, 506, 511, 518, 551
Dental records, 94, 269
Depressive illnesses, 448
Dermal nitrate test, 223
Dermatoglyphics, 82
Desert syndrome, 297
Desferrioxamine, 482
Designer drugs, 543, 552, 562
Diabetes, death from, 99
Diaphragm, injuries of, 253
Diatoms, 347, 348
Diazepam, 487, 489, 517, 539, 553, 555, 559, 565, 570, 589
Dichotomy, 27, 599
Diffuse axonal injury, 129, 239, 268, 540
Digitalis, poisoning by, 572
Diminished responsibility, 450, 462
Dinitro-compounds, 484, 490
Dipsomania, 449
Discharge of mentally ill person, 457
Disciplinary control, 25
Dismembered bodies, 82
Disputed maternity, 428, 435
Disputed paternity, 357, 405, 428, 443
Disseminated intravascular coagulation, 150, 284, 286, 290, 297, 587
Divorce, 31, 57, 357, 362, 364, 371
DMPS, 482, 502, 506, 508
DNA fingerprinting, 372, 394, 429
Doctor in witness box, 16
Doctor-patient relationship, 29, 49
Documentary evidence, 9, 11
Domestic gas explosion, 227
Dowry death, 7, 8, 275, 276
Drowning, 341, 342, 343, 346, 349, 350, 416
Drug, addiction, 469, 545, 562
Drug automatism, 477
Drug, dependence, 453, 562
Drug, habituation, 562, 563
Drug idiosyncrasy, 141
Drugs, hard, soft, 568
Drunkenness, 50, 240, 296, 343, 463, 533, 625, 626
Dry drowning, 342
Dry lung drowning, 346
Dry wine, 548
Duration of pregnancy, 373
Duret haemorrhages, 241
Durham rule, 460
Duties,
at scene of crime, 17
in criminal abortion, 382
in criminal matters, 33
in suspected poison, 477
in witness box, 16
of patients, 33
of physician, 597, 599
Dying declaration, 10, 11, 382, 478
Dying deposition, 11
E
Ear prints, 85
Ecbolics, 376, 517
Economy class syndrome, 287
Ecotoxicology, 467
Ecstasy, 555
EDTA, 395, 433, 440, 476, 482, 505, 508, 509, 542, 573
Effacement, of identity, 120
Electric burns, 309
Electric mark, 308
Electrophoresis, 610
Emasculation, 273
Embalming, 164
Embolism,
air, 104
amniotic fluid, 383
fat, 287
Emetics, 479
Emmenagogues, 376
Empathy, 448
Emphysema aquosum, 345
Emprosthotonus, 570
Emptying of stomach, 167
Encephalitis lead,
Endrin, 488
Entomology of cadaver, 167
Environmental suffocation, 336
Eonism, 404
Epidemic dropsy, 592
Epilepsy, death from, 141
Epileptic automatism, 462
Epileptic psychosis, 452
Epiphyses, union with shafts, 70
Erasure of name, 26
Ergot, 517
Erotomania, 448
Eruption of teeth, 67
Ether, poisoning by, 542
Ethical negligence, 42
Ethylene glycol, 542
Eunuch, 399
Euthanasia, 52
Evidence, collection, 19
Evidence, preservation, 19
Ewing's postulates, 293
Examination-in-chief, 13
Excited delirium, 282
Exhibitionism, 404
Exhumation, 126
proforma, 616
Exit wound, of bullet, 209
of shotgun, 208
Expert witness, 12
Extradural haemorrhage, 242
Eye, changes following death, 145
m.l. importance, 94
F
Fabricated wounds, 196
Face, injuries of, 243
Fall from height, 256
Falls, 256
False virgin, 366
Fat embolism, 287
Fecundation ab extra, 360
Feeble mindedness, 451
Feigned mental insanity, 454
Fellatio, 404
Female genital organs, injuries, 256
mutilation, 402
Fetichism, 403
Filicide, 409
Filigree burns, 312
Fingerprints, 84
Firearm wounds, 204
First-hand knowledge rule, 12
Fish, poisoning by, 593
Fishtailing, 189
Flash burns, 226, 300
Flashback phenomenon, 555
Floatation of body, 351
Florence test, 406
Fluidity of blood, postmortem, 108
Fluorides, 490
Fodere's test, 411
Foetal heart sounds, 369
Foeticide, 409
Foetus age estimation, 80
Foetus, compressus, 371
development of, 80
heart sounds, 369
ossific centres in, 81
papyraceus, 371
Follidol, 484
Food allergy, 591
Food poisoning, 590
Foot prints, 185
Forensic ballistics, 197
Forensic medicine, definition of, 1
Forensic odontology, 94
Forensic pathology, 1
Forensic psychiatry, 447
Forensic science laboratory, 615
Formaldehyde, 589
Formic acid, 498
Formulae for stature, 606
Fouling, 212
Fractures, 229
Friction burn, 172
Frigidity, 357
Frost bite, 295
Frotteurism, 405
Fugue, 448
Full term child, 81
Functional psychoses, 452
G
Gagging, 338
Ganja, 558
Garrotting, 336
Gastric lavage, 478, 479, 489
Gauge, of firearms, 198
Gay clubs, 401
Gerontophilia, 399
Gettler test, 349
Glass blower's shakes, 505
Glass, powder, 480
Glossory of legal terms, 595
Goose skin, 153, 344, 563
Graze, 172, 218
Grease or dirt collar, 212
Grenade, 201
Grievous hurt, 273, 275
Group specific substances, 426
Growth in bones, 69
Gunpowder, 201, 207
Gustafson's method, 67
H
Haase, rule of, 82
Haemin crystal test, 422
Haemochromogen test, 423
Haemodialysis, 483, 586
Haemoglobins, abnormal, 427
Haemorrhage, 439
Hair, 55, 91
Hallucinations, 448
Hallucinogenic drugs, 357, 554
Hanging, 315, 316
Hangman's fracture, 324
Hangover, 531, 568
