Ebook Biswas review of forensic medicine and toxicology: Part 2

(BQ) Part 2 book Biswas review of forensic medicine and toxicology has contents: Impotence and sterility, postmortem artifacts, forensic psychiatry, bloodstain analysis, torture and custodial deaths, general toxicology, corrosive poisons,... and other contents.

CHAPTER 22 Abortion „ „ „ ii Anatomic (10–15%) iv Infections (15%) vi Others i Genetic (50%) iii Endocrine (10–15%) v Immunological (5–10%) i Genetic: Majority of early abortions are due to chromosomal abnormality.2 z Autosomal trisomy is the commonest cause (50%) and most common is trisomy 16 (30%) z Monosomy and chromosomal aberration (including deletion, duplication, translocation and inversion) constitutes 20% and 2–4% of all abortions respectively ii Anatomic: Cervico-uterine factors usually cause second trimester abortions z Cervical incompetence z Congenital malformation of uterus, e.g hypo plasia, bicornuate/septate uterus or duplication of upper part of uterus z Uterine fibroid iii Endocrine and metabolic abnormalities z Diabetes mellitus z Hypo- or hyperthyroidism z Luteal phase defect z Deficient progesterone secretion from corpus luteum iv Infections z Viral: Rubella, cytomegalovirus, vaccinia, variola or HIV z z Classification of Abortion (Flow chart 22.1) z z z z z ­ ­ z z Flow chart 22.1: Classification of abortion z Abortion procedures, whether performed legally by trained professionals using modern technology or illegally using ‘traditional’ methods are subject to Incidence: 10–20% of all pregnancies (approx) Most frequent within first months, owing to weak attachment of ovum to uterine wall (75% abortions occur before 16th week, and out of these, 75% before 8th week of gestation) Abortion occurs without any induction procedures and usually coincides with menstrual flow Causes ­ Some authors use the term abortion as expulsion of ovum within first months of pregnancy; miscarriage for the expulsion of fetus from 4th–7th months; and premature delivery as the delivery of baby after months of pregnancy and before full-term The term miscarriage is synonymous with spontaneous abortion „ „ „ „ „ „ „ „ „ Natural or Spontaneous Abortion „ „ Medically, abortion (Latin aboriri: to get detached from the proper site) is expulsion or extraction from its mother of an embryo or fetus weighing 500 g or less, when it is not capable of independent survival (WHO) This 500 g of fetal development is attained at about 22 weeks of gestation Legally, abortion is defind as expulsion of products of conception from the uterus at any period before full term.1 Criminal abortion: It is the termination of a pregnancy in violation of the legal regulations in force Abortus: The non-viable product of abortion Abortifacient: Any agent that induces abortion „ „ substantial underreporting There is no valid data on the incidence of abortion in India Definitions 338 Review of Forensic Medicine and Toxicology imprisonment is upto 10 years and fine If the act is done without the consent of the woman, then the person is punished with life imprisonment or upto 10 years and fine z ­ „ Criminal Abortion z In De Materia Medica Libri Quinque, the Greek pharmacologist Dioscorides listed the ingredients of a drink called ‘abortion wine’– hellebore, squirting cucumber and scammony Hellebore (‘Christmas rose’), in particular, is known to be abortifacient „ „ „ Legal aspects: Dealt under Section 312–316 IPC.5 „ Sec 312 IPC: Whoever (including the pregnant women herself) voluntarily causes criminal abortion with the consent of the patient is liable for imprisonment upto years and with/without fine, and if the woman is quick with child, then imprisonment may extend upto years and fine.6 „ Sec 313 IPC: If miscarriage is caused without the consent of the woman, whether the woman is quick or not, then the person is punished with life imprisonment or imprisonment upto 10 years and fine „ Sec 314 IPC: If pregnant woman dies from the act done with the intent to cause miscarriage, then z „ It means willful termination of pregnancy before viability It can be: „ Legal or justifiable: When it is done in good faith to save the life of the woman, and performed within the legal provisions of the MTP Act (Details in Chapter 2) „ Criminal or illegal: Induced destruction and expulsion of fetus from womb unlawfully It is usually induced before the 3rd month, and causes infection and inflammation of the endometrium.4 Artificial or Induced Abortion Abortifacient drugs General violence Local violence Abortifacient drugs: Most of them have no effect on the uterus or fetus, unless given in toxic doses, and often sold to exploit distressed woman Usually used in the 2nd month of pregnancy i Ecbolics: They increase uterine contractions, e.g ergot preparations, synthetic estrogens, pituitary extract, strychnine or quinine ii Emmenagogues: These drugs initiate or increase menstrual flow, e.g estrogen, savin, borax or sanguinarin.7 iii GIT irritants: These causes irritation of uterus, e.g purgatives, like castor or croton oil, julap, senna or MgSO4 iv Genitourinary irritants: They produce reflex uterine contraction, e.g cantharides, oil of turpentine or tansy or pennyroyal v Drugs having systemic toxicity z Inorganic irritants, e.g lead, copper, iron or mercury z Organic irritants, e.g Abrus precatorius, Calotropis, seeds of custard apple and carrots, and unripe fruit of papaya or pineapple vi Abortion pills made of lead (diachylon) or diphenyl-ethylene   Common causes of abortion  First trimester: Genetic factors, endocrine disorders, immunological disorders, infections and unexplained  Second trimester: Anatomic abnormalities, maternal medical illness and unexplained z z z z Unexplained (40%): In spite of the numerous factors mentioned, it is sometimes difficult to pinpoint exact cause of abortion i ii iii I ­ ­ Methods for Inducing Criminal Abortion (Fig 22.1) z z z Bacterial: Ureaplasma, Chlamydia or Brucella Parasitic: Toxoplasma or malaria v Immunological: Both autoimmune and alloimmune factors can cause miscarriage vi Others z Maternal illness: Cyanotic heart disease or hemo globinopathies z Antifetal antibodies z Blood group incompatibility: Incompatible ABO and Rh group z Premature rupture of the membranes z Environmental factors: Cigarette smoking, drugs, chemicals, noxious agents, in-situ contraceptive agents, X-ray exposure and antineoplastic drugs z Fig 22.1: Various sites of action of methods designed to induce an abortion 339 z z z z z III Local violence (Table 22.1 and Fig 22.2) z Usually employed in 3rd–4th month when other methods have failed z Interference may be skilled, semi-skilled or unskilled Fig 22.2: Common methods used to procure criminal abortion Table 22.1: Different methods of interference Š Instrumentation Š Dilatation and evacuation Š Abortion stick Š Abortion paste—Utus paste Š Vacuum aspiration Š Slippery elm bark Š Laminaria tent Š Syringing Š Prostaglandins Š Š Š Š Š Electric current Š Intrauterine instillation of hyperosmotic solution Š Š Š Š Š Skilled interference Š Self-instrumentation Š Semi-skilled interference Š Unskilled interference Š Accidental: A general shake-up in advanced pregnancy can produce abortion, but if the fetus is healthy, abortion will not occur i Severe pressure on abdomen by kneeling, blows, kick, tight bandage and massage of uterus through abdominal wall ii Violent exercise, like horse riding, cycling, skipping, rolling downstairs, or jumping from height iii Cupping: A mug is turned upside down over a lighted wick and placed on the hypogastria Air escapes due to heat and the mug sets tightly on the abdomen The mug is then pulled which may result in partial separation of placenta iv Very hot and cold hip bath alternately z z z Intentional Various methods are: i Syringing: Ordinary enema syringe with a hand bulb is commonly used to inject fluid into uterus, the hard nozzle being inserted into cervix Higginson’s syringe can also be used Soap water is often used as injection material Irritating substances are added to water, such as lysol, cresol, alum, KMnO4 or formalin ii Syringe aspiration: Large syringe with a plastic cannula is inserted into cervix; develops suction which ruptures early gestational sac, and leads to aspiration and expulsion of contents iii Vacuum aspiration: The cervix is dilated and a tube attached to a suction pump extracts the fetus (Fig 22.3) iv Rupturing of membranes: The membranes are ruptured by introduction of an instrument, like probe, stick, uterine sound, umbrella ribs, catheter, pencil, pen holder, knitting needle or hairpin v Abortion stick: It is a wooden or bamboo stick, 12–18 cm long, wrapped at one end with cotton, wool or piece of cloth and soaked with juice of marking nut, calotropis or paste made of arsenious oxide or lead z It is introduced into the vagina or os by dais (traditional birth attendants) and retain there, till contraction starts (Fig 22.3).8 z Instead of this stick, a twig of some irritant plant, like Plumbago rosea, Calotropis or Nerium odorum may be used vi Dilation of cervix: Foreign bodies are introduced and left in cervical canal, like pessaries, laminaria (a dried seaweed) or sea tangle tent which dilate the cervix, irritate uterine mucosa and produce marked congestion and uterine contractions with expulsion of fetus z Cervical canal may be dilated by introducing a compressed sponge into the cervix and leaving it there Sponge swells from moisture in the uterine segment with expulsion of fetus II General violence z Any act directly on the uterus or indirectly to produce congestion of pelvic organs or hemorrhages between uterus and membranes z Resorted to upto end of 1st month z It is more likely to cause injury than abortion z It can be intentional or accidental z Abortion 340 Review of Forensic Medicine and Toxicology A B Figs 22.3A and B: Methods to bring about abortion: (A) Vacuum aspiration; (B) Abortion stick Slippery elm bark (Ulmus fulva) obtained from tree in Central America, is inserted into cervical canal in portions of 1–3 inches long It absorbs moisture, and on each side of the bark, a jelly like layer is produced that is as thick as the bark itself, due to which the cervical canal is dilated vii Air insufflations: Air is introduced into vagina and uterus by various means, like pumps or syringes leading to abortion viii Electric current: An electric current of 110 V with negative pole applied to posterior vaginal cul-desac and positive pole to lumbosacral region, leads to contraction of uterus and expulsion of contents ix Pastes: Utus paste (semi-solid soap mixed with potassium iodide, thymol and mercury) or Fetex paste is introduced in the extra-ovular space for abortion Complications of Criminal Abortion Most of the complications develop as a result of incomplete evacuation (retained products of conception) of the uterus, infection and injury due to instruments used during the procedure which may cause cervical laceration, uterine perforation with associated bowel and bladder injury (Fig 22.4) Complications that may occur due to criminal abortion are given in Table 22.2 z z     Other orally ingested abortifacients include indigenous and homeopathic medicines, chloroquine tablets, prostaglandins, high dose progesterones and estrogens and liquor before distillation Chloroquine is given intramuscularly as an abortifacient Fig 22.4: Uterine perforation with small bowel prolapse Table 22.2: Cause of death and complications of criminal abortion Š Vagal inhibition Š Septicemia Š Jaundice, hepatitis Š Chronic debility Š Air