Ebook Textbook of forensic medicine and toxicology (2/E): Part 2

(BQ) Part 2 book Textbook of forensic medicine and toxicology has contents: Trauma in its medicolegal view points, forensic radiology, forensic psychiatry, sexual jurisprudence, general principles, cardiac poisons, domestic poisons, irritant poisons,... and other contents.

Medicolegal aspects of injuries are often not taken heed by treating doctor, which may obviously lead to unnecessary legal litigation The various ingredients of this major subdivision which the doctor must better be aware of are: • IPC (Indian Penal Code) sections relevant to injuries • Examination of the injured • Complications of injuries • Injuries of medicolegal importance More emphasis is given to the former two subdivisions in the enumerated list as the latter two are already discussed in depth under relevant chapters (see Chapters 16 to 19) IPC SECTIONS RELEVANT TO TRAUMA Injury (Section 44, IPC) Section 44 defines injury Definition As per this section, injury is defined as any harm whatsoever illegally caused to any person in body, mind, reputation or property Explanation Thus, in the legal sense it is clear that injury can be caused by without touching the body Causing mental agony, damaging the reputation of the person by making false allegation (defamation case), or causing damage/loss of property belonging to another person, etc are also considered as injuries in law Hurt (Section 319, IPC) Section 319 defines hurt Definition Hurt is defined as causing bodily pain, disease or infirmity to a person Examples Pulling hairs of another person to cause pain, transmitting syphilis to the sex partner, or mixing some deleterious substance with food, leading to infirmity (ill health) to the person consuming it, etc are all examples of hurt Grievous Hurt (Section 320, IPC) Section 320 defines grievous hurt Grievous hurt is more serious kind of hurt and is a specific hurt, inflicted voluntarily to another person and comprise of any of the eight kinds (clauses) enumerated below Definition Section 320 designates following list of eight grievous hurt: • Clause — Emasculation • Clause — Permanent privation of sight of either eye • Clause — Permanent privation of hearing of either ear • Clause — Privation of any member or joint • Clause — Destruction or permanent impairment of powers of any member or joint • Clause — Permanent disfigurement of head or face • Clause — Fracture or dislocation of bone or tooth • Clause — Any hurt which endangers life or which causes the sufferer to be, during the period of 20 days, in severe bodily pain or unable to follow his or her ordinary pursuits Chapter 23: Trauma in its Medicolegal View Points 23 Trauma in its Medicolegal View Points Examples and Explanations Emasculation—This means depriving a male, of masculine vigour Accordingly castration, cutting away of penis, etc constitute ideal examples Permanent privation of sight of either eye or hearing of either ear – To be considered as grievous hurt, the loss or privation of sight or hearing has to be permanent Thus, injury which causes loss of vision due to fisting of the eye resulting in oedema, redness it cannot constitute the offence of grievous hurt, as the loss of vision with this injury is only of temporary nature On the contrary, a forcible slap on the left side of face near the ear leading to permanent loss of hearing constitutes an ideal example for the offence of grievous hurt (Note: Permanent does not mean that, it should be incurable For example, when the loss of sight is due to corneal opacity due to some injury over corneas, it is curable by corneoplasty But, since corneal opacity due to scarring resulting from an injury is permanent by itself, it will be considered grievous hurt and chance of cure by corneoplasty does not minimize its gravity) Privation of any member or joint – Privation of joint means cutting away of one limb or joint, which needs no explanation Destruction or permanent impairment of powers of any member or joint – This is self explanatory However, any injury leading to impairment of powers of any joint or member form an ideal example to constitute this offence Permanent disfigurement of head or face – Accordingly cutting the nose, ears or a deep wound on the cheek leading to an ugly scar, etc which brings about permanent disfigurement changes constitutes some of the examples This means, minor injuries on the face not come under this section 329 Part IV: Clinical Forensic Medicine Note: However, when we consider disfigurement factor, grievousness may not be same in all persons An irregular small, permanent scar on the face of a young unmarried girl or a stage or cinema actress may be considered as grievous hurt, because this may affect her life and career as well as livelihood, most adversely But, such a scar in an old woman may not be considered for the purpose of this offence to have disfigured her face as her face may be already having multiple creases and other scars due to aging Fracture or dislocation of bone or tooth: This is considered as grievous hurt (irrespective of size or extent), because it can cause great pain and suffering to the injured Bone need not cut through and through or crack need not extend to the whole thickness of bone Partial cut of the bone or fracture of outer table alone as with the fracture skull, come under this clause Note: However, dislocation of bone may not be a feature to persist for long but dislocation of tooth may retain the feature for considerably long period or may even be a permanent feature when the dislocated tooth falls off Eighth clause: Under this clause hurt which endangers life, meaning injury which may or may not be likely to cause death in ordinary course of nature, irrespective of whether treatment is given or not As regards severe bodily pain, it is correct that, one or two bruises or abrasions may not be considered as grievous hurt However, multiple bruises and abrasions involving excessive body surface may amount to grievous hurt, in a way causing severe bodily pain or even endangering the life Thus, only if the injury causes danger to life of the patient, it becomes grievous The phrase “unable to follow his ordinary pursuit” for 20 days means the person is unable to go to the toilet by himself, taking bath himself, or taking food himself, for 20 days Ordinary pursuits also mean those activities by which a person earns his livelihood (e.g a taxi driver cannot earn his livelihood if another person has caused fracture of his upper limb intentionally) Thus to say one is suffering from grievous hurt, mere hospital stay for 20 days is not enough It must be proved that during the stay, he was either in severe bodily pain or unable to follow his ordinary pursuits Punishment for Hurt and Grievous Hurt Sections 323, 324, 325 and 326 IPC, describe the punishments for hurt and grievous hurt, are given below Section 323, IPC Punishment for voluntarily causing hurt – imprisonment up to one year or with fine up to Rs 1000 or both Section 324, IPC Punishment for voluntarily causing hurt by dangerous weapons or means–imprisonment up to three years or fine or with both Section 325, IPC Punishment for voluntarily causing grievous