Haptoglobulins, 427
Harakiri, 193
Harrison Gilroy test, 223
Hashish, 558
Hatter's shakes, 505
Head, examination of, 115
injuries to, 228
Hearsay evidence, 9
Heart, dissection, 111
Heart, injuries, 294
Heat cramps, 296
Heat exhaustion, 296
Heat haematoma, 296, 302
Heat hyperpyrexia, 296, 544
Heat prostration, 296
Heat ruptures, 300, 438
Heat stiffening, 154
Heat stroke, 296, 297
Hegar's sign, 368
Hemlock, 571
Henry's law, 536
Hermaphroditism, 58
Heroin, 545
Hesitation cuts, 185
Hide-and-die syndrome, 296
Hijrah, 399
Hippocratic oath, 25
Hippus, 575
Hit and run, 267
HIV, 141
HLA, 427
Hog-tying, 280
Holograph will, 458
Homicide, culpable, 271
excusable, 271
justifiable, 271
Homosexuality, 399
Hostile witness, 13
Hot shot, 563
Household poisons, 468
Huffing, 565
Human experimentation, 600
Human organs, transplantation Act, 603
Human Rights Act, 604
Humane killers, 201
Hurt, 273
Hydrocarbons, 549
Hydrochloric acid, 495
Hydrocyanic acid, 582
Hydrogen sulphide, 579
Hydrostatic lung, 347
Hydrostatic test, 411, 412
Hymen, 391, 365
Hyoid bone, fractures, 72, 322, 441
Hyperthermic anhydrosis, 297
Hyperventilation deaths, 350
Hypnotism, 462
Hypostasis, P.M., 147, 148
Hypothermia, 91, 144, 147, 148, 150, 295
I
Iatrogenic diseases, 53
Icthyosarcotoxic, 593
Identification, data, 57
Idiocy, 451
Idiomuscular contraction, 130
Illusion, 449
Imbeciles, 328
Immediate restraint, 455
Immersion foot, 295
Immersion syndrome, 342
Immunoassay methods, 610
Immunological tests, for blood, 369
for pregnancy, 369
Impotence and sterility, 357
in female, 359
in male, 358
Impulses, 449
IMC regulations, 25
In camera, 386, 596
Incendiary bombs, 227
Incest, 398
Incised wounds, 183
Incised-like wounds, 180
Incremental lines, 67
Indecent assault, 398
Indian Evidence Act, 6
Indian Medical Degrees Act, 23
Indian Penal Code, 6
Inebriant poisons, 528
Infamous conduct, 26
Infanticide, 409
Infantile whiplash syndrome, 417
Inflow-outflow method, 106
Informed consent, 49
Inhibition of heart, 139
Injury, 271
Inquest, 6
Insanity, 447
certification, 454
civil responsibility, 457
classification, 451
criminal responsibility, 459
diagnosis, 454
diminished responsibility, 462
feigned, 454
murder in, 460
Insecticides, poisoning by, 484
Instantaneous physiological death, 139
Instantaneous rigor, 154
Insulin, 587
Intelligence quotient, 451
Intermittent uterine contractions, 368
International Code of Medical Ethics, 599
Intersexuality, 358
Intestines, injuries of, 109, 254
Intracerebral haemorrhage, 247
Intracranial haemorrhage, 242
Intraventricular haemorrhage, 247
Iodides, poisoning by, 514
Iris, in identification, 85
Iron, poisoning by, 510
Irresistible impulse test, 460
Irritant mechanical poisons, 552
Ischio-pubic index, 61, 63
Isopropanol, 542
Istanbul protocol, 279
J
Jaw, age changes in, 66, 67
Joints, injuries of, 259
Joule burn, 308
Judicial, electrocution, 311
execution, 585
hanging, 323
procedure of state council, 25
punishment, 79
Jury, 7
Juvenile, 79
K
Karate blow, 333
Kastle-Meyer test, 422
Kennedy phenomenon, 219
Kerosene, poisoning by, 118, 480
Kernohan's notch, 241
Kesari dhal, 591
Kidnapping, 80
Kidneys, injuries of, 255
Kleptomania, 449
Klinefelter's syndrome, 57
Knockout drops, 549
Knot, in hanging, 315
Korsakov's psychosis, 452
Kozelka and Hine test, 536
Krait, poisoning by, 519
Kronlein shot, 221
L
Lacerated wounds, 89, 91, 180, 197, 204, 256
Lachrymators, 581
Ladder tears, 264
Laryngeal oedema, 304
Lathyrus sativus, 591
Laughing gas, 580
Le facie sympathique, 321
Lead encephalopathy, 507
Lead line, 507
Lead palsy, 507
Lead, poisoning by, 506
Leading question, 14
Legal procedure, 6
Legal test, 459
Legitimacy, 362, 371
Lesbianism, 401
Leucomaines, 591
Lie detector, 445
Ligature mark, hanging, 317
strangulation, 324
Lightning, death from, 312
Linea nigra, 368
Lip prints, 85
Liquid gold, 553
Livebirth, signs, 410
Liver, injuries of, 254
Livor mortis, 147
Local anaesthesia, 355
Locard's principle of exchange, 443
Lochia, 372
Loco parentis, 51
Love philter, 466, 557
LSD, 554
Lucid interval, 243, 449
Lung irritants, 580
Lungs, wounds of, 252
Lust murder, 403
Lynching, 323
M
Maceration of foetus, 409
Magistrates, 7
Magistrate's inquest, 7
Maggots, 158
Magnan symptom, 561
Majoon, 558
Male genital organs, injuries, 256
Male prostitutes, 401
Male sexual assault, 402
Malignant hyperpyrexia, 354
Malingering, 53
Malpractice litigation, 42
Malpraxis, 34
Mandrax, 548
Manganese, 510
Mania, 449, 452
Manic-depressive psychosis, 453
Manual strangulation, 329
Marbling, 157
Marihuana, 552
Marital rape, 387
Marking nut, 517
Masochism, 403