embolism Š Generalized peritonitis Š Acute renal failure Š Chronic pelvic pain Š Fat embolism Š Pyemia Š Endocarditis Š Dyspareunia Š Hemorrhagic shock Š Toxemia Š Pneumonitis Š Ectopic pregnancy Š Amniotic fluid embolism Š Local infection Š Pulmonary embolism Š Secondary infertility Š Poisoning (rare) Š Tetanus Š Endotoxic shock Š Depression Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Š Remote complications Š Systemic complications Š Delayed Š Immediate 341 Abortion „ „ „ Gives an idea of the length of gestation Transfer of poisons, bacteria and antibodies across the placenta may result in death, disease or abnormalities of fetus In criminal abortion, pieces are often retained in the uterus „ „ „ z „ „ Medico-legal Importance of Placenta „ „ „ „ „ Definition: It is defined as a type of abortion associated with sepsis of the products of conception and the uterus Infection usually involves the endometrium and may spread into the myometrium and parametrium Parametritis may progress into peritonitis Pelvic inflammatory disease is the most common complication of septic abortion Microorganisms causing uterine sepsis (mixed infection is more common): z Anaerobic: Bacteroides group (fragilis), anaerobic Streptococci, Clostridium welchii and tetanus bacilli z Aerobic: E coli, Klebsiella, Staphylococcus aureus, Pseudomonas and hemolytic Streptococcus „ Fabricated abortion: Rarely, when a woman is assaulted, she may try to exaggerate the offence by alleging that it caused her to abort She may acquire a human or an animal fetus to support the charge „ „ Septic Abortion z   Cause of sepsis: „ Proper antiseptic and asepsis is not maintained „ Incomplete evacuation „ Inadvertent injury to the genital organs and adjacent structures, particularly the gut „ „   „   Second trimester abortion (rate is among the highest in the world) increases the risk in women—they are more likely to go to an uncertified provider, and the risk of complications is higher for physiological reasons Most common reasons for second trimester abortions—sex selective abortions and delay of accessing abortion services for an unwanted pregnancy Legal abortion is not an option for most Indian women from lower socioeconomic classes, hence these women gets the abortion done from less trained, but more accessible providers Amniotic Fluid Embolism Duties of a Doctor in Suspected Criminal Abortion „ „     Lendrum’s stain (Phloxine-Tartrazine): This stain is useful to detect amniotic fluid embolism deaths, since keratin of amniotic squames is stained red, nuclei blue and cytoplasm yellow.9 The ‘WHO’ method: It is helpful to demonstrate keratin and mucin-like substances in amniotic fluid embolism Medico-legal Aspects „ „ „ „ Nearly all criminal abortion take place at about 2nd and 3rd month of pregnancy, when the woman in certain about her condition It is resorted mostly by widows and unmarried girls i He should ask the patient to make a statement about the induction of criminal abortion If she refuses, he should not pursue the matter, but inform the police ii Doctor should keep all the information obtained by him as professional secret iii He must consult a professional colleague iv If the woman’s condition is serious, he must arrange to record the dying declaration v If the woman dies, he should not issue a death certificate, but should inform the police for postmortem examination „ „ z z z z Most of the cases occur during: z 1st and 2nd trimester abortion z Active labor z Amniocentesis z Abdominal trauma „ Amniotic fluid embolism is a rare, unforeseeable and dreadful complication This occurs when massive amount of amniotic fluid enters the maternal venous system „ There may be tonic-clonic seizures, breathlessness and loss of consciousness In half the cases, death occurs in the first hour „ It causes DIC and fibrin deposition in many organs „ Diagnosis is established by demonstration of mucin, lanugo hair, vernix caseosa, fat globules, meconium and fetal squamous cells in cut sections of the lung Examination of a Woman with Alleged History of Abortion The doctor may have to examine a living subject, or sometimes, a dead body may be sent for postmortem examination for alleged abortion The findings are similar to those found in the recent delivery and will depend upon the period of gestation, the mode of abortion procured and the time elapsed between abortion and examination The major differentiating features between natural abortion and criminal interference are given in Diff 22.1 342 Review of Forensic Medicine and Toxicology Differentiation 22.1: Natural and criminal abortion S.No Feature Natural abortion Criminal abortion Cause Predisposing diseases Pregnancy in unmarried woman or widow Injuries on genital organs Absent Contusions and lacerations may be present Marks of violence on abdomen Absent May be present Foreign bodies in genital tract Absent May be present Fetal injuries Absent May be present Toxic effect of drugs Absent Inflammation of vagina, cervix, GIT or urinary tract may be present Infection Rare Frequent Examination of a Living Individual „ „ „ „ „ „ „ „ „ „ Appearance of perineum, vulva and vagina is noted Presence/absence of injuries (abrasions/contusions/ lacerations) is noted Condition of os is noted It remains dilated for few days and may also show some injuries due to instrumentation Presence of recent tears, the marks of forceps or other instruments in and around genitalia should be noted Character and amount of discharge is noted In case of sepsis, offensive purulent vaginal discharge or a tender uterus with patulous os may be found z z z z Local Examination z „ „ Moreover, any criminal charge must be substantiated not only by positive evidence of interference relating to the deceased’s death, but also to exclude the possibility of self-induced abortion Postmortem Examination The autopsy involves identification of fetal remains and association with the alleged mother „ Autopsy examination should include absolute identification of the victim and careful examination „ Since, most of the abortifacients are irritants, the woman may show signs of ill health, GIT distur bances and exhaustion In case of sepsis, there will be pyrexia with chills and rigor, pain abdomen and increased pulse rate (100–120/minute) ­ „ „ z Clinical Examination The conviction of a person for criminal abortion should be based on autopsy, laboratory and circumstantial findings a Sudden death of a woman of child-bearing age should give rise to the suspicion of criminal abortion if: z The deceased was pregnant and deeply cyanosed z Instruments to procure an abortion or abortifacient drugs are found at scene of death z Underclothing appears to be disturbed after death z Fluid, soapy material or blood coming out of vagina b Following point should be proved to convict the abortionist: z The dead woman was pregnant z The accused was responsible for the act which resulted in the interruption of pregnancy z The accused acted for the purpose of procuring an illegal abortion z Death occurred as a result of attempt to interrupt the pregnancy z ­ Clothing must be examined, especially the under garments for bloodstains, stains from abortifacients (fluid, soapy materials)—preserved and sent to CFSL Examination of a Dead Body z „ „ „ „ „ It includes: „ Requisition from the concerned authority „ Identification of the female „ Written informed consent of the female „ A female nurse (if the doctor is male) „ Brief history—date time, place of abortion, method used to procure abortion History of illegal termination by an unauthorized person is mostly concealed The behavior of the woman may also be indicative, e.g if she refuses medical help or if there is evidence of contradictory statements Laboratory investigations: Serum and urine gives positive result for the test for hCG upto 7–10 days In abortion during early months of gestation, the signs will be ill-defined, whereas signs persist for a longer time if sepsis has taken place and if abortion has been carried out in late months of gestation 343 Abortion „ „         Trauma and Abortion „ Allegation may be leveled against a person that because of the alleged assault, the pregnant female suffered an abortion It may be a case of a mother who is the victim of an assault, which results in premature labor, delivery of an extremely premature infant who survives a few hours, but then dies because of prematurity Such a case could be considered a homicide, and criminal charges could well be pursued In similar cases, where the fetus dies in-utero, criminal charges are framed under various sections of IPC „ Travel, in the absence of trauma, does not increase the incidence of abortion „ Trauma may rarely cause an abortion, in the absence of serious or life-threatening injury to mother „ Following criteria suggests a causal relationship between trauma and abortion: a The traumatic event was followed within 24 hours by processes that ultimately lead to abortion b Appearance of the fetus and placenta should be compatible with the period of pregnancy at which the traumatic event occurred c The fetus and placenta should be normal d Factors known to cause abortion should be absent, such as: i History of repeated abortion without any cause or exposure to abortifacients, e.g X-ray or lead ii Chronic infections in mother, e.g syphilis, toxoplasmosis or tuberculosis iii Abnormalities of uterus including congenital defect of uterine development, leiomyomas, endometrial polyps and incompetent os iv Physical attempt to induce abortion „ „  „ „  „ „ „  Samples to be collected in criminal abortion Vaginal contents pipetted in a clean sterile container for chemicals, drugs or soap Pubic hair Blood, urine and stomach contents Blood from the inferior vena cava and both cardiac ventricles Any fluid from the uterine cavity Swabs of the uterine wall Tissues for histology from all organs „ „ „  „ „  „ „  „ „ Box 22.1 „ „ of the clothing including undergarments which must be preserved for any traces of foreign solutions External features of pregnancy should be looked for If death is due to hemorrhage, body will look pale Presence of injuries (general or local) is noted If abortifacient drug was injected, then the injection mark(s) can be detected over usual sites Local examination: Labia majora, minora, vagina, cervix may show injuries and may be congested It may be stained by locally used abortifacient agents To confirm or exclude air embolism, the body must be opened after radiological examination as it may show translucency of the right ventricle and pulmonary artery (details in Chapter 6) The abdominal cavity is opened and may be full of blood, if there is perforation of uterus Uterine and adnexal tissues are assessed for crepitation due to gas formation in the uterine wall, and venous channels and the inferior vena cava is inspected for air or soap embolism bubbles The skull vault must then be carefully removed, avoiding puncture of the meninges and vessels over the brain surface which allows air to enter these vessels; a detailed examination of the basal sinuses, veins and arteries is made for the presence of air embolism Following removal of the thoracic and abdominal organs in the usual manner, the pelvic organs are excised en-masse following separation of the symphysis pubis and a circular dissection to include vagina, vulva and rectum with adjacent skin, taking care to collect any foreign fluid or material for chemical and bacteriological examination The vagina and uterus are opened along their anterior surface because injuries are more likely to