hurt –imprisonment up to seven years and fine Section 326, IPC Punishment for voluntarily causing grievous hurt by dangerous weapons or means—life imprisonment or imprisonment upto for ten years and fine These two sections create the need for understanding the two terms–dangerous weapon and means causing hurt or grievous hurt 330 Dangerous Weapon Instruments used for shooting, stabbing or cutting or any other instrument which is used as a weapon of offense is likely to cause death, constitute dangerous weapons Means Causing Hurt or Grievous Hurt Fire, heated substances, a poison or corrosives, or explosives, or any substance deleterious to the body to inhale, swallow, or received into the blood or by means of animal constitute means causing hurt or grievous hurt HOMICIDE Homicide means causing the death of one person, by the act of another Homicide is punishable under certain circumstances (culpable homicide) and not punishable under other circumstances (excusable or justifiable) Thus homicide can be lawful and unlawful (Fig 23.1) Each of these is presented below with relevant IPC sections LAWFUL HOMICIDE These homicides which are not punishable and also known as simple homicide are enumerated as follows: • Homicide done by a person of unsound mind (Section 84, IPC) • Homicide by a child below the age of years (Section 82, IPC) • Homicide due to an accident/misfortune (e.g.: firing into a bush thinking that there is a rabbit and accidentally shooting a human being instead) (Section 80, IPC) • Homicide during private defence of body or property, e.g.: personal defence in order to prevent death or rape (Section 100, IPC), or private defence of property (Section 103, IPC) e.g inn robbery • Homicide done as per the order of the court (Judicial hanging) (Section 78, IPC) UNLAWFUL HOMICIDE Culpable Homicide (Section 299, IPC) This is also known as culpable homicide not amounting to murder (Manslaughter in UK) Definition Culpable homicide is defined as causing of death by doing an act: • With an intention of causing death or • With the intention of causing such bodily injury as is likely to cause death or • With the knowledge that he is likely to cause death by such act Examples • Immersing the head of a child under water column proves the intention to cause death • Firing a revolver aimed at the head of another person also proves the intention • Causing multiple injuries resulting in rib fractures, compound fracture of femur, rupture of one kidney, etc shows that the intention to cause bodily injuries are likely to cause death • Over a trivial quarrel in dim light, A threw a knife at B It pierced the chest and caused death of B There was no attempt to cause any more injury Here A had the knowledge that he is likely to cause death by his Act Chapter 23: Trauma in its Medicolegal View Points Fig 23.1: Murder: Different types and punishments Explanation: This Section says that if death is caused by bodily injury, the person causing it shall be deemed to have caused death even if death could have been prevented by restoring to proper skillful treatment (Proper remedy and treatment may not be within the reach of the wounded man Even if proper treatment is present, he may refuse to get it In such cases if the wounded man dies, the person who caused the injury is deemed to have caused the death) Punishment for Culpable Homicide Not Amounting to Murder (Section 304, IPC) • Life imprisonment or imprisonment up to 10 years and fine if the act by which death is caused is done with the intention of causing death or such bodily injury as is likely to cause death • Imprisonment up to 10 years or fine, or both if the Act is done with the knowledge that it is likely to cause death Murder (Culpable Homicide Amounting to Murder) (Section 300, IPC) Causing death by an Act done: • With the intention of causing death/kill Example – Stabbing on the heart with a dagger • With the intention of causing such bodily injury as the offender knows to be likely to cause death Here the assailant knows about the state of ill health of the victim and that the injury caused is likely to cause death in such a state of health, even though such an injury would not ordinarily have caused death of a healthy person Example – A hits over the area of spleen on the abdomen of B knowing fully well that it is enlarged and thus, rupture it • With the intention of causing such bodily injury, as is sufficient to cause death in the ordinary course of nature Here, as a result of the intentional act causing injury, the probability of death is very high (If the probability of death is lesser, then, it is an injury which is likely to cause death – refer culpable homicide not amounting to murder) Thus a stab injury into a vital organ like heart or a major blood vessel is sufficient to cause death in the ordinary course The intention to cause injury, which is sufficient in the ordinary course of nature to cause death, is absolutely necessary for making the offence of murder If during a struggle, the accused merely swing his knife towards the leg of the victim and by a misfortune a blood vessel of the leg was cut leading to death of the victim, the offence cannot be called as murder, as there was no intention to cause death or to cause an injury, which is sufficient in the ordinary course of nature to cause death (At the most, we can say that the accused had an intention to cause merely an injury on the leg) It is true that the injury caused was sufficient to cause death in the ordinary course as a major blood vessel was cut; however, the accused did not have the intention to cause it Hence, his crime will fall under culpable homicide not amounting to murder • With knowledge that the act is so imminently dangerous that it must in all probability cause death or such bodily injury as is likely to cause death Here the accused is presumed to have known that his act is imminently dangerous Example – Inflicting serious injury on the neck with an axe or chopper, firing a gun into a crowd, etc Exceptions: Five exceptions are given in Section 300 IPC, whereby, culpable homicide will not become murder, and they are: i Causing death by grave and sudden provocation: Example – husband finds his wife in bed with her paramour unexpectedly He kills the man then and there The offence is only culpable homicide and not murder ii Causing death by exceeding the right of private defence: Example – A slapped B on his cheek B stabbed A on the heart, and caused his death Here B had exceeded his right of private defence of body So he is guilty of only culpable homicide 331 Part IV: Clinical Forensic Medicine iii Public servant exceeds the powers given by law and causes death Example – Police constable accompanying the convicted person (on the way to court) kills him by firing revolver when the convict tried to escape from custody iv Death caused without premeditation in sudden flight, in the heat of passion Example – Room mates (friends) get involved in a sudden flight on some trivial matter and one gets killed If there was sufficient time for passion to subside and reason to interpose, the killing will become murder So suddenness of the flight is important v A person aged above eighteen years suffers