Masquerades, M.L, 17
Mass disasters, 269
Masturbation, 404
Mc Ewan sign, 531
Mc Naughten rule, 459
MCI regulations regarding medical records, 49
Mechanical antidote, 480
Mechanical asphyxia, 315
Mechanical explosion, 227
Mechanical injuries, 170
Meconium, 413
Medical certificates, 9
Medical certification of death, 10
Medical councils, 24
Medical education, 23
Medical ethics, 1
Medical etiquette, 1
Medical evidence, 9
Medical examiner's system, 7
Medical indemnity insurance, 47
Medical jurisprudence, 1
Medical maloccurrence, 37
Medical negligence, 35, 43
Medical records, 47
Medical register, 24, 25
Medical Termination of
Pregnancy Act, 374
Medicolegal autopsy, 98
Medicolegal cases, 20
Medicolegal reports, 10
Medullary index, of bones, 63
of hair, 91
Melancholia, 453
Mens rea, 459
Mental Health Act, 454
Mental retardation, 451
Meperidine, 546
Mercurial erethism, 505
Mercurialentis, 505
Mercury, poisoning by, 504, 507
Metal fume fever, 511
Metallic fouling, 222
Methadone, 546
Methaemoglobinaemia, 588
Methane, 580
Methaquolone, 548
Methyl alcohol, 540
Methyl isocyanate, 580
Mickey finn, 549
Microscopes, 611
Micturition syncope, 531
Miniature batteries, 499
Modes of death, 130
Molecular death, 130
Moles, 88
Molotov cocktail, 227
Moment of death, 128
Mongolian spots, 88
Monoamine oxidase inhibitors, 553
Morning sickness, 368
Morphine, 543
Motorcyclist's fracture, 265, 266
Mugging, 336
Multidose activated charcoal, 480
Mummification, 163
Munchausen's syndrome, 418
Munich beer heart, 531
Murder, 271
Muscular rigidity, p.m. due to gases, 168
Mushrooms, 592
Musket, 199
Mutilated bodies, 120
Mutilomania, 449
Mutism, 451
Muzzle-loading gun, 222
Mydriatic test, 558
Myiasis, 167
Myocardial infarction, 138, 293
Mycotoxicosis, 591
N
Naphthalene, 551
Narcoanalysis, 445
Narcotic and Psychotropic
Drugs Act, 465
Nasal irritants, 581
Near-drowning, 341
Neck, injuries, 139
Necrophagia, 403
Necrophilia, 403
Negative autopsy, 136
Negligence, precautions, 41, 45
Negligence, prevention, 41,
Neonatal cold injury, 296
Neonaticide, 409
Nerium odorum, 573
Nerve gases, 581
Nerves, injuries, 257
Neurasthenia, 451
Neurogenic failure, 283
Neuroleptics, 553
Neuroses, 451, 453
Neutron activation analysis, 610
Nickel, 511
Nicotiana tabacum, 572
Nitrates, 588
Nitric acid, 495
Nitrous oxide, 576, 580, 581
Nobbing fractures, 418
Non-accidental injury of childhood, 417
Noose, 317
Novus actus interveniens, 38
Nullity of marriage, 362, 364
Nux vomica, 569
Nymphomania, 402
Nystagmus, alcohol gaze, 531
O
Oath, 13
Obliteration of identity, 120
Obscure autopsy, 137
Obsession, 449
Occupant ejection, 264
Occupants of vehicles, injuries, 262
Occupation marks, 90
Odontology, 94
Oedema aquosum, 345
Oedipus complex, 405
Oesophagus, injuries, 253, 499
Offensive manual injuries, 195
Oleanders, 573
Oligophrenia, 484
Oneiroid state, 449
Oochronosis, 497
Operation deaths, 353
Ophitoxaemia, 522
Opisthotonus, 570
Opium, poisoning by, 544
Oral evidence, 11
Organochlorines, 488
Organophosphates, 487
Ossific centres of skeleton, 78
in foetus, 84
Osteometric board, 123
Overkill homicide, 193
Overlaying, 338
Oxalic acid, poisoning by 495, 496
Oximes, 487
P
Paederasty, 399
Palatoprints, 85
Palmar strangulation, 334
Paltauf's haemorrhages, 345
Pancreas, injuries, 254
Paracetamol, 587
Paradox gun, 199
Paradoxical undressing, 296
Paraffin test, 223
Paraldehyde, 549
Paralysants, 581
Paranoia, 539
Paraphilias, 402
Paraquat, poisoning by 489
Parasuicide, 471
Partial hanging, 315
Pascal's law, 255
Paternalism, 49
Paternity, 426
Pearson's formulae, 123
Pedestrians, injuries to 259
Pedophile, 399
Penal erasure, 26
Penal provisions and medical practice, 53
Penicillamine, 482
Peripheral nerve poisons, 571
Peritoneal dialysis, 483
Perjury, 13
Personality disorders, 453
Petechial haemorrhages, 131
Pethidine, 546
Pharmacological antidotes, 481
Pharmacy Act, 465
Phencyclidine, 553
Phenol, poisoning by, 497
Phenolphthalein test, 422
Phobia, 449
Phosphorus, poisoning by, 512
Phossy jaw, 513
Physical antidotes, 480
Physical evidence, 443
Physician-patient relationship, 33
Physiological antidotes, 481
Phytotoxin, 515
Piggyback bullet, 218
Pink disease, 506
Pink teeth, 94
Pistols, wounds from, 209
Plant toxins, 515
Plasma specific gravity test, 349
Play piercing, 405
Pleurosthotonus, 570
Ploucquet's test, 411
Plumbago rosea, 518
Plumbism, 506
Pneumothorax, 104
Point blank range, 211
Poisons, Acts, 464
action of, 470
analysis, 475
classification, 467
criminal offences, 469
conditions modifying, 470
diagnosis, in the dead, 471
diagnosis, in the living, 471