occur on the posterior vaginal wall following criminal interference Findings in the uterus: Cavity may show presence of products of conception in full or in parts It may be enlarged, soft and congested Wall may show thickening in longitudinal section Samples to be collected are given in Box 22.1 344 Review of Forensic Medicine and Toxicology MULTIPLE CHOICE QUESTIONS D B C D A B A C C Causing grievous hurt D Causing miscarriage Miscarriage is punishable under which IPC: AIIMS 13; NEET 14 A Sec 320 IPC B Sec 311 IPC C Sec 312 IPC D Sec 314 IPC Borax is: NEET 13 A Gastrointestinal irritants B Genitourinary irritants C Ecbolics D Emmenagogues Mechanism of action of abortion stick used in criminal abortion: AIIMS 06; AI 08 A Necrosis of endometrium causing infection B Uterine contraction C Stimulation of uterine nerves D Inducing uterine relaxation Lendrum’s stain is done for: NEET 13 A Air embolism B Fat embolism C Amniotic fluid embolism D Pulmonary embolism Abortion is defined as expulsion of fetus: TN 06 A Before viability B Before 28 weeks C Before full-term D None of the above Most common cause of first trimester abortion is: UP 09; JIPMER 10; Kerala 11; AFMC 12; CMC (Vellore) 14; COMEDK 15 A Chromosomal defect B Endocrine disturbances C Anatomic abnormality of uterus D Infections Most common cause of second trimester abortion: CMC (Vellore) 14 A Chromosomal defect B Cervical incompetence C Abnormality of uterus D Infections Mechanism of criminal abortion: AIIMS 06 A Infection and inflammation of endometrium B Uterine contraction C Placental separation D Stimulation of nerve Sections 312 to 316 deal with: NEET 14 A Kidnapping and abduction B Abetment to suicide C CHAPTER 23 Impotence and Sterility „ „ „ „ iii iv „ „ ii v „ „ „ „ „ „ Impotence: It is the inability of a person to perform sexual intercourse and achieve gratification (unable to copulate) Erectile dysfunction: Inability to develop and maintain an erection for satisfactory sexual intercourse in the absence of an ejaculatory disorder such as premature ejaculation Quod (impotence quode hanc, ‘as regards’): A male may be impotent with one particular female, but not with another.1 Frigidity (Latin, coldness): It is the inability to initiate or maintain the sexual arousal pattern in female (absence of desire for sexual intercourse or incapacity to achieve orgasm).2 Sterility: It is the absolute inability of either a male or a female to procreate In male, it is inability to make a female conceive, and in females, it is inability to conceive children Fertility: Capacity to reproduce or the state of being fertile Infertility: Failure to conceive (regardless of cause) after year of unprotected and regular intercourse.3 „ „ Definitions z Question of impotence and sterility arises in: and believed to be semen), widower syndrome, post-traumatic stress disorder or over-indulgence Excessive masturbation may also lead to impotence Age: Before puberty, boys are usually impotent and sterile with certain exceptions, like precocious puberty Poor physical development of penis is common cause of impotence—examination depends more on its development than the age In advanced age, libido diminishes, but they are not impotent or sterile As long as live spermatozoa are present in seminal fluid, individual is presumed to be fertile Developmental and acquired abnormalities: Absence of penis, intersexuality, malformations, e.g hypospadias, epispadias, absence of testicles, Klinefelter syndrome, retrograde ejaculation and cryptorchidism (Fig 23.1) Local diseases: Priapism, hydrocele, elephantiasis, phimosis, Peyronie disease, adherent prepuce, orchitis following mumps, syphilis and tuberculosis (Fig 23.1) Mumps may cause sterility, not impotence Exposure to X-rays may cause sterility General diseases: Impotence is common during acute illness and in any severe or debilitating illnesses z Neurological conditions, like tabes dorsalis, multiple sclerosis, paraplegia, hemiplegia, syrin gomyelia, temporal lobe damage and 3rd ventricle tumors; endocrine disorders, e.g diabetes, hypothyroidism, hyperprolactinemia and testicular atrophy following renal failure, hemochromatosis or cirrhosis; blood vessel and nerve trauma (e.g long-distance bicycle riding), CVS disorders, e.g Leriche syndrome, and diseases like tuberculosis and nephritis may cause impotence and sterility z Malnutrition, vitamin C and zinc deficiency may cause erectile dysfunction Injuries: Infertility is a significant problem after spinal cord injury The two major causes are poor semen quality and ejaculatory dysfunction „ „ Civil cases, like divorce, adultery, nullity of marriage, disputed paternity and legitimacy, claims for damages where loss of sexual function is claimed Criminal cases, like adultery, rape, or unnatural offences where impotence is cited as defense ­ „ „ i Psychological: Most important and frequent cause, though transient in nature.4 Absence of desire for sexual intercourse may result from dislike of partner, fear of failure, anxiety or mood disorder, guilt, aversion, low self-esteem, hypochondriacs, childhood sexual abuse, masturbatory anxiety (‘dhat syndrome’—passage of whitish discharge in urine z vi ­ ­ Causes of Impotence and Sterility in Males 346 Review of Forensic Medicine and Toxicology Fig 23.1: Causes of impotence and sterility in males Causes of Impotence and Sterility in Females   Penile erection is a complex process involving psychogenic and hormonal input, and a neurovascular nonadrenergic, noncholinergic mechanism Nitric oxide (NO) is considered as the main vasoactive neurotransmitter and chemical mediator of penile erection Impaired NO bioactivity is a major pathogenic mechanism of erectile dysfunction Treatment of erectile dysfunction often requires combinations of psychogenic and medical therapies Oral phosphodiesterase type (PDE-5) inhibitors are useful in this respect z z z z x  ix  viii z z vii i Age: Being passive partners in intercourse, age has no effect on potency Women are fertile from puberty to menopause, but may become pregnant before menarche and after menopause z Kraurosis vulvae in old women may cause narrowing of the vagina z The occurrence of infertility rises significantly as age increases ii Developmental and acquired abnormalities z Impotence may result from total occlusion of vagina, adhesion of labia, imperforate hymen— can be cured by surgery (Fig 23.2) z Injury or operation of vagina may cause stricture which can lead to impotence z Absence/abnormal uterus, ovaries or fallopian tubes produces sterility, but not impotence z Erectile dysfunction may occur following treatment for lower limb fractures due to perineal neurovascular traction injury acquired during surgery z Fracture of the penis (rupture of both corpora cavernosa with urethral rupture) may result in impotence The commonest causes of fracture of penis are coitus and penile manipulations, especially masturbation Chronic poisoning: Exposure to poisons, e.g lead, arsenic, pesticides or aphrodisiac agents may lead to impotence and/or sterility Medications: Antidepressants (e.g SSRIs), antipsychotics, anti-hypertensives, antiulcer agents (e.g cimetidine), cholesterol-lowering agents and finasteride may cause impotence Behavioral factors: Lifestyle choices—chronic alcoholism, smoking, being overweight and avoiding exercise are possible causes of impotence Tight-fitting underwear causes increase in scrotal temperature that may result in decreased sperm count Addictions: Certain drugs, e.g morphine, heroin, opium, cannabis, cocaine and tobacco (smoking) may cause impotence and sometimes sterility z Fig 23.2: Causes of impotence in females 643 Index Ear, changes in middle 327 Ears 550 Eating disorders 413 Ecchymoses 299 Ecgonine methyl ester 569 Edema aquosum 181 Edema of glottis/lungs 131 Edema of lungs, larynx 163 Edgeoscopy 87, 88 Eggshell skull rule 19 Ekbom syndrome 404 Elapidae bite 532 Elapinae and viperine bite signs of 528t symptoms of 528t Elemental mercury 494, 494f, 495 Emasculation 296 Embalming 156 Embalming artifacts 401 Emotional abuse 333 Emphysema aquosum 181 Emphysema, interstitial 254 Emphyseme hydroaerique 181 Emprosthotonus 573 En bloc removal 103 En masse 103 Enamel of teeth, incremental line in 328 N e N N Encephalopathy syndrome, chronic traumatic 238 Endocrinal disturbances 116 Endocrine disorders 345 Endogenous burns 276 Endosulfan 602 Endotoxins 630 Endrin 601, 601f action 601 medico-legal aspects 602 postmortem findings 602 signs 601 symptoms 601 treatment 602 Enlisting injuries 291 Enterococcus faecium 122 Enterotome 100 Enterotoxin 630 Envenomation, assessment of severity of 530t Enzyme bioscavengers 600 Enzyme markers 428 Enzyme typing 436 Enzyme-linked immunosorbent assay (ELISA) 532 Eosinophilia 509 Epidural hematoma 243, 271 Epilepsy 136 Epithelial cells 264 Erectile dysfunction 345 treatment of 346 Ergot 522 active principles 522 medico-legal aspects 523 postmortem findings 522 signs of 522 symptoms of 522 treatment 522 Erotomania 404 Erroneous BAC results 554 Erythema 268, 274 Erythroblastosis fetalis 329 Erythroxylum coca 569 leaves and cocaine 569f Esophagus 148 poisioning in dead 469 Ethanol 542 action 543 administration of 555 detoxification 543 distribution 543 Ethyl alcohol See Ethanol Ethylene glycol 479, 556 postmortem findings 557 signs of 557 symptoms of 557 Ethylenediaminetetraacetic acid 476 Ethyliodoacetate 591 Euthanasia 12, 26, 27 reasons for 26 Evisceration methods 103 Ewing’s postulates 304 Excitement, stage of 538, 544, 567 facilitated sexual assault 624 habituation 618t intoxication 128 removal, extracorporeal 560 Drumstick appearance 60 Drunken gait 563 Drunkenness 548 Drunkenness and concussion 238 Drunkenness, clinical examination 549 Drunkenness, consent for examination 549 Drunkenness, diagnosing case of 549 Drunkenness, general examination 549 Drunkenness, mistaken for 586 Drunkenness, opinion 552 Drunkenness, specific physical examination 549 Dum-dum bullet 212 Duplex bullet 213 Duret hemorrhages 251 Durham’s rule (1954) 417 Dyadic death 129 Dying declaration 48, 49 Dying deposition 49 Dysarthria 563 Dysbarism 310 Dysomnias 414 hypersomnia 414 insomnia 414 Dysphagia 563 Dysrhythmia, ventricular 613 Dystonia (acute), 613 Dystonic reactions 613 N N N Dicing injuries 285, 287 Digitalis (digitalis purpurea) 576 Digitalis purpurea (foxglove) 578 action 578 medico-legal aspects 578 postmortem findings 578 signs 578 symptoms 578 treatment 578 Dihydrotestosterone 63 Dimercaptosuccinic acid 476 Diphenyl chlorarsine 591 Diphenylamine chlorarsine 591 Direct agglutination test 357 Direct toxic effects 588 Direct violence 234 Disease, signs of 101 Diseases, exhausting 130 Disorder, dissociative 413 Disputed chastity 363 Distant shot 220 Divorce 353 and nullity of marriage cases 428 grounds for 363 Dizziness 252 DNA fingerprinting 438, 440, 461 uniqueness of 444 uses of 443 DNA profiling 436 procedure of 439f D A storage and FTA card 443 D A testing, limitations of 444 D A to nylon, transfer of 439 D A, isolation/extraction of 439 D A, mitochondrial 444 D A, sources of 442 Dopamine levels, causes increased 544 Down syndrome 80 Dowry death 296 D-penicillamine 496, 506 Dragon’s breath 211 Dribbling of saliva 164 Drink spiking 624 Drinks, diluted 543 Drowning 136, 177 accidental 183 atypical 178 classification of 177 dry 178 secondary 179 Drowsiness 563 Drug 618 abuse complications of 623 examine for 550 postmortem findings 623 postmortem findings internal 624 addiction 618t dependence 618 and date rape drugs 618 producing 619t facilitated rape 368 644 Review