death or takes the risk of death with his own consent Example – A doctor gives some poison to a cancer patient, who, due to the pain and suffering, pleads for it and thus death ensues (mercy killing) Differences between Grievous Hurt, Culpable Homicide and Murder The line between grievous hurt and culpable homicide not amounting to murder is very thin In the former, the injury should endanger life and in the latter, the injury must be of the nature which is likely to cause death Thus, if the culpable homicide is genus, murder is a species All murders are necessarily culpable homicides but not the vice versa The Penal Code recognises three degrees of culpable homicide in order to fix punishment proportionate to the gravity of offence.1-15 Culpable homicide of first degree – the gravest form of culpable homicide also called as ‘murder’ (Section 300, IPC) Culpable homicide of the second degree – punishable under the first part of Section 304, IPC Culpable homicide of the third degree – lowest form of culpable homicide punishable under the second part of Section 304, IPC Mental Elements in Culpable Homicide The offence of culpable homicide supposes an ‘intention’ or ‘knowledge’ of likelihood of causing death In the absence of such intention or knowledge, the offence committed may become grievous hurt or hurt, even if death is caused Thus, if death is caused by an injury, which the offender did not know would endanger life or would be likely to cause death, it is treated as only grievous hurt or simple hurt But, if the act was deliberate, and was not the result of an accident, rashness or negligence, then it becomes culpable homicide Case law: In the course of an altercation on a dark night, the accused ‘A’ aimed a blow at ‘B’ with a stick To ward off the blow, the wife of ‘B’ who had a child in her arm, intervened between ‘A’ and ‘B’ The blow missed its aim and fell on head of the child, who died due to head injury In this case, the accused was held guilty of simple hurt only (He had the intention to cause hurt only on ‘B’ it was not a violent blow intended to cause death (culpable homicide) or endanger life (grievous hurt) Thus, the Court approaches the problem in three stages: Was death caused by the act of accused another parson? (i.e is it a homicide?) Was it culpable homicide? (i.e it is not coming under any of the exceptions mentioned under Lawful homicide) a If the act does not come under any one of the four clauses under Section 300, IPC, it will only be culpable homicide not amounting to murder 332 b If the act comes under any of the four clauses of Section 300, IPC, but, at the same time, it comes under any of the five exceptions (refer above) given under Section 300, IPC, then again, it is culpable homicide not amounting to murder c If the act comes under any one of the four clauses in Section 300, IPC, and does not fall under any of the five exceptions mentioned in Section 300, IPC, it becomes murder Injury likely to Cause Death and Injury Sufficient to Cause Death in the Ordinary Course of Nature: (Refer above) Punishment for Murder (Section 302, IPC) – death or imprisonment for life and fine Rash or Negligent Homicide (Section 304 A) If death of a person is caused by any rash or negligent act, not amounting to culpable homicide, the punishment is imprisonment up to years, or fine or both Rash and Negligent Act Here, the person doing the act is conscious that a dangerous consequence may follow; however he hopes that it may not result in that particular case e.g.: Penicillin injection given without a test dose But since the doctor had no intention to cause death, it is not considered as culpable homicide It may be noted that he would be charged for criminal negligence under this section Section 336, IPC Deals with rash and negligent act endangering human life or personal safety of others (up to months imprisonment or fine up to Rs 250 or both) Here punishment is given even though no harm is actually caused Rash act means, something more than mere inadvertence or want of ordinary care It implies an indifference to obvious consequences For example, a doctor may give penicillin injection without doing a test dose, knowing fully well the consequences of penicillin reaction, but neglecting to test It is typical example of a rash act If the patient suffers a reaction because of it, Section 335, IPC, is applicable If the patient dies due to it, Section 304A IPC comes in play Section 337, IPC Rash and negligent act leading to hurt caused to another person (up to months imprisonment or fine up to Rs 500 or both) Section 338, IPC Rash and negligent act leading to grievous hurt caused to another person (up to years imprisonment or fine up to Rs 1000 or both) Abetment of Suicide (Sections 305, 306, IPC) It is also considered as unlawful homicide, since the accused is abetting or aiding the victim in committing suicide It may be noted that if the person who wants to die asks another person to kill him, then it becomes culpable homicide only (i.e by consent) • Punishment for abetment of suicide (Section 306, IPC): the person abetting the suicide of another person shall be punished with imprisonment up to 10 years and shall also be liable to fine • Attempt to commit suicide (Section 309, IPC): If any act towards the commission of suicide is done, the punishment is imprisonment up to one year, or fine, or both EXAMINATION OF AN INJURED1-5 Any case of injury is a potential medicolegal issue When a case of injury is referred, normally the doctor will concentrate on providing all the best services as to save the life of the victim However, an equally important entity that has to be taken into consideration at this juncture is the medicolegal management of the case Usually this remains unattended and ignored unintentionally by the doctor mainly due to lack of knowledge about the same A schematic representation on managing trauma case is shown in Figure 23.2 MEDICAL MANAGEMENT Medical management is mainly the treating clinician’s concern and includes the following four steps: • Save life • Proper diagnosis (use all available laboratory diagnostic aid) • Proper treatment • Hospitalisation if necessary Medicolegal Management Medicolegal management includes specific and general measures I • • • • Specific Measures Consent for the examination of the injured Informing the police (Appendix-1) Confidentiality of medical examination findings of the patient If the patient is conscious, ask him as to how the injury was caused Record it in patient’s own words If the patient dies later, it will be accepted as dying declaration by the court If the injured is unconscious, ask the friends/ relatives accompanying him In such cases, it must be mentioned in the wound certificate (i.e as informed by the relatives/ friends) Fig 23.2: Managing a trauma case II General Measures Prepare, preserve and maintain the following documentary requirements • Accident register/wound register (Appendix-2) • Case sheet, date, time of examination and observations noted • Special reports or other laboratory test reports • Hospital discharge certificate (Appendix-3) • Dying declaration – whenever death is likely to occur • Death certificate – is not issued unless postmortem