duties of doctors, 477
elimination, 470
environmental, 466
epidemiology, 466
failure to detect, 476
false positive, 476
fate in body, 469
household, 468
ideal, homicidal, 467
ideal, suicidal, 467
information centres, 467
occupational, 466
prevention, 467
routes of administration, 469
treatment, 478
types, 471
Police inquest, 6
Polygraph, 445
Poppy capsules, 543
Poroscopy, 83
Positional asphyxia, 130
Postepileptic insanity, 485
Postmortem, caloricity, 147
changes, 144
examination, 98
hanging, 323
interval, 167
lividity, 151
purge, 158
Posthumous child, 370
Post-traumatic automatism, 239
Postural asphyxia, 131
Potassium permanganate, 510
Powdered glass, 514
Power piston, 202
Pralidoxime, 487
Precipitate labour, 415
Precipitin test, for blood, 423
Pregnancy, diagnosis of, 367
biological tests, 369
immunological tests, 369
length of, 379
ml. importance, 392
Prenatal Diagnostic
Techniques Act, 604
Preservation, m.l evidence, 19
Preservation of viscera, 117
Presumption of death, 169
of survivorship, 169
Preternatural combustion, 307
Primary flaccidity, 151
Primary impact injuries, 259
Primary markings, on bullets, 222
Primary shock, 283
Primers, 202
Privileged communications, 32
Privileges of
medical practitioners, 27
patients, 33
Products liability, 46
Professional, death sentence, 26
misconduct, 26
negligence, 34
secrecy, 31
Prostate specific antigen, 406
Pseudocyesis, 371
Pseudostrangulation, 325
Psychedelics, 554
Psychological autopsy, 114
Psychopath, 450
Psychoses, 450
Psychotropic drugs, 552
Ptomaine poisoning, 591
Puberty, changes at, 78
Pugilistic attitude, 300
Punchdrunk, 268
Punctate basophilia, 507
Punctured wounds, 187
Punishments, 8
Puppe's rule, 213
Putrefaction, 161
in water, 161
Pyrethrins, 490
Pyromania, 405, 449
Q
Quickening, 368
Quoad hoc, 359
R
Race, in identification, 85
Radioactive carbon, 169
Radiology in identification, 43, 79, 567
Radio-opaque poisons, 567
Railway injuries, 268
Railway spine, 251
Raindrop pigmentation, 503
Rape, 384
accused, exam, 388
crisis centres, 396
date rape, 387
deflorate woman, 393
marital, 387
medicolegal questions, 396
on a child, 394
on a virgin, 391
statutory, 387
trauma syndrome, 396
victim, exam, 388
Raygat's test, 411
Reaction phenomenon, 345
Reception order in lunacy, 456
Reciprocal undressing, 296
Recoil abrasion, 205
Record of evidence, 13
Red cell, enzyme polymorphisms, 428
Red cross emblem, 28
Reefer, 558
Re-examination, 15
Refrigerated bodies, 150, 437
Regional injuries, 228
Religion in identification, 57
Res indicata, 44
Res ipsa loquitur, 37, 43
Res judicata, 44, 596
Respirator brain, 241
Respirator lung, 99
Respondeat superior, 45
Restraint of the mentally ill person, 455
Retina, in identification, 85
Revolver, wounds from, 200, 209
Reye's syndrome, 586
Rh system, 425
Rib, fractures, 251
Ricinus communis, 515
Ricochet of bullets, 217
Rifle, wounds, 216
Rifled slugs, 202
Rifling, 198
Rights, of medical practitioners, 27
of patients, 34
Rigor mortis, 151
Risus sardonicus, 570
Road poison, 557
Rockets, 201
Rolling injuries, 261
Rule of nines, 298
Run amok, 559
Run over injuries, 267
Ryle's tube, 479
S
Sadism, 402
Salicylic acid, 586
Saponification, 162
Saturday night paralysis, 538
Saturnism, 506
Satyriasis, 358
Scalds, 306
Scalp, wounds, 242
Scandinavian method, 547
Scars, 88
Scene of crime, visit to, 219
Sciatic notch index, 61
Schizophrenia, 451, 452, 453
Scoptophilia, 404
Scorpion, poisoning, 526
Scratch, 172
Scuba diving, 350
Sea snakebite, 523
Seat belt injuries, 264
Second autopsy, 127
Second collision, 279
Secondary drowning, 342
Secondary flaccidity, 151
Secondary impact injuries, 259
Secondary markings, 222
Secondary sex characters, 78
Secondary shock, 283
Secretors, 426
Self-inflicted wounds, 184
Semecarpus anacardium, 517
Seminal fluid, 394, 395, 405
Serious professional, 26
misconduct, 24, 25
Serum protein polymorphism, 427
Sessions trial, 20
Sewer gas, 580
Sex chromatin, 57
Sex, in identification, 57
differences in skeleton, 63
Sexual asphyxias, 351
Sexual assault, 402
Sexual dysfunction, 357
Sexual harassment, 385, 398
Sexual offences, 384, 621
proforma, 621
Sexual oralism, 404
Sexual perversions, 402
Shear strain, 236
Shock, 283, 284
Shock lung, 285
Shored exit wound, 215
Shotguns, wounding by, 204
Signs of death, 144
Simple injury, 275
Sin of Gomorrah, 401
Skeleton, sexual characters, 60
Skeletonisation, 162
Skin, changes after death, 145
Skull, age and sutures, 88
firearms wounds, 224
identification of sex from, 61
thermal fractures, 302
types of fractures, 244
Slippery elm bark, 378
Smegma, 398
Smothering, 337