of Forensic Medicine and Toxicology p Food-borne disease outbreak 629 Footprints 88 Forced alkaline diuresis 560 Forearm 530f Forensic autopsy 98 Forensic practice, samples encountered in 442 Forensic psychiatrist, role of 407 Forensic psychiatry 403, 461 Forensic serology 422 Forensic toxicology 465 Formication 571 Fossa navicularis 355 Fourchette 355 Fracture contusion 240 Fracture dislocation 168 Fracture la signature 234 Fracture anterior cranial fossa 236 middle cranial fossa 236 orbital plate of frontal bone 234 posterior cranial fossa 236 skull 286 tibia, type bumper 283f transverse processes 253 vertebral bodies 253 Fracture, angulation and compression 258 Fracture, angulation, compression, rotation 258 Fracture, classification of 258f Fracture, comminuted 235, 257 Fracture, common sites of 253 Fracture, complications of 259 Fracture, distraction 258 Fracture, elevated 235 Fracture, healing of 258 Fracture, hinge 236, 286 Fracture, open 257 Fracture, signature 234 Francisella tularensis 594 Frangible bullet 213 Free air movement 152 Freebase or crack 569 Freezing 156 Fresh water drowning 179, 181 Friction skin, cross section of 84f Front impact crash 284 Frostbite 264 Froth, production of 180 Frotteurism/toucherism 396 Frustules 182 Full metal jacket 212 Fulminant hepatic failure 131 Fulminant poisoning 465, 485, 515 Fumigants 595 Furosemide 532 g Gait 549 Galli- ainini test 357 Gamete intrafallopian transfer 351 Gamma (malignant) alcoholism 619 m   d Fabricated injuries 206 Face 549, 573 and visceral congestion, congestion and edema of 130 of clock orientation with lithotomy position 376f Facial hair growth 155 Facial injuries 251 Facial pallor 502 Facial sensation 127 Faculty evelopment rogramme Fainting attack 136 Fangs 524, 527 Farwell’s brain 455 Fascia, destruction of deep 268 Fat embolism 301 Fatal dose 527 Fatal dose and fatal period 587 Fatal period 163, 179, 314 Fatal stab wound 204 Fatality 314 Fate of body 151 Fate of PM staining 141 Fatigue 144, 252 Fatty liver 469 Fatty meal 154 FDI system, modified 95 Feather test 136 Fecal matter 436 Feigned insanity 407 Female anatomy, normal (in virgins) 353 Female feticide 320 Female genital organs 257 Female genitalia 105 normal (vulva) 353f Female infertility 350 Female prostitute 123 Female, examination of 348 f Femur and upper end of tibia, lower end of 323f, 324 Feni 542 Fetal cells in mother’s blood 358 Fetal death, diagnosis of 324 Fetal death, radiological signs of 358 Fetal heart sounds 358 Fetal movements and parts 358 Feticide 320 Fetish objects 396 Fetishism 396 Fetus compressus 359 Fetus papyraceus 359 Fetus, age of 322 Fetus, death of 320 Fetus, determination of age of 323t Fetus, signs of dead-born 328 Fetus, signs of stillborn 328 Fetus/infant, viability of 324 Fibers, artificial 90 Fibrin 303 Fibroblasts 113, 303 Fictitious child 360 Filicide 320 Filigree burns 278f Finger nose test 551 Fingernails 102 Fingerprint 227 classification 87 development 86 powders 86 recording of 85 ridges, types of 85t types of 85f Firearm 209 classification of 210 entry and exit wounds 223f injuries 93, 209, 458 wounds 216, 221 Fired bullets 225 Fired cartridge 225 Fireman’s cramps 265 Fiscal, procurator 45 Fish-mouth-like appearance 148 Flameless atomic absorption spectrophotometry 229 Floatation test 327 Florence test 432, 432f Flow-cytometry 155 Fluid and electrolyte management 616 Fluid resuscitation 269, 612 Flumazenil 615 Fluorescence in situ hybridization 434 Fluorescence tissue spectroscopy 155 Fluorescent feulgen reaction 60 Flying missiles 291 Fodere’s/static test 326 Folate therapy 555 Folie deux 404 Fontanelle, closure of 328 Food poisoning 629 causes 629 Excretion, enhancement of 608 Exhibitionism 395 Exotoxins 629, 630 Exploding bullet 213 Explosion injuries 459 Explosives, classification of 290 Exposure causes anosmia, chronic 510 Extracorporeal life support 608 Extractor 209 Extradural hematoma 271 Extradural, subdural and subarachnoid hemorrhage 248 Extragenital injury 374 Extrapyramidal signs 613 Eye and nostril, large head scales with pit between 525f Eye burns 484 Eye drops 564 Eyeballs, prominent 164 Eyes 332, 550 cause of black 233, 234f 645 Index N Habits 524 Habitual passive agent of sodomy 389f Haderup system 95 Haemoglobin, reduced 423 Haemophilus influenzae 630 Haemorrhage, subendocardial 469 Hagedorn’s needle 100 Hair 57, 89, 112, 270, 378, 490 and nail clippings 478 bulb, healthy 92f bulbs 196 cross section of 91f follicles with roots 442 follicles with roots, plucked hair 442 parts of 89f tip of 92f Hallucination 404 auditory 404 psychomotor 404 types 404 Hallucinogens 622 Halo or ring sign 237 Handgun 210 Handia 543 Handwriting 550 Hanging 161, 164, 170, 184 atypical 162 classification of 162 complete 162 Hangman’s fracture 167, 167f Harmful use 618 h Harris lines 75 Harris’s hematoxylin 433 Harrison and Gilroy test 229 Hash oil 566 Hashish 566 Hatter’s shake 497 HBV 122 HC gas 582 Head in infants, dissection of 110 Head injuries 154, 179, 251, 293, 406 closed 232 open 232 to precipitate labor and blunt force 330 Head of wound 198 Head scales 524 large 526f of poisonous and non-poisonous snakes 525f Head, drooping of 528 Headache 252 Health care workers and hiv infection 451 Health consequences, psychological 383 Heart 106, 148, 176, 254, 264, 266, 293, 492, 496, 509, 515, 561, 609, 624 and blood vessels 181 and liver 511 auscultation of 136 changes in 328 dilation of 518 disease 130 poisioning in dead 469 syndrome, holiday 546 Heat cramps 265 Heat effects, artifacts environmental 401 Heat exhaustion 265 Heat flexures of limbs 271f Heat hematoma 271 Heat hyperpyrexia 265 Heat injury 265 Heat prostration 266 Heat rupture 271 and lacerated wound 271 Heat stiffening 144, 145 Heat stroke 144, 265, 266 Heat syncope 266 Heavy metals 505 arsenic 479 iron 479 lead 479 mercury 479 Hegar’s sign 356 Hemagglutination inhibition test See Antiglobulin consumption test Hematochezia 484 Hematoma 242, 246 and depressed skull fracture 236 Hematomyelia 252 Hematopoietic tissues 311 Hematorrhachis 252 Hematoxylin-eosin autofluorescence 133 Hemin crystal test See Teichmann test Hemin crystals 424f Hemiplegia 163 Gonorrhea 347 Goodell’s sign 356 Goose skin 180 Gossypiboma 19 Gossypol 349 Gramoxone 603 Grandeur or exaltation, delusion of 403 Gravid uterus 148 Gravindex test 357 Green tobacco sickness 578 Green-stick fractures 257 Greiss test, modified 229 Grenz rays 87 Grey Turner’s sign 192 Grievous hurt 96, 296 clauses of 296t Grinding compression 196 Growing skull fracture 237 Guillotine 47 Gunshot entrance wounds, atypical 222 Gunshot residues, detection of 229 Gunshot wounds 191 Gustafson’s criteria 70t Gustafson’s method 70 Gustatory hallucination 404 Gutter fracture 236 Gutter wound 221 Gynecologic examination 348 Gynecological examination 354   L Gamma hydroxybutyrate 624 Gangrene 300 Garlic/decaying fish-like odor 606 Gas 591, 622 liquid chromatography 553 stiffening 144, 145 Gastric aspirate, ee jones test for 583 Gastric contents, consistency of 154 Gastric decontamination See Poisons, ingested Gastric lavage 473, 473f, 474, 599 fluid for 473 with sodium 511 Gastric mucosa 616 Gastrointestinal system 131, 552 Gastrointestinal tract 290, 293, 496, 505, 508, 510, 517, 577, 612, 614, 615 acute inflammation of 522 hemorrhage of 516 mucosa of 518 signs of irritation of 512 Gastrojejunostomy operation 154 Gastromalacia 147 Gel electrophoresis 439f Gelineau’s syndrome 414 Genetic markers in blood 426 Genital and anal evidence 378 Genital examination, lithotomy position for 375f Genital injury 376 labia 376 vulva 376 Genital organs development of 384 diseases of 347 Genital pubic hair 384 Genitalia, external 102 Genitals 375, 384 Genitourinary system 131 Geriatric euthanasia 26 Gestation, maximum and minimum period of 358 Gestational age from size of foot 322f Gestational surrogacy 352 Gettler test 181 Giemsa stain 434 Glaister-keen globes 375, 377 Gland 527 Glass particles, fragments of 516 Gliding contusion 240 Glottis, acute edema of 269 Glucose-saline and plasma, transfusion of 515 Glue sniffing 184 Glutyl-transferase 619 Glycopyrrolate 599 Glycosides 578 GM and KM systems 427 Gonadal agenesis 60 Gonadal biopsy 58 Gonadal dysgenesis 60 mixed 62 Gonadarche 74 646 Review of Forensic Medicine and Toxicology Hyperventilation deaths 184 Hypnopompic hallucinations 414 Hypochondriacal delusion 403 Hypotension 128, 472 and shock 531 correction of 613 Hypothermia 127, 141, 263, 472 Hypothyroidism 345 Hypovolemic hypodynamic septic shock 300 Hypovolemic shock 299 Hypoxia 128 Hypoxic encephalopathy 163 Hypoxyphilia 184 Hysterotomy 35 i Iatrogenic deaths 328 Iatrogenic pneumothorax 254 Ideal homicidal poison 577 Identification of human remains 94 Idiopathic epilepsy 131 Ignitability 514 Illegitimate child or bastard 360 Illicit drugs, multiple-wrapped packets of 540 Illicit liquor 556 Illusion 405 and hallucination 405 and hallucination, difference between 405 IMC, constitution of Immersion blast 289 Immersion burns 274 Immersion syndrome 178, 264 Immunoassays with radioisotopes 357 Impotence and sterility 345, 460 in females, causes of 346, 346f in males, causes of 345, 346 Imprint marks 287 Impulse 405 dipsomania 405 homicidal impulse 405 kleptomania 405 mutilomania 405 oniomania 405 pyromania 405 suicidal impulse 405 trichotillomania 405 types 405 In situ dissection 103 In vitro fertilization 351 Incendiary bombs 289 Incendiary bullets 213 Incest 385 circumstances of 385 Incised wound 197, 198f, 233 Incomplete androgen insensitivity 63 Indian Evidence Act 1872 43 Indian Medical Council Act, 1956 Indian Medical Degrees Act, 1916 Indian medical register, maintenance of Indian Penal Code (IPC) 1860 43 infection 123 medico-legal aspects of 451, 461 testing 451 policy 451 Human organs authority for removal of 30 removal of 30 Human RBCs 424f Human rights 12 Humero-femoral index 57 Humidity 139 Hunan hand 521 Hydrochloric acid 468 Hydrocution 178 Hydrocyanic acid 582, 589 absorption and excretion 582 alternative therapy 584 antidotal therapy 583 judicial execution 585 medico-legal aspects 584 postmortem findings 584 signs 582 symptoms 582 treatment 583 Hydrofluoric acid 468 Hydrogen borate/orthoboric acid 485 Hydrogen cyanide 582 action 582 physical properties 582 sources 582 uses 582 Hydrogen sulfide 589 action 589 fatal dose 589 fatal period 589 medico-legal aspects 590 postmortem findings 590 properties 589 signs 589 sources 589 symptoms 589 treatment 589 Hydrostatic lungs 181 Hydroxyl radical 603 Hymen 353, 355 annular 353 causes of rupture of 354 cribriform 353 infantile 353 semilunar 353 septate 353 signs of recent rupture of 377 types of 353, 354f Hymeneal examination 377 Hyoid bone, fracture of 173, 173f, 401 Hyoscyamus niger 562 Hyperdynamic septic shock 300 Hypergonadotropic hypogonadism 62 Hypertension 129, 472 Hypertensive heart disease 131 Hyperthermia 472 malignant 613 N Hemochromogen crystals See Takayama test Hemodialysis 616 Hemodialysis/peritoneal 509 Hemoglobinuria 506 Hemolysis 506 Hemoperitoneum 129 Hemorrhage 130, 131, 144, 196, 198, 203, 237, 242 external 299 internal 299 primary 299 secondary 299 Hemorrhagic pancreatitis, acute 131 Hemostatic disturbances 532 Hemothorax 254 Hepatic 505 Hepatitis B virus 122 Hepatitis C infection 123 Hepatitis C virus 122 Hepatotoxic poisons 469 Herniation contusion 240 Heteropaternal super-fecundation 359 Hexagonal scales on middle of back, central 526f Hide and die’ syndrome 264 High environmental temperature 139 High order explosives 290 High tension injuries 275 Hilt mark’ injuries 203 