examination is completed In doubtful circumstances • Consult a professional colleague available nearby • Refer standard textbook • Refer the case to another hospital with better facilities (Appendix-4) • Perform the clinical and other essential medical investigation procedure as available to confirm the diagnosis, e.g radiographic examination in suspected case of fractures Chapter 23: Trauma in its Medicolegal View Points Dowry Death (Section 304 B, IPC) When death of woman is caused within seven years of her marriage and it is shown that soon before her death she was subjected to cruelty or harassment by her husband or any relatives of the husband for, or in connection with any demand for dowry such husband/ relative shall be deemed to have caused her death The punishment for such dowry related death is imprisonment for not less than seven years, but may be extended to life imprisonment COMPLICATIONS OF INJURIES Injuries of Medicolegal Importance This includes certain specific injuries2,3,4,7-15 (refer Chapters 16 to 19 for details), and are as follows: Hesitation cuts Defense wounds/cuts Self-inflicted wounds (fabricated wounds) These are wounds inflicted by oneself on his/her own body for false accusation purposes, e.g artificial bruises Crush syndrome It constitutes multiple injuries, as seen with road traffic accidents and such other cases, wherein death may result due to renal failure Concealed punctured wound Head injuries—following head injuries are important medicolegally: i Coup and contrecoup injuries ii Cerebral concussion iii Cerebral compression iv Lucid interval Homicide and suicide Injuries and volitional acts Fatal wound—if an injury is present on a cadaver, then the question arises as to whether the injury could have been fatal in the normal course, if death is a result of this injury or could he have died of some other cause If the victim dies after the injury and has no other cause detected to account for death, then we can conclude it as fatal wound Injury to vital organs can also be opined as fatal wounds When many injuries are present, opinion can be given as death is due to cumulative effect of all injuries, e.g multiple contusions When complication of wound results death is confirmed by meticulous autopsy and opinion should be given as “deceased died because of the complications of the wounds sustained.” 10 Necessarily fatal Injuries (imminently fatal Injuries)—Injuries that end in death as a direct result of the injury irrespective of any medical aid constitutes necessarily fatal injury Some examples – crush injury to head, decapitation, and separation of body into two or more fragments (railway accidents) 333 Part IV: Clinical Forensic Medicine 11 Injuries likely to cause death and Injuries sufficient in the ordinary course of nature to cause death—The former is given in the definition of culpable homicide (Section 299 IPC) and the latter in the definition of murder (Section 300 IPC) The distinction between the two is fine but real In fact it is the degree of probability of death, which makes the distinction ‘Likely to cause death’ means that it is not just a possibility, but it is probable ‘Injury sufficient to cause death in ordinary course’ denotes that death will be the most probable result of injury in ordinary course In ‘Likely to cause death’, death is not a surprise Some examples are: • A blow from the front by a stick on the head causing scalp contusion and concussion; • Multiple contusions over the body 12 In Injury sufficient to cause death in ordinary course – survival of the victim is surprise Some of the commonly encountered injuries which can be quoted as examples are: • A stab wound or rupture of heart; Injury to large blood vessels; • Stab on the chest/abdomen; • Blow on the head with an iron rod causing comminuted fracture of skull, intracranial hemorrhages and laceration of brain • Incised wound of the neck – as such is not an injury sufficient to cause death Unless the major neck vessels and trachea are cut, this is only an injury which endangers life, i.e grievous hurt • Squeesing of the testicles–as such is not an injury sufficient to cause death Unless the major vessels are cut, it is only an injury which endangers life, i.e grievous hurt; • Burns > 1/3rd of the body surface; • Administration of large dose of poison APPENDICES Appendix 1: Police Intimations Given below is the standard format of Police intimation letters giving information about a Medico-legal Case (e.g Road Traffic Accident Case, Unnatural Death Case, Brought Dead Case, Dead on Arrival to Hospital Case, etc.) to the Police It is the duty of the medical officer (DMO) to inform about all such cases to police as any other citizen, which, if not done amounts to suppression of evidence and is punishable Details of death may be informed to the nearest police station by phone, followed by a written intimation in specific format given below Medicolegal Case Police intimation letter on a medicolegal case is drafted as shown below: Ref No: Place: Date: Time: From: Name of MO Designation Name of Institution/Hospital Address To: The Sub-Inspector of Police Name of Police Station Address Sir, I write to inform you that a patient by name aged about inhabitant of (Address) ……………………… has been brought into the casualty/ outpatient department (OPD) of … … Hospital, at AM/PM On …… is alleged to have been .……………… at ….…… AM/PM at (place) .…………………………………………………………………… He/she is being treated as outpatient/inpatient in Ward No ………………… Please the needful Yours faithfully Signature Name Reg No Designation Address 334 Official Seal The doctor who attends the injured patient usually has to record the details of the injuries found, in the Accident-Register-cum-Injury or Wound Report/Certificate The duty doctor should keep this register under safe custody The forms in the register are arranged in duplicates making a carbon copy The original of the Injury or Wound Report/Certificate, is to be detached and issued to the Police Officer The carbon copy will remain in the register and serve as a permanent record for the Medical Officer The standard formats of the accident register and injury/wound certificate are given below: Accident Register Serial No Date and hour of examination: Name: Age: Sex: Address: Marks of identification a ……………………………………………………………… b ……………………………………………………………… Brought by: History and alleged cause of injury Details of injuries/clinical features No of additional sheets, if any Is dying declaration required? 10 If yes, whether Police/Magistrate is informed? 11 Investigation result, if any 12 Date of admission as inpatient and IP No 13 Date of discharge 14 Condition on discharge 15 Opinion as to cause of injury Name of Institution Signature of DMO* Station Name of DMO Chapter 23: Trauma in its Medicolegal View Points Appendix 2: Injury/Wound Report Registration No: Date Designation Address: Official Seal Issued to of Police Station, as per his requisition No Dated * Duty Medical Officer (DMO) Injury Report Also known as Injury Certificate/Wound Certificate Ref No.: …………… Place: ……… Date: ………… Time: ………………… Name: …………………………………………………… Age: …………… Sex: … …………… Address: …………………………………………………………………………………………… ………………………………………………………….