Snake venom, 520
Snakes, 519
Sniffing, 565
Sodomy, 399, 622, 623
Solvent abuse, 565
Somatic death, 128
Somnambulism, 462
Somnolentia, 462
Souvenir bullet, 219
Spalding's sign, 369, 370
Spark burns, 309
Sparrow foot marks, 263
Spectrophotometry, 608, 609
Spectroscopic exam, of blood, 423
Speedball, 545, 560
Spermatozoa, human, 407
Spiders, 527
Spinal, anaesthesia, 356
Spinal cord, concussion of, 250, 251
injuries of, 250
p.m. exam, 119
Spinal poisons, 569
Spleen, injuries, 272
Spontaneous combustion, 307
Stab wounds, 196
Stack's method, 69
Stalking, 386
Starvation, 313
State Medical Council, 24
Static test for respiration, 439
Stature, assessment of, 82
Statutory rape, 387
Steering-wheel impact injury, 268
Sterilisation, 361
Sternutators, 581
Stillbirth, 409
Stomach, 113
contents, examination of, 108
in estimation of time, 176
of death, 176
in poisoning, 508
injuries, 254
tube, use of in poisoning, 514
Stomach-bowel test, 413
Stomping, 176
Strangulation, 416
Strychnine, poisoning by, 570
Stud gun, 201
Subarachnoid haemorrhage, 245, 294
Subdural haemorrhage, 243, 244, 245
Subendocardial haemorrhages, 108
Subpoena, 8, 596
Sudden death, after violent
struggle, 280
Sudden death, cause of, 142, 280
Sudden infant death syndrome, 418
Suffocation, 336, 415
Suicide, 193, 196, 306
Suicide, abetment, 272
Suis, 517
Sulphur dioxide, 580
Sulphonamide, 472, 588
Sulphuric acid, 493
Summons, 8, 596
Sunstroke, 296
Superfecundation, 370
Superfoetation, 371
Superimposition, skull-photo, 86
Supposititious children, 372
Suprarenal haemorrhage, 290
Surrogate motherhood, 363
Survivorship, 169
Suspended animation, 144
Swallow tails, 182
Symphysis pubis, 71
Syncope, 135, 531
Syringing in abortion, 381
T
Tache noir, 145
Tail-gating, 264, 266
Takayama test, 423
Tandem bullet, 218
Tandem cartridge, 219
Taphonomy, 144
Tardieu spots, 134
Tattoo marks, 89
Tear gases, 581
Teeth, 63
charting, 95
eruption of, 67
identification by means, 94
Teichmann's test, 422
Temporal bone haemorrhages, 347
Tentative cuts, 184
Test tube babies, 362
Testamentary capacity, 458
Thallium, poisoning by, 510
Thanatology, 128
Therapeutic index, 476
Therapeutic misadventure, 44
Therapeutic privilege, 49
Therapeutic wounds, 197
Thermal deaths, 295
Thermal fractures, skull, 302
Thrombosis, 287
Throttling, 329
Tik 20, 484
Time since death, 121
Tissue bridges, 182
Tobacco, 572
Torture, 278
Tower of silence, 169
Toxalbumen, 515
Toxicologic radiology, 567
Toxicology, definition, 464
Trace evidence, 443
Traffic accidents, 259
Trafficking of person, 386
Tranquilisers, 553
Transplantation of Human Organs Act, 603
Transsexualists, 404
Transvestism, 404
Trauma, 246
Trauma and disease, 293
Trauma and myocardial infarction, 293
Traumatic asphyxia, 340
Trench foot, 295
Triage, 265
Tribadism, 401
Trichology, 91
Troilism, 405
Trotter and Glesser's formulae, 606
Truth serum drugs, 445
Turkey skin, 566
Turner's syndrome, 58
Turpentine, 550
Twilight state, 452
Typical drowning, 342
U
Ultrasonography, 369
Umbilical cord, changes in, 414
Under the influence, 537
Underrunning, 266
Undertaker's fracture, 105
Undinism, 405
Unethical acts, 599
Unintentional cuts, 184
Universal antidote, 481
Unnatural offences, 399
Uranism, 402
Uterine souffle, 369
V
Vacuum aspiration, 378, 379
Vagal inhibition, 135
Vaginismus, 360
Vagitus, uterinus, 412
vaginalis, 412
Vegetative state, 129
Vehicle occupants, injuries, 262
Veins, injuries, 257
Venomous fish, 594
Verdigris, 509
Vernix caseosa, 414
Vertebral column, examination, 113
fractures of, 250
Vesicants, 580
Viability, of foetus, 410
Vicarious liability, 45
Video superimposition, 86
Viper bites, 525
Virginity, signs of, 367
Virtopsy, 114
Virtual autopsy, 114
Viscera, preservation, 584
Vitreous humour, 168
Vitriol throwing, 494
Volatile substance abuse, 565
Volunteering of information, 17
Voyeurism, 385, 404
W
Wad, 222
War gases, poisoning by, 580
Warning notice, 26
Warrant cases, 19
Washerwoman's hands, 345
Water intoxication, 587
Wax drippings, 310
Weed killers, 468, 484, 489, 490, 501
Weights and measures, 627
of organs in adults, 627
Whiplash injury, 250, 263, 265
White cell antigens, 427
Whole bowel irrigation, 482
Widmark's formula, 535
Wife battering, 398
Witness box, 16
Witnesses and evidence, 9
Word association, 446
Workmen's Compensation Act, 601
Wounds, 90, 170
abrasions, 171
accident, suicide or murder, 195, 196
antemortem or postmortem, 290
cause of death in, 282
certificate, 619
chop, 186
contusions, 174
defence, 194
fabricated, 196
firearms, 204
healing, 291
histochemical changes, 290
incised, 183
lacerated, 180
offensive, 195