Hindu Marriage Act, 1955 363 Hippocratic oath Hippus 576, 577 Histotoxic anoxia 131, 582 Hit-and-run 281 Hollow-point bullet 212 Homicidal burns 273 Homicidal drowning 184 Homicidal hanging 167 Homicidal laceration 197 Homicidal strangulation 169 Homicidal throttling 172 Homicidal wounds 199 Homicidal, ideal 468 Homicide 204, 295, 363, 492 Homosexuality 391 in males 396 Honey comb 148 Hooch tragedy 556 Horseradish 577 Hospital records 50 Hostile witness 51 House fly, common 150 House fly, life cycle of 151f Household insecticide (low toxicity) 595 Huffing 622 Human and animal hair 90 Human bites 197 Human blood 425f Human D A quantitation 428 Human hair 91f Human immunodeficiency virus 122 clinical trials and 453 647 Index Iron 612 investigations 612 medico-legal aspects 612 postmortem findings 612 signs 612 symptoms 612 Iron-desferrioxamine complex 612 Irreversible cessation of circulation 136 Irritant gases 586 Ischemic anoxia 131 Ischemic injury 232 I-shaped incision 102 Isoenzymes 426 Isopropyl alcohol 556 postmortem findings 556 signs 556 symptoms 556 IV immunoglobulin 532 j Jacketed bullets 212 Jacquemier’s or Chadwick’s sign 356 Jaundice 469 Joint 257 deformity 270 Joule burn 276, 276f Judicial death sentence, execution of 363 Judicial electrocution 277 Judicial hanging 167 Judicial punishment 76 Jugular vein 173 Juvenile Justice Act, 2000 46 k N N N Kallmann syndrome 80 Karl Pearson’s formula 118 Kastle-Meyer test 423 Kastle-Meyer test See Phenolphthalein test Kayser-Fleischer ring 507 KC / AC poisoning 584 Kennedy phenomenon 223 Keraunos 278 Kernohan-Woltman notch 251 Kerosene oil poisoning 627 action 627 chronic poisoning 628 complications 628 investigations 627 medico-legal aspects 628 on ingestion 627 postmortem findings 628 signs 627 symptoms 627 treatment 627 Kidnapping 76, 77 Kidneys 104, 148, 182, 256, 264, 486, 491, 492, 496, 506, 507, 509, 511, 515, 561, 609, 612 effect on 503 Kimura’s base-wing index 64 Kit, contents of safe 371f Injury, diffuse axonal 239 Injury, diffuse ischemic 250 Injury, diffuse vascular 250 Inorganic mercuric salts, ingestion of 495 Inorganic mercury compounds 496 Inorganic metallic irritants absorption 505 acute poisoning signs 505 symptoms 505 arsenic 489 copper 505 excretion 505 lead 499 mercury 494 postmortem findings 506 thallium 508 treatment 506 Inorganic salts 494, 494f Inquest, types of 43 Insanity or unsoundness of mind 403 Insanity, acute attack of 547 Insanity, true and feigned 408 Insect activity, artifact to 400 Insecticides 595 Insemination types, artificial 350 Insemination, artificial 13, 350, 351f Insensitivity syndrome, complete androgen 63 Instantaneous rigor 144 Insulin 617 Intercourse, medical proof of 369 Intermediary coup contusion 240 Intermembral index 57 Internal ballistics 209 Internal complaints committee 39 Intestine 104, 264 small 491, 492, 506 Intestines 469, 515 Intoxicated patient, management of 545 Intoxication, acute 618 Intoxication, diagnosis of 552 Intoxication, pathological 545 Intra-aortic balloon pump 609 Intracerebral hematoma 248 Intracerebral hemorrhage 129, 131 Intracervical See Artificial insemination Intracranial hematoma 242, 243f types of 242 Intracranial hemorrhage 232, 539 Intracranial pressure 232, 250 Intracytoplasmic sperm injection 351 Intradermal bruise 192 Intraparenchymal hemorrhage 254 Intravascular coagulation, disseminated 302 Intravenous drug abuser 123 Intravenous electrolytes 611 Intraventricular hemorrhage 249 Inward compression fracture 173 of hyoid bone 172 Iodine fuming 86 Ionizing radiation burns 267 Indirect fractures 257 Indirect violence 234 Inebriants–alcohol 542 Infant brain 321 Infant clothings and wrappings 320 Infant death 329 accidental causes 329 causes of 329 criminal causes 330 natural causes 329 perinatal 329 postnatal 330 syndrome, sudden 333 unnatural causes 329 Infant extremities 320 Infant face 320 Infant general features 320 Infant genital area 321 Infant head 320 Infant injuries 321 Infant limbs and sternum 322 Infant measurements 320 Infant neck 322 Infant thorax 322 Infant, viability of 324 Infanticide 320 and child abuse 320, 460 Infants, external examination of 320 Infants, internal examination of 321 Infection 131, 163, 203, 237, 254 acquired 122 and intoxications 630t type 629 Infidelity/jealousy, delusion of 403 Influence/control, delusion of 403 Influenza-like syndrome 512 Infrared photography 224 Ingestion, case of 627 Inhalants 619, 622 Inhalation, case of 627 Inhalational exposure 570 Inhaled poisons 472 Inheritance claims 360 Injections 623 Injuries, accidental 124 Injuries, classification of 290 Injuries, duration of 307 Injuries, electrical 275, 275f Injuries, explosion 289 Injuries, external 102, 149, 287, 291 Injuries, internal 287, 292, 333f Injuries, primary impact 281-283 Injuries, recognition of 152 Injuries, regional 459 Injuries, secondary 281, 283, 290 impact 281, 283 Injuries, sharp force 191 Injuries, surface 332f Injuries, transportation 459 Injury report 305 Injury, age of 194, 198 Injury, cause of 92, 197 648 Review of Forensic Medicine and Toxicology L L L L L L L L L L L L L L L L L L L L L L m Maceration 147 Madea’s formula 155 Magenstrasse 484 Maggots 113 Magic bullet 224 Magistrate and police inquest 43 Magistrate inquest 44 Magistrates’ courts 46 Magnan’s syndrome 571 Magnesium sulfate See Gastric lavage with sodium Magnesium sulfate 599, 609 Magnus hirschfeld 395 Mahua 542 Majum 566 Male and female mandible 65, 65f Male and female pelvis 66, 66f Male and female sacrum 67 Male and female skull 64, 65f Male genital organs 257 Male homosexual 123 Male reproductive system 431f Male urethra 257 k     e facie sympathetique 164 abia majora 353, 355 abia minora 353, 355 acerated wound 195, 196f aceration, accidental 197 aceration, dating of 197 acerations 232, 233, 256 acrimators/tear gases 591 actate dehydrogenase 155 actate dehydrogenase isoenzyme 435 actic acid 154 anger’s lines 198 aryngeal spasm 174, 179 arynx 148, 172, 181 ate onset of rigor 144 atex test 425 athyrus sativus 629 athyrus sativus ( esari dhal) 631 active principle 631 signs 631 symptoms 631 treatment 631 attes crust test 426 awful homicide 295 ead (shisha) 499 ead acetate 499f ead encephalopathy 502 ead palsy 502 ead poisoning signs chronic 501f symptoms of chronic 501f ead snowstorm 229 ead tetraoxide 499f eathery stomach 487 egitimacy and paternity 360 egitimate child 360 endrum’s stain 341 etulle’s technique 322 eucomalachite green 423 ewis system 427 GBTI (lesbian, gay, bisexual, transsexual and intersex) 372 L L L L L L L L L L L L L L L L L L L L L L L L L L L l Male, examination of 347 Malignant hyperthermia 317 Malingering 25 cases of 428 Maltese cross abrasion 219 Mandibles of infancy 74 Mandragora officinarum 562 Manmade (synthetic) 595 Manner of burial 149 Manner of death 128, 129 Manner of injury 191, 194 Maqianzi 572 Marchiafava-Bignami syndrome 548 Marfan syndrome 80 Marijuana 566 Marjolin’s ulcer 270 Marking nut 520 Marquis test 539 Marriage, void 363 Marshall’s triad 291 Martius scarlet blue stain 302 Masochism/passive algolagnia 394 Masque ecchymotique 175, 176 Mass disaster 117 Mass movement of air 289 Massive hemoptysis 131 Master-servant rule 21 Masturbation 354 Masturbation/onanism 396 Mayer-Rokitansky-Küster-Hauser syndrome 80 McEwan’s sign 545 MCI, functions of Mechanical irritants 516 medico-legal aspects 516 postmortem findings 516 signs 516 symptoms 516 treatment 516 Meconium 327 Medical Council of India Medical defense procedure 18 Medical ethics, code of Medical indemnity insurance 18, 34 Medical jurisprudence Medical maloccurrence 20 Medical malpractice 11 Medical negligence 11 Medical practitioner and torture 449 Medical records 25 maintenance of Medical register, maintenance of Medical tattoos 79 Medical Termination of Pregnancy Act, 1971 34 Medicinal poisons 611 Medulla 89 Mellanby effect 545 Menarche 74 Meningeal hemorrhages 194 Meningitis 131 Menke’s syndrome 333 L L L L L L L L L L Lichtenberg flowers 278, 278f ife support, advanced 583 illiputian hallucination (micropsia) 404 imb, lower 72 imbs, technique for lower 530f ip prints 88 types of 89f iquid 591 chromato-graphy, high performance 611 gold 621 ithopedion 360 ive birth, signs of 324 iver 104, 148, 182, 256, 264, 293, 469, 491, 492, 496, 506, 507, 509, 515, 520, 609, 612, 624 inferior surface of 138 necrosis 469 iving cadavers 128 iving individual, examination of 342 ivor mortis 136, 140 ocard’s principle of exchange 86 oco parentis 24 oganin—glucoside 572 ong-scarf syndrome 170 ow order explosives 290 ow tension injuries 275 ucid interval 406 in insanity 406 ucilia sericata 150 ugol’s iodine test 384 ungs 105, 112, 148, 169, 176, 180, 254, 264, 266, 290, 293, 509, 511, 515, 561, 609, 612, 616, 624 abscess 174 ying prone 140 ynching 167 ysergic acid diethylamide 622 L L Kleine- evin syndrome 414 Klinefelter syndrome 61, 62 Knee reflexes 550 Knee-elbow (genupectoral) position 389f Knob fractures 333 Knockout drops 616, 624 Knot 163 Knot, position of 162 Kohn or O’kelly test 423 Korsakoff’s psychosis 548 signs 548 symptoms 548 treatment 548 Kozelka and hine method or cavett method 553 Krait 528 common 527f Krönlein shot 224 649 Index signs 632 symptoms 632 treatment 632 Musket 211 Mutilated bodies 117 Muzzle blast 216 Muzzle flash 216 Muzzle velocity 210 Mycobacterium tuberculosis 122 Mydriasis See Pupil, diplopia to dilated Myocardial infarction 132, 132f, 133t, 304 Myocarditis 131 Myocardium 107f Myrtiformes See Carunculae hymenales Myxedemic coma or crisis 131 n N N N N N N N N N N N N N N N N N N N N N N N N N -acetyl cysteine 515, 532, 611 -acetyl-P-benzoquinone 611 ail scrapings 378 ails 113, 490 print 96 aphthalene 602 action 603 balls 602f medico-legal aspects 603 postmortem findings 603 signs 603 symptoms 603 treatment 603 arco-analysis 455 principle 455 procedure 456 arcolepsy 414 cataplexy 414 hypnagogic hallucinations 414 sleep attacks 414 sleep paralysis 414 arcosis, stage of 567 arcosis/coma, stage of 539 arcotics Drugs and Psychotropic Substances Act, 1985 465 ational AIDS Control Organization guidelines 451 atural cause of rupture of heart 255 atural diseases 116, 192, 300 Natural fibers 90 Natural orifices 101 atural tattoos 79 ature of assault 93 ature of bite marks 94 ature of injury 191, 194, 197, 198 ature of knot 163 ature of weapon 92, 198 ausea 252 eck injuries 293 eck, autopsy of 163 eck, dimension of 165 ecrosis 274, 300 eedle, fragments of 519 egative autopsy 116 N N Minamata disease 497 Mineral/inorganic acids 482 Mineralized methylated spirit 542 Mirror test 136 Missile injury 232 Mnemonic ABCD 471 Moderately toxic See Animal insecticide Moisture 149, 151 Molecular death 126 Molotov cocktail 289 Monash technique 530 Mongolian spots 57 Monoclonal antibody mouse antihuman semen 435 Monovalent (specific) antivenom 532 Montgomery’s tubercles 356 Mood disorder 410 affective 411 bipolar 412 depressive episode 412 depressed 412 depressive ideation/cognition 412 psychomotor activity 412 manic episode 411 persistent 412 recurrent depressive 412 Morbidity and mortality audits 18 Morphine poisoning, chronic morphinism 541 fentanyl 541 Mortis, rigor 328, 399 Motile sperms 381, 434 Motility of stomach 154 Motor behavior, disorders of 410 Motor vehicle collision 281 Motorcycle and cycle injuries 286 Motorcyclists fracture 237, 286 Mountain sickness, acute 312 Mouth, dryness of 563 Mouth, poisioning in dead 469 mR A analysis 435 MTP Act rules 34 Mucopolysaccharides 303 Mucosa of GIT 629 Mucous membrane of esophagus 510, 533 Mucous membrane of stomach to poisoning, color of 