………………………………… ……… Brought and Identified by the Police: Constable No Name: of Police Station Informed Consent: Question asked …………………………………………… …………………… .…………………………………………… Reply given …………………………………………… …………………… .…………………………………… 335 Part IV: Clinical Forensic Medicine Signature/Left hand thumb impression of consenting person: Marks of Identification: …………………………………………… …… …………………………………………… …… Brief history: …………………………………………………………………………………………… General Examination: Details about the injury/wounds S.No Type Size—Dimensions Other aspects Location Simple or grievous Kind of causative weapon Time since injury Other remarks Name & Signature of DMO: Designation: Reg No.: Official Seal: Appendix 3: Discharge Certificate Issuing a Discharge Certificate of an injury case registered as medicolegal is very important It may be drafted as below and sent to the concerned Police authority: Hospital Discharge Certificate Ref No From Name of MO Designation Name of Institution Station To The SI of Police Address of Police Station Sir, In continuation of wound certificate No dated I have informed you that Sri/Smt/Kum .……………………………………… aged ……… … was admitted on … in our hospital, IP No .……………… He/she is discharged/cured/relieved on .…… Given below are further comments about the case: a X-ray and other special investigations ………………………………………… b The following surgeons and specialists were concerned in the treatment of the case c Other relevant information … .…… Place ………… Name & Signature ……… Date ………… Registration No .………… Designation & address ……… Official Seal: 336 For referring injury cases it is better to observe following formalities: All medicolegal (injury) cases brought to a hospital should be examined by the Medical Officer first and treatment given However, if the patient is to be shifted to another hospital due to want of adequate facilities for treatment in the first hospital, necessary first aid should be given by the Medical Officer who examined the patient first A copy of the accident register/wound certificate should invariably accompany the patient referred to the next institution If the injured was admitted and treated in the first hospital and later referred to a second hospital for advance treatment, the Medical Officer of the first hospital should issue the wound certificate to the Police Officer so that it can be produced before the Medical Officer in the second hospital who continues the treatment of the injured Discharge certificate is issued by the attending doctor of the referral hospital (As in Appendix-3) REFERENCES Chandran MR (Ed) Guharaj’s Forensic Medicine Orient Longman: India, 2004 Rao NG Practical Forensic Medicine (3rd edn) Jaypee brothers medical Publishers Ltd, New Delhi, 2007 Nandy A Principles of Forensic Medicine, Reprint edn New Central Book Co., Kolkata, 2002 Mathiharan K, Patnaik AK (Eds): Modi’s Medical Jurisprudence and Toxicology (23rd edn) Lexis Nexis Butterworth’s 2006 Mukharjee JB Forensic Medicine and Toxicology Arnold: Kolkata, 1995 Krishnan MKR Handbook of Forensic Medicine and Toxicology Kothari Books: Hyderabad, 1992 Major Criminal Acts, Athul Law Agency: Allahabad, 1989 Indian Penal Code (Act No: XIV of 1860 as amended, 1988), Central Law Agency: Allahabad, India, 1989 Chandrachud YV, Manohar VR, Avtar Singh, Ratanlal, Dhirajlal The Indian Penal Code (Act XLV of 1860), (30th edn) (Thoroughly Revised and Revitalised), Wadhwa and Co Nagpur, New Delhi, 2004 10 Chandrachud YV, Manohar VR, Avtar Singh The Code of Criminal Procedure (Act II of 1974), (17th edn) (Thoroughly Revised and Revitalised), Wadhwa and Co Nagpur, New Delhi, 2004 11 Parikh CK Parikh’s Medical Jurisprudence and Toxicology for Courtroom and Classroom (6th edn) CBS Publishers: Mumbai, 2002 12 Rao NG Forensic Pathology (6th edn) HR Publication Aid: Manipal, 2002 13 Rao NG Clinical Forensic Medicine, HR Publication Aid: Manipal, 2004 14 Sukho P (Ed) B Knight’s Forensic Pathology, (3rd edn) Arnold: London, 2002 15 Eckert W Transportation injuries In Tedeschi L, Eckert WB (Eds): Forensic Medicine WB Saunders: Philadelphia, 1977 Chapter 23: Trauma in its Medicolegal View Points Appendix 4: Referring an Injury Case to Second Hospital 337 Part IV: Clinical Forensic Medicine 24 Domestic Violence— Medical and Legal Aspects INTRODUCTION Synonyms for domestic violence include partner violence, relationship violence, and intimate partner abuse, spouse abuse, domestic abuse, and wife abuse, wife beating, and battering Domestic violence is also described as a “pattern of interaction” in which one intimate partner is forced to change his or her behavior in response to the abuse or threats of the other partner Domestic violence is considered to have occurred when one intimate partner uses physical violence, coercion, threats, intimidation, isolation, and/or emotional, sexual, and economic abuses over the other intimate partner to maintain power and control Domestic violence refers to the victimisation of a person with whom the abuser has or has had an intimate, romantic, or spousal relationship Domestic violence encompasses violence against both men and women and includes violence in gay and lesbian relationships.1,2 DEFINITION The domestic violence in India is defined by the Protection of Women from Domestic Violence Act 2005 Accordingly, the term domestic violence includes elaborately all forms of actual abuse or threat of abuse of physical, sexual, verbal, emotional and economic nature that can harm, cause injury to, endanger the health, safety, life, limb or wellbeing, either mental or physical of the aggrieved person The definition is wide enough to cover child sexual abuse, harassment caused to a woman or her relatives by unlawful dowry demands, and marital rape 338 or adolescent These behaviors, which can occur alone or in combination, sporadically or continually, include three types:3 • Physical violence, • Psychological abuse, and • Nonconsensual sexual behavior Each one is discussed individually However, it may be noted here that, each incident builds upon previous episodes, thus setting the stage for future violence Physical Violence Among the variety of physical violence observed, pushing, shoving, slapping, punching, choking, kicking, holding, binding, assault with weapons are frequent Usually two forms of physical violence have been noticed at home and they are: occasional outbursts of bidirectional violence (i.e., mutual combat) and frank terrorism.4 According to United States of America Preventive Services Task Force survey among the frank terrorist type patriarchal (male dominating) form of domestic violence, is more prevalent.5 INCIDENCE Domestic violence affects people from all races, religions, age groups, sexual orientations, and socioeconomic levels Victims/ persons of domestic violence are mostly women and they usually belonging to one of the following three categories: Single and legally divorced, recently widowed, recently separated, recently sought an order of protection, younger than 28 years of age, addicted to alcohol or other drugs, pregnant, having excessively jealous or possessive partners Witnessed or experienced physical or sexual abuse as children Have partners who have witnessed or experienced