medicolegal aspects, 271
self-inflicted, 196
stab, 187
therapeutic, 197
Wredin's test, 413
X
Xanthoproteic reaction, 495
Xenograft, 129
X-ray
of bones in identification, 88
of gunshot, 216
in diagnosis of pregnancy, 367
Y
Yawning bullet, 217
Yellow oleander, 119, 476, 573
Yellow phosphorus, 468, 474, 475
Z
Zasko's phenomenon, 130
Zenana, 399
Zinc phosphide, 492
Zip gun, 201
×
Chapter Notes

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1FORENSIC MEDICINE

INTRODUCTIONCHAPTER 1

There are two distinct aspects of law–medicine relationship: (1) Forensic medicine, and (2) Medical jurisprudence. They are essentially different subjects, but are closely related.
Forensic or legal medicine (forensic = forums of or used in Courts of law) deals with the application of medical and paramedical knowledge to aid in the administration of justice. It is used by the legal authorities for the solution of legal problems. Some examples are: Applying the medical knowledge in deciding cases of injuries, murder, suicide, accidents, sexual offences, poisoning, etc. In short, it deals with medical aspects of law.
Medical jurisprudence (juris = law; prudentia = knowledge) deals with legal responsibilities of the physician with particular reference to those arising from physician–patient relationship, such as medical negligence cases, consent, rights and duties of doctors, serious professional misconduct, medical ethics, etc. In short, it deals with legal aspects of practice of medicine.
Forensic pathology deals with the study and application of the effects of violence or unnatural disease in its various forms in or on the human body, in determining the cause and manner of death in case of violence, suspicious, unexplained, unexpected, sudden and medically unattended deaths.
Medical ethics deals with the moral principles which should guide members of the medical profession in their dealings with each other, their patients and the State.
Medical etiquette deals with the conventional laws of courtesy observed between members of the medical profession. A doctor should behave with his colleagues as he would have them behave with himself.
Ethical behaviour is a self-imposed duty upon each doctor. A doctor should not criticise or denigrate the professional ability of another doctor, while dealing with a patient.
Forensic medicine deals almost entirely with crimes against human beings, in which medical examination and evidence are required. Forensic medicine is mostly an exercise of common sense, combined with the application of knowledge and experience, already acquired in the study of other branches of medicine, surgery, obstetrics, etc. Its aim is to find out the truth. Its particular field of activity is judicial investigation, both civil and criminal. All medical work is of a responsible character, especially the medicolegal work, such as issuing certificates of lunacy, ill-health, etc. In all cases of crime involving the person, e.g. homicide, suicide, assault, sexual offences, traffic accidents, poisoning, etc., the help of the medical practitioner is sought by the police. In all such cases, the doctor will be required to appear as an expert witness in a Court of law. In some cases, the doctor is the chief source of evidence upon which legal decisions are made. In cases of sudden death, the authorities will depend mostly or completely on medical evidence in establishing the cause of death, and in case of accident to determine blame.
A doctor may be called to testify (1) as an ordinary witness who saw an incident, (2) as the medical practitioner who treated the patient, (3) as an expert to give his opinion on matter of science. In the first two conditions, it is his duty and obligation to testify. In the last condition, he may refuse the request: (1) if he feels reluctant to undergo what he fears will be a painful experience, (2) if he feels that he is not sufficiently qualified to testify with any conviction in that particular case, and (3) if he feels that he cannot spare the time to prepare properly or to make long appearances in Court. A properly prepared physician often finds his Court room experience educative and not as traumatic as he would have anticipated. His introduction to the legal process may be unpleasant, if he is irritated by an aggressive prosecuting or defence lawyer. The reluctance of medical practitioners to become witnesses is mainly due to the pressures of their private practice. Other factors include a fear of merciless cross-examination, harassment, and even the recall.