470t Mugging 167 Muir and Barclay formula 269 Müllerian agenesis 80 Multiorgan dysfunction syndrome 506 Mummification 152 Mummified bodies 141 Murder 295 Musca domestica 150 Muscarinic 597 Muscles 264 atrophy of 507 of extremities 528 relaxation of 146 secondary relaxation of 145 Mushrooms 632 postmortem findings 632 Mental and behavioral disorders, classification of 409, 409t Mental depression 154 Mental disorder and responsibility 415 Mental disorders delirium, organic 409 Mental disorders, organic 409 Mental Health Act, 1987 39 Mental retardation 403, 414 Mental retardation mild 414 Mental retardation moderate 414 Mental retardation profound 415 Mental retardation severe 415 Mental status examination 407 Mentally ill person 403 Menthol, metabolism of 555 Mercurial erethism 496 Mercurialism 494 Mercuric chloride 468, 494f Mercuric chloride (corrosive sublimate) 494 Mercuric cyanide, oxide and iodide 494 Mercuric sulfide 494f Mercuric sulfide (cinnabar or vermilion) 494 Mercurous chloride (calomel) 494 Mercury cyanide poisoning 584 Mercury poisoning, chronic (hydrargyrism) 496, 497 signs 496 symptoms 496 treatment 497 Mercury treatment 495 Mercury, acute poisoning signs 495 symptoms 495 Mercury, organic 495 Mercury, types of 495 Mercy killing 26 Mesmeric trance 136 Mesobuthus tamulus 534 Metabolic abnormalities 337 Metabolic acidosis 556 Metabolic conditions 539 Metabolism of ethanol in liver 544f Metal fume fever 506, 510, 512 Metallic irritants, inorganic 510 Metallic mercury See Elemental mercury Methamphetamine 621 Methanol 479 Methemoglobin 423, 513 Methemoglobinemia 513 Methemoglobinemia inducing agents 513 signs 513 symptoms 513 treatment 513 Methyl alcohol (methanol) 554 Methyl isocyanate 592 Methylated spirit, industrial 542 Methylene blue 513 Methylene-dioxy-methamphetamine 622 Mickey finn 624 Miles’ method 70 Miliaria profunda 267 Miliary plaques 148 650 Review of Forensic Medicine and Toxicology N mda d N N N N N c c N Obliteration of external auditory meatus 270 Obscure autopsy 116 cause of 116 Obsessive compulsive disorder See Anxiety neurosis Obsessive-compulsive disorder 413 Obturator foramen 67f Occupational marks 96 Ochronosis 486 Odor 514 Oleander ( erbera thevetia, erbera odorum) 576, 579 Olfactory hallucination 404 Oliguria 532 Oocyte freezing 351 OPC and carbamate 596f OPC poisoning 597 management of 598 signs and symptoms of 597f OPC, symptoms of 600 Ophiophagus hannah 524 Ophitoxemia, signs of 527, 529 Ophitoxemia, symptoms of 527, 529 Opiate 538 Opioid receptors, activation of 538 Opioid receptors, types of 538 Opioids 479, 619, 620 N N N N N N N N N N o Opisthotonus 573, 573f Opium 537 action 538 clinical toxidrome 538 distribution 537 metabolism 538 smell of 539 toxic part 537 Optic atrophy 502 Oral ASV 532 contraceptive pills 349 Organ contusion 193 Organic acids 485 Organic amnestic syndrome 410, 548 Organic irritants animal 524 plant 517 Organophosphorous 592 Organophosphorus compounds 595 classification 595 based on chemical composition 595 based on toxicity 595 Organs 124 Organs, other 520 Osiander’s sign 356 Osmium tetraoxide 87 Osmotic pressure of gastric contents 154 Ossification centers 328 Ossification of bones 71 Othello syndrome 403 O-tolidine test 423 Ouchterlony method 425 Ovarian dysgenesis 80 Ovaries 105 Overdose, treatment of 620 Ovotesticular DSD 60 Ovum donation 351 Oxalic acid 468, 485, 556 signs 485 symptoms 485 treatment 485 Oxygen, supplemental 512 Oxyhemoglobin 423 Oxytocin infusion 35 N N N N N N N N N N N N N N N N N N N N N N N N N N N N       omogram method 139 on-accidental injury, sites of 331f on-bailable offences 47 on-cellular semen markers 434 on-C S effects 613 on-cognizable offence 47 on-habitual passive victim 389 on-human blood 425f Non-inflammatory diarrhea 629 on-metallic and mechanical irritants 514 on-osseous method of estimating maturity 322 on-poisonous snakes 524, 532 on-protein nitrogen 154 on-serum protein analysis 425 on-toxic shot 213 on-voluntary euthanasia 26 oonan syndrome 80 orman kreitman 406 ose print 96 Notifiable clauses 10 Notifiable disease ovichoks 592 ovus actus interveniens 20 uclear sexing 58, 59 uclear terrorism 311 ucleic acid analysis 113 ullity of marriage and divorce 360, 363 urns 268 ymphomania 391 ystagmus test, horizontal gaze 550f ysten’s law 143 N N N N N N N N N N N N N N N k N N N N N Neisseria 630 meningitidis 123 eoplasia 304 eoplasm 131 eostigmine 532 ephritis, chronic 131 ephrolithiasis 131 Nerium odorum (white oleander, aner) 579 action 579 medico-legal aspects 579 postmortem findings 579 symptoms 579 treatment 579 erve agents 592 erve gases 592 sites of absorption 592 symptoms 592 treatment 592 erve poisons, peripheral 574 signs 574, 575 symptoms 574, 575 erve poisons, peripheral treatment 574, 575 erve poisons, spinal and peripheral 572 erve trauma 345 erves, effect on peripheral 503 ervous apoplexy 134 eurogenic cardiovascular failure 317 eurogenic shock 269, 299 eurolathyrism, 631 euroleptics, atypical 613 eurological manifestations 600 eurological sequelae 317 europrotective drugs 600 europsychiatric disorder, chronic organophosphate-induced 601 eurosis and psychosis 406 eurotic and somatoform disorders 412 eurotic disorders 413 eurotoxic and vasculotoxic venom 527t eutralizing agents, abandonment of 484 ewborn, normal skull of 73f ewton’s law of cooling 138 Nicotiana tabacum See icotine Nicotiana tabacum (tobacco) 577 action 577 acute poisoning 577 chronic poisoning 577 medico-legal aspects 578 postmortem findings 578 signs 577 symptoms 577 treatment 578 icotine 576, 619, 623 action 623 properties of 577 treatment 623 ihilistic delusion 404 ipples 355 itric acid 468 itrites 622 -methyl- -aspartate (n ) 600 odding face’ sign 236 p Pachymeningitis hemorrhagica interna chronica 245 Painter’s colic 500 Palliative care 26 Pallor, contact 140 Palm wine See Toddy Palmer’s notation 95 Palmer’s sign 356 Paltauf’s hemorrhage 181 Panchnama 44 Pancreas 104, 264 Panic disorder 412 Papanicolaou staining 434 Papaver somniferum 537f Papyraceus See Fetus compressus 651 Index Ploucquet’s test 327 PM staining 153 color of 141 development of 140 distribution of 140 fixation of 140 medico-legal importance of 141 Pneumonia 144, 174 Pneumothorax 131, 203, 254 demonstration of 111 P-nitrophenol test 598 Poisioning in dead duodenum 469 Poison 465 action of 467 apparatus 527 by excretion, elimination of 476 failure to detect 470 ideal infanticidal 330 ideal suicidal 468 removal of unabsorbed 472 Poisoned bullets 213 Poisoning 116, 130, 152, 539 by thallium 509 cases, management of 471 causes, chronic lead 500 in dead external findings 468 diagnosis of 468 in living 467 sign, chronic lead 500 symptoms, chronic lead 500 Poisoning, acute 465, 485, 544 signs 490 symptoms 490 Poisoning, chronic 465, 468 carbol marasmus 486 ergotism 522 lead plumbism 500 lead saturnism 500 phenol 486 Poisoning, delayed 485 Poisoning, duties of doctor in suspected 470 Poisoning, management of case of 472 Poisoning, signs of chronic 615 Poisoning, subacute 465 Poisoning, symptoms of chronic 615 Poisoning, symptoms suggestive of 468 Poisonous 526f and non-poisonous snakes 524t snakes 524, 532 features of common 524, 525t Poisons action of 467 classification of 466 contact 473, 595 corrosive 482 ingested 473 injected 472 medico-legal aspects of 465 Sec 284 IPC, 465 Sec 328 IPC 465 smell to various 469t L Petechiae, electrical 277 Petechial hemorrhages 130 Pfropf schizophrenia 411 Phenanthrene derivatives 537 Phencyclidine 622 Phenolphthalein test 423 Phenoxide 486 Phloxine-tartrazine See endrum’s stain Phobia, needle 413 Phobia, social 413 Phobia, specific (simple) 413 Phobia, types of 412 Phobic disorder 412 Phophorous-enzyme 596 Phosfume 606 Phosphite and hypophosphite of aluminum 606 Phosphoglucomutase 428 Phosphorous 514 action 514 acute ingestion 514 acute poisoning signs 514 symptoms 514 contact injury 514 first stage 514 poisoning, chronic 516 red 515f or amorphous 514 second stage 514 treatment 515 white 515f or crystalline 514 Phossy jaw 516 Phostoxin 606 Photobacterium fischeri 147 Photon fluorimetry, single 434 Physical abuse 333 Physical appearance 527 Physical health consequences 383 Physical properties 554 Physical torture 446 Physical violence 373 Physician-assisted suicide 26 Physiological antidote 564 Physostigmine salicylate 564 Phytotoxin See Toxalbumin Piggyback bullet 213 Pilocarpine 509 Ping-pong fracture 235 Pink disease See Acrodynia Pink feathery crystals 424 Piskacek’s sign 356 Placenta 321 medico-legal importance of 341 Plant penicillin 601 Plant seeds, ingestion of castor 518 Plasma (pseudo or butyryl) cholinesterase 598 Plasma magnesium 181 Plastic bag asphyxia 176 Plastic bullets 213 Pleurosthotonus 573 Paracetamol 611 action 611 diagnosis 611 metabolism 611 postmortem findings 611 signs 611 symptoms 611 toxicity 611 treatment 611 Paradox guns 211 Paraffin test 229 Paralysants 592 Paralysis, acute (type I paralysis) 600 Paralyzed muscles 144 Paraphilia 394 Paraquat 603 action 603 medico-legal aspects 604 postmortem findings 604 signs 603 symptoms 603 treatment 604 Parasuicide 406 Parathyroid crisis 131 Parkinsonism 613 Parkland formula 269 Parotitis 163 Parous uterus 362 Partial metal-jacketed bullet 212 Passive defense injuries 205 Pavor nocturnus See Sleep-terrors PCM poisoning, signs and symptoms of 611t PCR based methods 441 PCR, steps in 441f Pedestrian injuries 281 Pediatric euthanasia 26 Pedophilia 396 Pellets 225 Pelvic fractures 258 Pelvis 66f, 67, 67f, 104 Penetrating fractures 257 Penetrating wound 201, 216 Penetrative sexual assault 37 Penicillamine 476 Penile erection 346 Penis 384 Percutaneous inoculation 122 Percutaneous nephrolithotomy 22 Perforating wound 201, 216 Perianal signs of abuse 390t Pericardial fluid 155 Pericarditis 131 Pericardium 108 Perineum 353 Periodic acid-schiff stain 133 Permanent teeth 68 Persecution, delusion of 403 Persistent vegetative state 130 Personality disorder, multiple 413 Perthes syndrome 175 Pesticides 595 based on hazard, classification of 595t 652 Review of Forensic Medicine and Toxicology Pulmonary embolism 131, 301 acute 299 Punch drunk syndrome 239 Pupil, dilated 563f Pupil, diplopia to dilated 563 Pupil, normal 563f Puppe’s rule 221, 221f Purpuric hemorrhages in skin 515 Purtscher’s retinopathy 176 Putrefaction 147, 148, 153 medico-legal importance of 149 Pyloric stenosis 154 Pyrethrins and pyrethroids 604 Pyrethrins action 604 medico-legal aspects 604 signs 604 symptoms 604 treatment 604 uses 604 Pyrogallol test 112 q Quaternary injuries 291 Quickphos 606 Quinacrine dihydrochloride 60 Quinine 576, 580 action 580 medico-legal aspects 580 postmortem findings 580 signs 580 symptoms 580 treatment 580 r Raccoon eyes 233 Race 56, 71, 79 Radiant heat burns 267 Radiation effects, acute ionizing 311 Radiation sickness 311 Radiation syndrome, acute 311 Radioactive carbon 119 Radioactive sulfur dioxide 87 Radiocarbon dating of tooth enamel 70 Radio-immunoassay 532 Railway injuries 288 Rape 76, 367 accused, examination of 384 and adultery 386 consent, punishment for 368 constitutes 369 corroborative signs of 380 date 624 drug, date 624 drug, date (predator drug) 624 drugs 625t exceptions 367 explanations 367 gang 367 intra-marital 383 kit 371 in dead, diagnosis of 359 length of 34 phantom 359 positive/conclusive signs of 358 probable signs of 356, 357f signs of 355, 359t symptoms of 355, 359t termination of 34 toxemia of 131 Prenatal diagnostic techniques, regulation of 36 Preparations of cannabis 566, 566t Pressure gradient theory 242 Pressure immobilization technique 