physical or sexual abuse as children Psychological Abuse This includes threats of physical harm to the patient or others, intimidation, coercion, degradation and humiliation, false accusations, and ridicule Annoyance may occur during a relationship, or during and after a relationship has ended Of women who are stalked by an intimate partner, 81 per cent are also physically assaulted A new development is psychological abuse (generally threats) expressed through the Internet, so-called cyberstalking Usually the Cyberstalkers target their victims through chat rooms, message boards, discussion forums, and e-mail Cyberstalking takes many forms such as: threatening or obscene e-mail; spamming (in which a stalker sends a victim a multitude of junk e-mail); live chat harassment or flaming (online verbal abuse); leaving improper messages on message boards or in guest books; sending electronic viruses; sending unsolicited e-mail; tracing another person’s computer and Internet activity, and electronic identity theft.7,8 Recent federal law has addressed cyberstalking as well The Violence Against Women Act passed in 2000, made cyberstalking a part of the federal interstate stalking statute in USA.9 MEDICAL ASPECTS OF DOMESTIC VIOLENCE Domestic violence consists of a pattern of coercive behaviors used by a competent adult or adolescent to establish and maintain power and control over another competent adult Sexual Abuse This may include nonconsensual or painful sexual acts (often unprotected against pregnancy or disease) Sexual abuse under domestic violence is said to have occurred when any one of Textbook of Forensic Medicine and Toxicology Sec 350 IPC defines “Criminal force” Criminal force means force used intentionally without consent of the person on whom the force has been used, to commit an offence or with intention or knowledge that such use of force is likely to cause injury, fear or annoyance to the person Sec 351 IPC This section defines assault Whoever makes any gesture, or preparation intending or knowing it to be likely that such gesture or preparation will cause any person present to apprehend that he who makes that gesture or preparation is about to use criminal force to that person, is said to commit an assault Sec 353 IPC Punishment for causing assault or using criminal force to deter public servant from discharge of his duty shall be imprisonment of either description for a term which may extend to years and or fine Sec 354 IPC Punishment for causing assault or using criminal force to a woman with intent to outrage her modesty shall be imprisonment of either description for a term which may extend to years and or fine Sec 355 IPC Punishment for causing assault or using criminal force with intent to dishonour a person otherwise than on grave provocation—up to years imprisonment of either description and or fine Sec 356 IPC Punishment for causing assault or using criminal force in attempt to commit theft of property carried by a person— up to years imprisonment of either description and or fine Sec 357 IPC Punishment for causing assault or using criminal force in attempt to wrongfully confine a person—imprisonment of either description up to year and or fine up to one thousand rupees Sec 358 IPC Punishment for causing assault or using criminal force on grave provocation—simple imprisonment up to month and or fine up to 200 rupees OFFENCES RELATED TO CAUSING HURT AND DEATH DURING ROBBERY OR DACOITY (Sections 394, 396, 397) AND CRUELTY TO MARRIED WOMEN (Section 498-A) Sec 394 IPC Punishment for voluntarily causing hurt in committing robbery shall be imprisonment for life or with rigorous imprisonment for a term which may extend to 10 years with or without fine Sec 396 IPC Punishment for causing dacoity with murder shall be death or imprisonment for life or rigorous imprisonment for a term which may extend to 10 years with or without fine Sec 397 IPC Punishment for committing robbery or dacoity with attempt to cause death or grievous hurt—shall be minimum years imprisonment Sec 459 IPC Punishment for causing grievous hurt whilst committing lurking house, trespass or house-breaking shall be imprisonment for life or imprisonment of either description for a term which may extend to ten years with or without fine Sec 498-A IPC Punishment for the husband or relative of husband of a woman subjecting her to cruelty, shall be imprisonment for a term which may extend to years with or without fine 596 Indian Evidence Act, 1872 This act deals with the evidences and describes the procedure of collection, preservation and presentation of evidence in the court and also lays down punishment for failure of collection/ preservation of evidence or concealment of evidence/damaging the evidence CPC (Code of Civil Procedure), 1908 It regulates civil proceedings and includes Law of Fort (Medical negligence) Workmen’s Compensation Act, 1923 This act provides for payment of compensation by the employer to the employees for suffering any injury or disability or disease resulting from accident or occupational hazards during the course of delivery of duty The amount of compensation is related to the degree of disability, extent of injury or nature of the decease Compensation is paid on the basis of, whether the disability is permanent or temporary and also the degree of disability whether total or partial In case of partial disability, its percentage is counted in terms of extent of loss of function of different parts or systems of the body If death of worker occurs resulting from accident or occupational hazard, compensation is paid to the legal heir and dependent family members of the deceased To be entitled for compensation, conduct of employee needs to be proved not responsible for the accident or hazard For example, if an employee sustains injury while working with machine under the influence of alcohol, he or she may not get compensation for the accident or injury The role of a doctor is very important to assess the degree of disability or harm suffered by the worker from the occupational sources The Mines Maternity Benefit Act, 1941 This act provides maternity leave and other benefits for the female workers of the mines Employees’ State Insurance Act, 1948 This act provides a scheme of compulsory health insurance for industrial workers and managed by the Medical Benefit Council It provides for the establishment and maintenance of hospitals and dispensaries and maternity centres The insured employer is entitled to sickness cash benefit, maternity benefit, disablement and dependant benefit and medical treatment The cost is met on tripartite basis i.e by employer, employee and state Person to whom dependant benefit is payable requires to obtain the death certificate of deceased issued by the attending Insurance Medical Officer Insurance Medical Officer requires to fill up the Medical Certificates in prescribed forms provided as per this Act Factories Act No 63 of 1948 As per provisions of this act, registered medical practitioners are appointed to inspect and supervise the factories to ascertain whether the factory is liable to create any health hazard and also to certify the health of workers A child below the age of 14 years cannot be