A doctor should not become partisan. Once a theory is embraced, it is only human nature to eagerly search for facts which support that theory, and reject those which indicate some other theory. Brouardel, the French medicolegal authority wrote, “if the law has made you (the physician) witness, remain a man of science; you have no victim to avenge, no guilty person to convict, and no innocent person to save. You must bear testimony within the limits of science”. All forensic science expert witnesses must strive to achieve respect, understanding and credibility in Court. They must give the appearance, the aura of being independent, non-partisan witnesses. The appearance and projected image of neutrality, impartiality and objectivity are as important as the authentic characteristics. Demeanour, appearance, professional manner and general behaviour of the expert witness are almost equal in importance to forensic ability during testimony. The attitude of a scientific witness should be the same whether he is called by the prosecution or by the defence. The doctor really testifies neither for nor against the prosecution or the defence. The doctor's expertise is in the application of science to a legal controversy and the proper interpretation of scientific findings. The doctor must be honest, for confidence is inspired by honesty and success depends upon confidence. His sole obligation is to present the truth as he sees it, adding nothing, withholding nothing and distorting nothing. He should not concern himself with the previous character of the accused or with other evidence in the case. He should not be influenced in any way by emotional consideration, such as sympathy or antipathy.
The medicolegal aspects of any case must always be secondary to life saving treatment of the patient. It is advisable that the doctor should learn to look from the medicolegal standpoint upon such of his cases as are likely to become the subject matter of judicial investigation. He should acquire the habit of making a careful note of all the facts observed by him. Alan Moritz statedIf evidence has been properly gathered and preserved, a mistake in interpretation may always be corrected. If the facts required for a correct interpretation are not preserved, the mistake is irreversible”. He should examine the facts which come to his knowledge in his special capacity, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and indicate to the Court that interpretation, along with the grounds on which it is based. Vagueness and theory have no place in forensic medicine. Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on his witness for an opinion and expects him to assist it with his special knowledge and experience. The burden of presenting medical facts and medical opinions in the best possible way rests on the doctor. Forensic pathologist testifies on so-called “fact issues”, such as cause and manner of death, rather than “ultimate issue” of guilt or innocence, so that opinion based upon reasonable medical certainty is adequate to support the testimony of the forensic pathologist. Medical evidence is not a substantive evidence, but is a corroborative evidence. The medical evidence does not itself prove the case of prosecution. Other things being equal, the better the presentation of medical evidence, the better is the administration of justice. A good command of language, clear presentation, and ability in expressing a relatively firm opinion are necessary for the success of the medical witness. The presentation of findings involves both writing skills and an ability to express in the courtroom while being examined by trained lawyers. The doctor should avoid talking too much, talking too soon, and talking to the wrong persons. Prejudicial and sensational statements should not be made prior to trial. The pathologist should never overlook an opportunity to remain silent. The doctor must be guarded in what he says and how he says it.
The medicolegal expert is not a detective. He may use his knowledge and intelligence to help the police to solve a crime. His role should be to furnish the police with specific information on matters of 3which he has specialised knowledge. Because of his special knowledge, a non-medical clue may have a significance to him, which even an experienced police officer has not grasped. The medical expert should be very careful when he is examining living people. He should not encourage an accused person to talk about the crime with which he is charged, or about the events that led to his arrest. If, during a medical examination, an accused says anything that might incriminate himself, it should be neither recorded nor reported. However, occasions may arise when a doctor may use an admission to direct the police to certain lines of inquiry and action without actually disclosing what has been said.
Three things are needed for success : (1) the power of observation, (2) a wide range of exact knowledge, (3) the power of deduction. The power of constructive imagination is also essential when there are no more facts to be observed, and no further inferences to be drawn. There is no substitute for basic intelligence and clinical competence. Experience, common sense, and willingness to consider other possibilities are as essential in the practice of forensic medicine as a wide range of theoretical knowledge. The attributes of the physician are : (1) caution, (2) foresight, and (3) wisdom.
The doctor should develop a fair understanding, satisfactory appraisal and high index of awareness of the medical, philosophical and legal problems related to the determination of the manner of death. He should be thoroughly familiar with the problems of causality and manner of death. He should realise that total complications of extraneous injuries do not change the manner of death from unnatural to natural, e.g., the victim of a homicidal attack dying with peritonitis following abdominal injuries and surgery should be certified as homicide victim and not as surgical complications. The doctor must be alert to where evidence should be looked for, and how it should be interpreted. His failure may make the difference between life and death or between freedom and imprisonment of a suspected person. It may deprive a widow of compensation to which she is entitled, may cause an innocent person to be prosecuted or punished, may permit a murderer to escape punishment, or may cause some person or institution to be held financially liable to damages for which they were not responsible.
William Osler wrote : “Medicine is a science of uncertainty and an art of probability. Absolute diagnoses are unsafe and are made at expense of the conscience”. Medicine is a biological science with the variability inherent in biological matters. Forensic medicine is not an exact science. Unexpected results are produced due to biological variations. One thing that makes medicine so difficult is that there is no such thing as the average man. We can only say the reading is 'within the range of normal”. The most extraordinary events occur in medicolegal practice, and a careful evaluation must always be made to ensure that dogmatic statements by medical witnesses do not mislead the investigating officers. In every case, there is an element of uncertainty, and absolute proof is a rarity in any medical problem. There is always a possibility for a difference of opinion among the doctors. No possibility is wholly excluded in medical experience. Doctors should bear in mind the essential difference between probability and proof. The medical witness should not be dogmatic about his opinion, and also lawyers should not expect him to be so. They should be reasonable in their opinions and should not overstate the likelihood of a relationship between cause and effect. The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds. The doctor should put before the court all the materials which are the basis of his conclusions. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved. Forensic pathologists have an ethical obligation to contribute to further knowledge, research and education in their field. For the purpose of illustrating and clarifying his testimony, the medical expert may employ photographs, maps, diagrams, charts, X-rays, skeletons, models, slides, films, tapes, etc., when they are properly verified.