530 Pressure pad 530 Presumed consent 25 Presumption of death 156 Presumptive evidence of sex 58 Presumptive signs 355 Presumptive symptoms 355 Presumptive tests 432 for blood 422 Preventing medical litigation 16 Primum non nocere 529 Prinsloo gordon artifact 399 Prisoners 23 Prodromal symptoms 573 Prostate 105, 148 Protection of Children from Sexual Offences Act, 2012 37 Protection of Women from Domestic Violence Act, 2005 39 Protein markers 428 Proteins and enzyme systems, functional moiety of 505 Proximate causes of death 129 Prussian blue 509 Pseudicide See Suicide attempted Pseudocyesis 359 Pseudohermaphroditism 60 Pseudomonas 630 aeruginosa 269 Psychiatric assessment 407 Psychiatry 403 Psychic or changes in sensorium 622 Psychoactive drug 618 Psychoactive substance use disorders 410 Psychoactive substances 619 Psychogenic shock 300 Psychological autopsy 98 Psychological development, disorders of 415 Psychological maltreatment 333 Psychosis and neurosis 406 Psychotic disorders 412 Pterygia 75 Pubarche 74 Pubic hair 376 matted 432 Pubic symphyseal morphology 64 Pubic symphysis 73t Pugilistic attitude 270, 271 Pulmonary capillary wedge pressure 607, 608 Police inquest 44 Polygraph test 454f procedure 454 Polygraphs in court, admissibility of 454 Polyvalent antisnake venom 531 Pond or indented fracture 235 Poppy seeds (non-poisonous) 537f Poroscopy 87, 88 Post-autopsy reconstruction 110 Post-concussion syndrome 239 Posthumous births 360 Post-immersion syndrome 179 Postmortem abrasion 191 Postmortem artifacts 399, 461 Postmortem caloricity 139 Postmortem changes, artifacts to 399 Postmortem corrosion, artifacts environmental 401 Postmortem examination 342 of infants 320 Postmortem findings 324, 511, 515, 518520, 522, 575 external 515 internal 515 medico-legal aspects 515 Postmortem fracture 259 Postmortem glycogenolysis 139 Postmortem imbibition of arsenic 492 Postmortem luminescence 147 Postmortem maceration, artifacts environmental 402 Postmortem purge 148 Postmortem report 25 Postmortem samples 554 Postmortem staining 140, 142, 179, 270, 399 and bruise 142 Postmortem submersion 184 Postmortem thrombus 106 Postmortem wounds 302 Postmortem, color of 141t Post-partum depression 320 Postpartum psychiatric disorders 414 Post-schizophrenic depression 411 Post-traumatic automatism 239 Post-traumatic intracerebral hemorrhage 249 Post-traumatic stress disorder 291, 448 Potassium chloride 509 Potassium chromate 468 Potassium permanganate 475 Poverty, delusion of 403 Powder, grading of black 215 Pralidoxime 599 Prazosin therapy 534 Preauricular sulcus 64 Precipitin test, ring 425, 425f Pre-conception and prenatal diagnostic techniques 36 Pregnancy 354 and delivery feigned 363 medico-legal aspects of 363 diagnosis of 354 653 Index Sacral index 67 Sacrum 67f, 74 Sadism/algolagnia 394 Saline diuresis 477 Salmonella 629, 630 Salt water drowning 181 Salt, common 475 Sandwich technique 107 Saturated solution of common salt 114 Saturnine gout 504 Scalding 274 Scalds 267, 274   L s Scales distal to anal plate 524 Scalp lacerations 232 Scalp, removal of 108f Scalpel and disposable blades 100 Scandinavian method 560 Scanning electron microscopy 87, 276 Scars 78 Scene of crime 99, 224 Scheele’s green See Copper arsenite Schizophrenia 410 autistic thinking 410 catatonic 411 delusions 410 disorganized/hebephrenic 410 neologisms 410 paranoid 411 residual and latent 411 simple 410 thought blocking 410 type I or positive 411 type II or negative 411 types of 410 Sciatic notch index 67 Sclerotinum of fungus 522 Scold’s bridle 447 Scorpion antivenom 534 Scorpions 534 action 534 physical properties 534 postmortem findings 534 signs 534 symptoms 534 treatment 534 SDH, acute 245 SDH, causes of 245t Sea snake 529 Sea water drowning 179 Sedative hypnotic 538 Sedative-hypnotic—barbiturates 559 Seeds cause, dust of 517 Seeds injected, extract of 519 Seeds of abrus precatorius 519 Seeds, dentification of 519 Seeds, fragments of 518 Seeds, identification of 520, 572 Seizures, control 570 Self-inflicted bite 94 Self-inflicted wounds 206 Self-poisoning 561 Self-throttling 172 Semecarpus anacardium (seeds) 520, 520f active principles 520 medico-legal aspects 520 signs 520 symptoms 520 Semen 350, 431 from victim, detect 380t Seminal collection of material 431 Seminal fluid 380 Seminal identification, purpose of 431 Seminal stains and other biological samples 431 Seminal stains, dried 432 a b e c d Rhabdomyolysis 529 Rhesus system 427 Rib 254 fracture, complications of 254 shear 100 Ricinus communis 594 Ricinus communis (castor) 517 action 517 active principle 517 identification of seeds 517 medico-legal aspects 518 postmortem findings 518 signs 517 symptoms 517 treatment 517 Ricinus communis (seeds) 517f Ricochet bullet 222 Rifle and shotgun barrel 210f Rifled cartridge, parts of 214f Rifled firearm 210, 222, 226 Rifled weapons 209f, 210 Rigor mortis 136, 141, 142f, 143, 143t, 144, 153, 180 and cadaveric spasm 146 and cold stiffening 146 and heat stiffening 146 medico-legal importance of 144 Rimmed cartridge 214 Ring fracture 236 Risus caninus 573 Risus sardonicus 573 Robert’s sign 328, 358 Rokitansky’s method 110 Rolled impression 85 Roll-over crash 285 Romberg test 551 Rope burns 165 Rotational acceleration 233 Rotational shear force theory 242 Rubber bullets 213 Rule of 12 143 Rule of consent 23 Rule of hasse 322 Rule of palms 269 Rumack-Matthew nomogram 611 Rupture of abdominal aneurysm 131 Rupture of ectopic pregnancy 131 Ruptured liver abscess 131 medical examination of victim of 370 medico-legal aspects of 368 on children 382 on deflorate 381 pack See Rape, gang preserved in victim of 375f punishment for 367 Sec 376- IPC 367 Sec 376- IPC 367 Sec 376- IPC 367 Sec 376- IPC 368 Sec 376- IPC 368 Sec 376 (1) IPC 367 Sec 376 (2) IPC 367 statutory 367 survivor, stepwise approach to 370 survivor/victim, examination of 370 trauma syndrome 383 treatment 383 victim of 369 Rat hole 219 Rave drug 622 Rayalaseema phenomenon 224 Raygat’s test See Floatation test RBC (true) cholinesterase 598 Reactionary hemorrhage 299 Rear impact crash 285 Rectum 138 Red cross emblem 13 Reflex vagal inhibition 163 Refrigeration, artifacts to 402 Regional injuries 232 Register, maintenance of 35 Register, medico-legal 305 Registered medical practitioner 30, 99 Registration numbers, display of Registration, renewal of Rehydration 611 Renal 505, 557, 559 excretion 477 failure 532 Report, medico-legal 25, 48 Reproductive organs 257 Reproductive system 131, 311 effects on 502 Res judicata 18 Resolution of rigor 143 Respiration 136 irreversible cessation of 136 Respirator brain 127 Respirator lung 254 Respiratory failure 316 Respiratory system 131 poisioning in dead 469 Restraint of insane 40 Retina 138 Retraction balls/bulbs 239 Retrograde amnesia 239 Retroperitoneal organs 293 Retropharyngeal abscess 163 Revolver 210 Reye’s syndrome 615 RF P and PCR 438 654 Review of Forensic Medicine and Toxicology L   iv venom 479, 527 metalloproteases 532 ophthalmia 529, 532 Sniffing 622 Snowfield vision 555 Socio-familial factors 331 Sodium amytal 456 Sodium and potassium arsenate 489 Sodium bicarbonate 600 Sodium formal-dehyde sulfoxylate 496 Sodium nitrite 511 Sodomy 388 examination of active agent of 390 passive agent of 388 Soiling of wound 196 Solid 591 blasts 289 Somatic death 126, 136 and molecular death 126 Somatoform disorders 413 Somnambulism (sleep walking) 414 Somniferous poisons active principles 537 detection 539 differential diagnosis 539 narcotic 537 opiate 537 opioids 537 postmortem findings 539 body packers 540 chasing dragon 540 external 539 internal 540 medico-legal aspects 540 signs 538 symptoms 538 toxidrome 537 treatment 539 Somniloquy (sleep-talking) 414 Somnolentia 414 Sonti 543 Soot tattooing 623 Souvenir bullet 213 Spacing of jaw 69 Spalding’s sign 328, 358 Spanish fly See Cantharides Spark burns 276 Sparrow foot marks 285 Spasm of larynx 329 Species identification 425, 532 Species origin, identification of 435 Spectacle hematoma 233 Spectra of hemoglobin and derivatives 423 Spectroscopic examination 423 Speech 549 Speedball 621 Sperm donors, rights of 351 Spermatozoa under light microscope 434f Spermatozoon, morphological appearance of 434f Spermine picrate crystals See Barberio’s test Sphenoid sinuses 182 g Shotgun weapons 212 Shotgun wounds 218f Shotguns 222, 226 Sickle cell crisis 131 Silver nitrate impregnated paper test 607 Sims-Huhner test 348 Sin of omorrah 392 Singeing, cause of 270 Single base powder 215 Single bullet theory 224 Single cell gel electrophoresis 155 Sinsemilla 566 Six-penny bruises 195 Skeletal injuries 332 Skeletal muscle 126 electrical excitability of 126 Skeletal remains, dating of 119 Skeletonization of body 149 Skin 101, 113, 270, 311, 559 and mucous membrane to poisoning, color changes in 468t applied on 518, 520, 521 autofluorescence 155 burns 483 changes in 325 color of 192 color, changes in 325t destruction of superficial 268 dry hot (hot as a hare) 563 exposure of 506 incisions 102 marbling of 147 of lower limbs, marbling of 148f pigmentation of 356 slippage 147 Skull 57, 108, 271 cap, removal of 108f deformation 242 fracture, compound 237 fractures 232, 234, 258t complications of 237 suture closure 73 X-rays 237 Sleep disorders 414 Sleep-drunkenness 414 Sleeping beauty syndrome See Kleine- evin syndrome Sleep-terrors 414 Slippery elm bark (ulmus fulva) 340 SMC, functions of Smell, poisioning in dead 469 Smokeless powder 215 Snake 524 bite envenomation severity scale 530 bite poisoning, management of 530 bite, clinical spectrum of 527 bite, external features of 533f bite, history of 529 classification of 524 nomenclature 524 non-poisonous 526f postmortem findings 532   Seminal stains, examination of 432 Seminal stains, individualization of 435 Semi-smokeless powder 215 Semisomnolence See Somnolentia Sensory functions 413 Sepsis 269 cause of 341 Septic shock 300 Serotonin reuptake inhibitors, selective 614 Serum glutamic oxaloacetic transaminase 607 Serum glutamic pyruvic transaminase 607 Serum iron level 612 Serum strontium 181 Severity of brain injury stratification 238t Severity of concussion 238 Sex 58, 149 chromatin 58, 59 determination of 12, 59, 71 verification tests 58 Sex-linked offences 366 Sexual abuse 333 indicators of 383 victim of 123 Sexual asphyxia 184 Sexual assault 38, 94, 191, 366, 436 forensic evidence (safe) 371 forensic evidence kit 371 suspected seminal stain in 432 Sexual battery 368 Sexual characters, secondary 64, 74 Sexual contact 436 Sexual development classification of disorders of 61, 61t disorder of 60 Sexual harassment 38, 366 of women at workplace (prevention, prohibition and redressal) Act, 2013 38 Sexual intercourse 354 Sexual natural offences 366 Sexual offence, unnatural 366, 388 Sexual offences I 366, 460 Sexual offences II 388, 460 Sexual offences III 394, 461 Sexual offences, classification of 366t Sexual offences, natural 366 Sexual perversions 366 Sexual torture 448 Sexual unnatural offences 366 Sexual violence 366 Sexually active woman 381 Shaken baby syndrome 333 Shallow water drowning 179 Shamming 25 Sharia Islamic law 385 Sheehan syndrome 80 Sheehan’s hemorrhages 108 Shigella 629, 630 Shock 128, 131, 299 types of 299 Shotgun cartridge, parts of 214f Shotgun pellets 211 655 Index L Strychnine, medico-legal aspects 574 Strychnine, metabolism 572 Strychnine, postmortem findings 574 Strychnine, properties of 572 Strychnine, signs 572 Strychnine, symptoms 572 Strychnine, treatment 573 Strychnine—alkaloid 572 Strychnos nux-vomica family loganiaceae 572 kuchila 572 seeds 572f Stryker saw 