employed in a factory Above the age of 14 years and below 18 years, a person can be employed in a factory provided a certificate of physical fitness is obtained from the medical officer Such a fitness certificate is issued for a period of year at a time and may be renewed annually or may be revoked depending on the effect of the job on the health of the young employee India which refers the case to Medical Council of India and the decision of the Medical Council of India ultimately settles the case The Plantation Labour Act, 1951 The provisions of this act in connection with appointment of young workers and medical supervision of plantation labours are similar to Indian Factories Act No 63 Consumer Protection Act (COPRA/CPA), 1986 The main purpose of the Act is to provide simple procedure and speedy remedies for suffering patient/party and enables a consumer patient to make complaint to the appropriate Redressal Forum in respect of defective service of the doctor provided that the service has been paid for The Indian Medical Council Act, 1956 As per provisions of this act, Medical Council of India and also the State Medical Council for the State are constituted Medical Council of India is concerned with maintenance of medical education, recognition of medical qualifications and degrees conferred by the recognized institutions inside the country and also the medical degrees of foreign countries on reciprocal basis, and maintains the register of registered medical practitioners and prescribes code of conduct and ethics for the medical practitioners, violation of which makes the doctor liable for appropriate action The State Medical Council maintains the medical register including the names of registered medical practitioners of the State and exerts disciplinary control over the medical practitioners Issuing of warning notice, reprimentation and also penal erasure of name of registered medical practitioner found guilty of infamous conduct fall under the purview of State Medical Council Medical practitioner punished by the State Medical Council can appeal to the Ministry of health, Government of The Medical Termination of Pregnancy (MTP) Act, 1971 The Act provides the conditions for medical termination of pregnancy and insists on strict compliance of prescribed guidelines and lays down the punishment for violation of provisions of the Act Appendices Constitution of India, 1950 Article 21 states that no person shall be deprived of his life or personal liberty except according to the procedure established by law (the fundamental right to life) Article 47 states that it is the duty of the State to raise the level of nutrition and standard of living of its people and to improve public health (this is a Directive Principle) Article 32 gives every citizen the right to ask the Supreme Court to enforce his or her fundamental rights (the right to enforce a fundamental right) Action can be brought to remedy a situation which vidates the right to life Where legal injury is caused to a person or a class of persons who by reason of poverty, disability or socially or economically disadvantaged position cannot approach the courts for judicial redress, any member of public acting in good faith can bring an action before the court seeking judicial redress for them This is an useful tool to initiate proceedings in the Supreme Court or High Court in the form of PIL (Public Interest Litigation) though the applicant is not the actual victim of the harm Cr PC (Code of Criminal Procedure), 1973 This code lays down the provisions and procedure to deal with different crimes and regulates criminal prosecution Narcotic Drugs and Psychotropic Substances Act, 1985 This act repeals the Dangerous Drugs Act 1930, the Opium Act 1957 and the Opium Act 1978 and makes provisions for effective control over the drugs of abuse and prescribes enhance penalties for illicit traffic of Narcotic Drugs and Psychotropic Substances The Mental Health Act, 1987* This Act includes regulatory provisions for proper care and rehabilitation of mentally ill persons Psychiatric hospital or nursing home can be established or run only on obtaining the license from State or Central Authority for mental health services The Transplantation of Human Organs Act, 1994* This Act provides for regulation for removal, storage, and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs and for matters connected herewith or incident thereto The Prenatal Diagnostic Technique Act, 1994* This law was enacted by the Parliament in 1994 to prevent the selective abortion of female foetus and thereby injustice to woman and also to prevent the imbalance of sex ratios The Act prescribes punishments for the abuse of medical techniques for professional gain * For detail particulars of the above Acts/Statutes (except IPC) reader is requested to refer to the concerned ‘Law/Statutes’ 597 Textbook of Forensic Medicine and Toxicology APPENDIX 4: STARVATION AND NEGLECT AND LAW Definition: ‘Starvation’ is defined medically in two parts and that is: the act or process of starving and the condition of being starved, while ‘neglect’ is defined as - to fail to give due care, attention, or time to some one an adult/elderly/a child especially Malnutrition (Synonyms: ‘Cachexia’, ‘emaciation’ and ‘marasmus’): It is better we know about this terminology as well at this juncture This result from deficiency of bodily constituents like proteins, carbohydrates, vitamins/minerals, etc added with partial deprivation of food, qualitatively and/or quantitatively for some period Weight of the body is diminishing gradually as a consequence of loss of carbohydrates, fats and proteins There will be slow wasting of the body fats and muscles and emaciation of the body takes place Rest of the findings in the body will be the same as described under starvation above Cause of death will be usually due to various infections or malnutrition syndromes Some of the metabolic disorders in infants and children may cause wasting and ‘Marasmus’ which may not be diagnosed by autopsy, has to be excluded by medical history if available as it may be a criminal issue in case of intentional neglect by parents/guardians It is better we are aware of another related terminology of legal significance In India, IPC Sections 317 and 318, dealing with ‘Abandoning of Infants’ and ‘Concealment of Birth’, respectively, are the steps to curb this evil Presently, ‘child abuse’ p (physical, sexual and mental) is inviting more attention than starvation and neglect IPC Sections 317 and 318 Section 317: Exposure and abandonment of child under twelve years, by parent or person having care of it Whoever being the father or mother of a child under the age of twelve years, or having the care of such child, shall expose or leave such child in any place with the intention of wholly abandoning such child, shall be punished with imprisonment of either description for a term which may extend to seven years, or with fine or with both Explanation: This section is not intended to prevent the trial of the offender for murder or culpable homicide, as the case may be, if the child dies in consequence of the exposure Section 318: Concealment of birth by secret disposal of dead body