Medicolegal practice requires knowledge, skills and attitudes. The skills needed are: (1) Clinical : the ability to elicit a history, to examine for injuries and to perform the appropriate investigations. (2) Precision in recording the findings. (3) The ability to present the findings in a clear, concise, correct and meaningful manner. (4) Attitudes : (a) Proper respect to the patient. (b) Maintain objectivity in recording the findings.4
Forensic medicine can be mastered only by an extensive practical experience acquired by an application and study of medicolegal problems. Courts of law are open to the public. Medical students and newly qualified doctors should attend the Courts, where they can follow the proceedings, hear the evidence given by medical witness, and note the questions put and the replies given. This will familiarize the doctor with legal procedures and help to lessen the painful experience of giving evidence.
The general public is fast becoming law conscious and the doctors are being sued from time to time in a Court of law for their acts of omission or commission. Therefore, it is incumbent upon doctors to have good knowledge of the law governing their profession, in order not to transgress the law. Doctors should avoid special efforts to “cover up” medical negligence or intentional wrong doing.
HISTORY : Medicine and law have been related from the earliest times and the bonds which united them were religion, superstition and magic. The Charaka Samhita (about seventh century B.C.) lays down an elaborate code regarding training, duties, privileges and social status of physicians. It gives a detailed description of various poisons and their treatment. In fourth century, B.C., Manu (King and law-giver) in his treatise, Manusmriti, laid down various laws including punishment for various sexual and other offences, and recognised mental incapacity due to intoxication, illness and age. Between fourth and third century B.C. Arthashastra of Kautilya defined penal laws and regulated medical practice. Physicians were punished for negligence. Medical knowledge was utilised for the purpose of law. It mentions about the examination of dead bodies in unnatural deaths. Abortion, sexual offences, kidnapping, etc. were punishable offences. Law-medicine problems are found in the written records in Egypt, Sumer, Babylon, India and China dating back 4000 to 3000 B.C. A Chinese materia medica of about 3000 B.C. gives information on poisons. Imhotep (27th century B.C.), Grand Vizir, Chief Justice and chief physician of King Zoser of Egypt, enacted rules for medical practice, which was brought under law. The Code of Hammurabi, King of Babylon (about 2200 B.C.), is the oldest known medicolegal Code. Rig Veda and other Vedas (3000 to 1000 B.C.) mention about crimes like incest, adultery, abduction, killing an embryo, murder, drunkenness, etc. and their punishments. Physicians were identified as professional people. Atharva Veda gives details about remedies for various conditions. Hippocrates (460 to 377 B.C.), the “Father of Western Medicine” was born and practiced in the island of Kos in Greece, discussed the lethality of wounds. His contribution to medical ethics is by far his greatest in medical field. About 300 B.C., the Rabbis of the Rabinical Court, responsible for implementing the Jewish laws, sought the aid of medical expert in the administration of justice. Later, Greek and Roman jurists and medical men collaborated in the development of the principles of forensic medicine. Shushruta (father of Indian surgery), between 200 to 300 A.D. in his treatise Shushruta Samhita dealt with various medicolegal problems. Duties of physicians were defined. Wounds and fractures were classified. Poisons and snakes were classified and treatment prescribed. Modes of administration of poisons was described. In the sixth century A.D. the Justinian Code (Roman emperor) and Institutes regulated the practice of medicine and surgery, and established the function of the medical expert for legal procedure. The first medicolegal autopsy was done in Bologna (Italy) in 1302, by Bartolomeo De Varignana. In the thirteenth century, a manual was prepared to aid in the investigation of death in China. George, Bishop of Bamberg, proclaimed a penal code in 1507, where medical evidence was a necessity in certain cases. Caroline Code was proclaimed in 1553 in Germany by Emperor Charles V. With this expert medical testimony became a requirement rather than an option to give opinions in cases of murder, wounding, poisoning, hanging, drowning, infanticide and abortion, etc. It recognised that there were several types of homicide which were not punishable under certain conditions, one of which was an offender who was 'deprived of his understanding'. The first book on Forensic Medicine was published in 1602 by an Italian physician, Fortunato Fedele. The greatest of all works was the “Questiones Medicolegales” (medicolegal questions), written by Paulus Zacchias, who was principal physician to Pope Innocent X, and Alexander VII, and an expert before the Rota Romana, the Court of Appeal. This was published 5in seven volumes from 1621 to 1635 and two additional volumes in 1666, at Amsterdam. This work remained an authority in medicolegal matters until the beginning of the nineteenth century. Paulus Zacchias is considered to be the Father of Legal Medicine as well as Father of Forensic Psychiatry. In Questiones Medicolegales, he declared that physicians should have exclusive competence in the field of pathological mental states, amentias. He provided a classification of mental disorders keeping in mind the legal issues at that time. Around the end of the sixteenth century, autopsies in medicolegal cases began to be generally practised. In the eighteenth century, professorships in legal medicine were founded by the State in Germany. Orfila (1787 to 1853), professor of chemistry and legal medicine at Paris introduced precise chemical methods into toxicology. He is considered the founder of modern toxicology. In 1843, the law regarding the criminal responsibility of insane persons was established in England in Mc Naughten's case.