100 Stud guns 211 Stupor 406 stage of 539 Sturner’s formula 155 Subacute SDH 245 Subarachnoid hematoma 246 Subarachnoid hemorrhage 131 Subcapsular laceration 256 Subconjunctival hemorrhage 164, 194 Subcutaneous bruise 192 Subdural hematoma 244, 246t age of 246 Subdural hygroma 246 Subendocardial hemorrhages 108 Subendocardial infarcts 132 Submersion inhibition 178 Succimer or DMSA 476 Suction bruise 193f Sudden death 131 Sudden infant death syndrome 144, 175 Sudden withdrawal of steroids 131 Sudorifics See Diaphoretics Suicidal and homicidal cut-throat wounds 199 Suicidal burns 273 Suicidal lacerations 197 Suicidal poisoning, common mode of 588 Suicidal strangulation 169 Suicidal, accidental and homicidal firearm injury 228 Suicide 183, 199, 203 Suicide See Homicide Suicide attempted 406 Sulphmethemoglobin 147 Sulphuric acid 468 Super-added permanent teeth 69 Superfecundation 359 Superfetation 359 Superficial perforating wound 224 Superglue fuming 86, 87 Supplice de baguettes 447 Supportive therapy 612 Supposititious child 360 Surest sign of antemortem burns 271 Surrogacy, traditional 352 Surrogate mother 351 Surrogate parenting 352 Surrogate pregnancy 351 Sutures 111 Swabs 384 Sweet almonds 582f Swelling 194 Swiss cheese appearance 276 Swollen, cyanosed face 164 Swyer syndrome 62 Sympathomimetic 538 Symphyseal surface of pubis 73 Symphysis pubis 103f Symptomatic patient, emergency management of 471 Syncope 130 Syndrome, compartment 532 Syndrome, dependence 618 Syndrome, intermediate (type II paralysis) 600 Syndrome, second impact 239 Synovial fluid 155 Systemic disorders 130 Systemic reactions 311 t Tactile hallucination 571 Tactile/haptic hallucination 404 Tail 524 Tailing of wound 198 Takayama test 424, 425f Talunex 606 Talus, center of ossification for 323 Tandem bullet 213 Tangential entrance wounds 221 Tannic acid 475 Tardieu’s spots 130, 165, 181 Tarsal bones 323f Taste 514 Tattoo marks 78 Tattoos, classification of 79 Tattoos, professional 79 Teardrop sign 236 Tears 196 Teeth, charting of 95 Teeth, eruption of deciduous 69f, 69t Teeth, eruption of permanent 69t Teeth, pink 148 Teeth, successional permanent 69 Teeth, temporary 68 and permanent 68 Teichmann test 424, 424f Tension pneumothorax 254 Terminal ballistics 209 Tertiary impact injuries 283 Testamentary capacity 77, 407 Testicular feminization syndrome 63 Testimony 51 Testing of rigor mortis 143, 143f Tête de négre’ appearance 180 Tetramethylbenzidine 423 Tetrathiomolybdate 507 Textiloma 19 Thallium acetate 508 Thallium stress test 509 Spill burns 274 Spinal anesthesia 317 Spinal cord 110, 251 concussion of 253 Spine, hyperflexion of 328 Spiral fracture 258 Spirit, proof of 542 Spirit, surgical 542 Spirits (whisky, brandy, rum, gin, vodka) 542t Spleen 104, 148, 182, 256, 264, 293, 491, 509, 624 Split lacerations 195 Split transplants 128 Spontaneous cerebral hemorrhage 249 Spontaneous hemorrhage 299 Spontaneous pneumothorax 254 Spotted hemlock 575 Stab wounds, classification of 201f Stack’s method 70 Staphylococcus aureus 122, 269 Starvation deaths 313, 460 Starvation acute 313 chronic 313, 314 State Medical Council composition of Statutory rape 76 Steam burns 274 Steering wheel impact abrasions 287 Steering wheel impact injury 284 Sterilization 348 classification of 348 medico-legal aspects 349 methods 349 permanent 349 temporary 349 Sternal index 67 Sternal notch 103f Sternum 254 Stillborn and dead-born fetus 329 Stomach 104, 114, 148, 153, 181, 264, 486, 492, 506, 509, 515, 520, 561, 609, 616, 624 agent in 484f and intestines, changes in 327 bowel test See Breslau’s second life test contents 154 damage in empty 484 poisioning in dead 469 poisons 595 wash 509, 518 washing See Gastric lavage Stone baby See ithopedion Strangulated hernia 131 Strangulation 167, 169, 170 accidental 170 Streak gonads 60 Streptococcus pyogenes 123 Stretch lacerations 195 Striking velocity 210 Struck hoop theory 242 Strychnine poisoning and tetanus 574t Strychnine, action 572 656 Review of Forensic Medicine and Toxicology Tumor 131 of kidney/bladder 131 Turkey skin 623 Turner syndrome 61, 62 Twin syndrome, vanishing 360 Twins, fraternal 360 Twins, identical 360 Two-digit system 95 Two-finger test 377 Typhoid 144 Torture, sequelae of 448 Torture, sequelae of management 448 Torture, types of 446 Toxalbumin 517 Toxemia 269 Toxic agent 479 Toxic compounds 494, 499 and uses 499t, 505, 508 Toxic principles 523, 527 Toxicity 514 by inhalation 510 of aconitine 576 of copper, action 505 Toxicological analysis, samples preserved for 477 Toxicological artifacts 401 Toxicology 463 clinical 465 general 465 Toxidromes 538 clinical 538t Toxin type 629 Toxinology 465 Tracer bullet 213 Trachea 148, 181, 264, 271 and bronchi 509 Tracheal reflexes 127 Transcapsular laceration 256 Translational acceleration 233 Transmissible spongiform encephalopathies 123 Transmitted wave theory 242 Transmural infarcts 132 Transplantation of human organs 31 Act, (amendment 2011, 2014) 30 Transplants, types of 128 Transportation injuries 281 Transverse fracture 236 Transvestic fetishism/eonism 395 Trauma 295, 304 and abortion 343 and nervous system 305 Traumatic and nontraumatic ICH 249 Traumatic brain injury 232 Traumatic cardiac rupture, common sites of 255 Traumatic epilepsy 237, 305 Traumatic hemorrhage 299 Traumatic shock 299 Traumatic tattoos 79 Tree bark appearance 106 Trendelenburg position 474 Tricyclic antidepressants 614 signs 614 symptoms 614 treatment 614 Trimetazidine 609 Triphasic withdrawal syndrome 620 Triphenyl tetrazolium chloride 133 Tropical anhidrotic asthenia 267 Tuberculosis 123, 144 of kidney 131 Tug fracture 173 u U U U U U U U U U U U U U U U U U U U U U U U ndertaker’s fracture 402 ndinism 397 nfavorable witness 51 niversal (Cunningham) system 95 niversal illusions or permanent illusions 405 nlawful homicide 295 nrespired and respired lung (stillborn and live-born) 326 pper limb 72 pper respiratory tract 176 ranism 396 rinary bladder 105, 153, 154 rinary disturbances 356 rine 436, 490, 554 alcohol 553 alkalization of 616 sample 378 robilin 436 rolagnia 397 rophilia 397 sefulness of X-rays 224 -shaped incision 103 terine cavity in nulliparous, shape of 362f parous woman, shape of 362f terine hemorrhage 131 terine perforation with small bowel prolapse 340f Uterine soufflé 357 terine wall 362 terus 105, 148 after delivery, size of 362t nulliparous and parous 362 postdelivery (in days), level of upper border of 361f v Vacuum metal deposition 86 Vagal inhibition 130, 134, 171, 174, 179 Vagal inhibitory phenomenon 136 Vagal stimulation 179 Vagina 105, 353, 355, 362 Vaginal discharge 380 Valve 108 Valvular heart disease 131 van Gogh syndrome 411 Vascular injury 232 Vasovagal shock 134, 299 Vegetative signs 407   Thallium sulfate 508 Thallium, absorption and excretion 508 Thallium, action 508 Thallium, acute poisoning signs 508 symptoms 508 Thallium, diagnosis 509 Thallium, laboratory investigations 508 Thallium, postmortem findings 509 medico-legal aspects 509 Thallium, treatment 509 Thanatopraxia 156 Tharra 542 Thelarche 74 Therapeutic artifacts 400 Therapeutic privilege 23 Therapeutic waiver 23 Thermal injuries 263, 459 classification of 263 Thermogenic anhidrosis 267 Thin layer chromatography 423 Thiopentone sodium See Sodium amytal Thioxanthenes 613 Thoracic blood vessels 293 Thorax 102 Thought and speech disorders 410 Throat, poisioning in dead 469 Thrombosis 301 Throttling 171, 172 accidental 172 Thumb pressure 140 Thunderclap headache 248 Time of assault 381 Time since death 93, 101, 152 Tincture iodine 475 Tinnitus 252 Tissue injury, soft 233 Tissue paper scars 624 Tissue, deep 193 Tobacco smoke 489 Toddy 542 Tongue 168, 179, 549 protrusion of 164 Tonic contractions 573 Tooth dislocation 258t Tooth, parts of 68f Toothed forceps 100 Tooth-grinding See Bruxism Torture and custodial deaths 446, 461 Torture bell (campana) 447 Torture branks 447 Torture chepuwa 447 Torture flying airplane 447 Torture helicopter trip 447 Torture interrogation chair 447 Torture iron maiden 447 Torture judas cradle 447 Torture methods, specific physical 448t Torture torment of sticks 447 Torture, forms of 447 Torture, pharmacological 448 Torture, psychological 448 Torture, reasons for 446 657 Index Waddell’s triad 282, 283f Walk and turn test 551 Wallace rule of nines 268, 268f Wandering bullet 229 War gases 591 and biological weapons 591 chemical warfare 591 Warrant case 47 Washburn/ischiopubic index 67 Washerwomen’s hand 180 Wasting diseases 144 Water 514 current 150 Wax drippings 276 Weapon, types of 203 Weedol 603 Welding of shot 211 Wernicke’s encephalopathy 548 signs 548 symptoms 548 Wernicke-Korsakoff syndrome 548 Wet drowning 181 Whiplash injury 252 Whole-bowel irrigation 477 Widmark’s formula 553 Wife syndrome, symptoms of battered 384 Wine 542t Winslow’s test 136 Wischnewsky spots 264 Witness torture 448 Witness, types of 50 Woman with alleged history of abortion, examination of 341 Wood’s lamp, examination with 374 Workmen’s Compensation Act, 1923 34 Wound 276 accidental 199 w x Xenograft 128 Xtracorporeal membrane oxygenation 608 y Yaw 223 z N Y-shaped incision 103 modified 103, 164f Ziehl- eelsen’s method 434 Zinc 512 action 512 chloride 468, 512 medico-legal aspects 512 oxide fumes 512 oxide, inhalation of 512 phosphide 512 postmortem findings 512 shakes 512 signs 512 stearate, inhalation of 512 sulfate 512 symptoms 512 treatment 512 uses 512 Zip guns 210 Zsako’s phenomenon 126 Zygote intrafallopian transfer 351 age of 303f ballistics 209, 216 contact 218, 220f dating of incised 198, 198t defense 199, 205, 205f entry 221 and exit 222 exit 221, 222 healing of lacerated 197t of entry 201 of exit 201 shape of stab 202f sharp 197, 198f types of 206 Wreden’s test 327 Wrist drop 502f Vitriolage treatment 484 Voluntary breath holding 136 Voluntary euthanasia 26 Vomiting and salivation, signs of 549 Voyeurism/scoptophilia 395 Vulva 353 carcinoma of 131 Venom, prevention of spread of 529 Venom, spread of avoid manipulation 530 immobilization 529 pressure-immobilization 530 reassurance 529 Venous air embolus 112 Venous bleeding 430, 430f Venous congestion 163 combined asphyxia and 163 Venous thrombosis, deep 301 Ventricular fibrillation 179 Ventricular hypertrophy 108 Verbal/mental abuse 333 Vernix caseosa absence of 321 presence of 321 Vertical compression fracture 258 Vertigo 252 Vesicles, formation of 533 Vessels, dissection of 105 Vessels, staining of 532 Vibrating saw 100 Victim or offenders, identification of 428 Vin rose 612 Vineyard sprayer’s lung 507 Violence, degree of 194 Viper 525t, 527f, 528 head 529 Viperine bite 532 Viral hemorrhagic fever 594 Virchow’s method 103 Virgin 353 true and false 355 Virginity, pregnancy and delivery 353, 460 Virginity, principal signs of 354 Virilizing ovarian tumor 80 Virtopsy 98 Viscera containment 111 Viscera, preservation of 113 Visceral injuries 332 Vision, protection of 580 Visual hallucination 404 Vitamin D 510 Vitamin K 515, 611 Vitreous humor 112, 114, 138, 155 Vitreous potassium and hypoxanthine 138 Vitriol throwing ... 26 A 27 B 25 A 24 A 23 C 22 C 21 C 30 C 20 A 29 A & C 19 B 28 A 18 C 24 Immediately after delivery, uterus is at the level of: MP... vi ­ ­ Causes of Impotence and Sterility in Males 346 Review of Forensic Medicine and Toxicology Fig 23 .1: Causes of impotence and sterility in males Causes of Impotence and Sterility in Females... rugae become less marked, and the vagina lengthens into the posterior fornix 354 Review of Forensic Medicine and Toxicology Fig 24 .2: Types of hymen „ „ Causes of Rupture of Hymen When a virgin