Whoever, by secretly burying or otherwise disposing of the dead body of a child whether such child dies before or after or during its birth, intentionally conceals or endeavours to conceal the birth of such child, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both Forced Feeding of a Fasting Prisoner The Law in India is currently vague There are arguments that if the doctor does not force feed the prisoner, he may be sued for abetment of suicide (Section 306 of IPC) On the contrary if the doctor force feeds the prisoner against his wish, he may be sued for using criminal force (Section 350 and 352 of Indian Penal Code A lawyer can argue the case from either side) 598 World Medical Association (WMA) - has however given guidelines to doctors in its Declaration of Tokyo (adopted in 1975 and amended in 2005) and Declaration of Malta (adopted in 1991 and amended in 1992) Declaration of Tokyo basically gives guidelines to physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment Basically both these Declarations respect the autonomy of the patient, and consider very much the opinion that the doctor should not force feed such cases It affirms the facts that: Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially However, the decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician The consequences of the refusal of nourishment shall be explained by the physician to the prisoner In cases of Hunger strikers, role of the doctor is specifically highlighted by Declaration of Malta Argument is that the doctor is indeed under a serious dilemma On one hand, “there is a moral obligation on every human being to respect the sanctity of life This is especially evident in the case of a doctor, who exercises his skills to save life and also acts in the best interests of his patients” and on the other hand “it is the duty of the doctor to respect the autonomy which the patient has over his person A doctor requires informed consent from his patients before applying any of his skills to assist them, unless emergency circumstances have arisen in which case the doctor has to act in what is perceived to be the patient’s best interests.” Following guidelines are given to resolve this conflict: The doctor should ascertain on a daily basis whether or not the patient wishes to continue with his hunger strike The ultimate decision on intervention or non-intervention should be left with the individual doctor without the-mtervention of third parties (such as jailor etc) whose primary interest is not the patient’s welfare However, the doctor should clearly state to the patient whether or not he is able to accept the patient’s decision to refuse treatment or, in case of coma, artificial feeding, thereby risking death If the doctor cannot accept the patient’s decision to refuse such aid, the patient would then be entitled to be attended by another physician (article of the preamble of this Declaration) The hunger striker must be professionally informed by the doctor of the clinical consequences of a hunger strike, and of any specific danger to his own particular case An informed decision can only be made on the basis of clear communication An interpreter should be used if indicated The doctor has a responsibility to inform the family of the patient that the patient has embarked on a hunger strike, unless this is specifically prohibited by the patient When the hunger striker has become confused and is therefore unable to make an unimpaired decision or has lapsed into a coma, the doctor shall be free to make the decision for his patient as to further treatment which he considers to be in the best interest of that patient, always taking into account the decision he has arrived at during his preceding care of the patient during his hunger strike, and reaffirming article of the preamble of this Declaration (Source: Aggrawal A., Self assessment and review of Forensic medicine and toxicology, 1st Ed, Peepee Publishers and Distributors 2006) Clinical Features: In acute starvation, there is a feeling of hunger for the first 30 to 48 hours, followed by pain in the epigastrium After to days of starvation, general emaciation and absorption of the subcutaneous fat begins to occur Before death body has offensive odour Usually the loss of 40% of body weight is fatal Death occurs from exhaustion, circulatory failure due to brown atrophy of the heart, or inters current infection During starvation the substance which heart uses as energy source is aceto acetate If starvation exceeds days then the major nutrition supply of brain comes from ketone-bodies The changes in starvation seen are Hypoglycemia, Hypothermia, Hyper triglyceremia and Keto-acidosis Fatal Period: Death usually occurs in 10-12 days if both water and food are totally withdrawn If food alone is withdrawn, death may occur in 6-8 weeks or even more The period, however, is influenced by number of factors like age, sex, condition and environment of the body Case Report: A 50-year-old Jain woman s successfully completed a lO8-day religious fast She used to have only boiled water during the fast, as t reported Autopsy Findings: It is always advisable to perform radiography prior to autopsy so as to exclude the physical abuse which is often associated with neglect Photography should also be performed In both children and adults, the major problem remains the connection between the cause and effect, especially when some disease is also present External: Body of a victim of starvation death is emaciated and may emit disagreeable offensive odour Eyes are usually dry and open, with sunken eye balls and dilated pupils Malar bones will be prominent as facial contours not maintained due to loss of fat Chest is with sunken intercostal spaces and prominent ribs Abdomen is scaphoid or boat shaped and also sunken Tongue is dry and coated Skin is dry and shrivelled Body fat is wholly deficient Appendices Certain Clinical and Autopsy particulars of starvation are discussed below: Starvation may be the consequence of complete/partial deprivation of regular supply of food It is regarded as ‘acute’ when food and water are suddenly withdrawn as in mines or landslides, in entombment in pits, willful refusal to take food Likewise when there is a gradual deficient supply of food, as in famines and /or in camp conditions constitutes ‘chronic starvation’ The minimum food requirement for an adult weighing 60 kg would be 1800 calories per day Life in a person is at risk when the body weight is lost more than 40% of the original weight Internal: Findings are enumerated as below: General - Fat is absent from subcutaneous tissues and muscles Brain – is pale and soft with congested meningeal vessels (at times) Heart – is small in size with cardiac muscles by and large found flaccid and empty Hear chambers are usually empty, pale and collapsed, and show hypostatic congestion Gastro intestinal tract: Stomach is small, contracted, and empty Mucous membrane of stomach and upper part of intestine is stained with bile Large intestine has hard faecal matter Gall bladder - is unusually distended It contains dark, and filled with dry and inspissated bile Liver - shows necrosis Spleen, kidneys and pancreas - are small and shrunken Urinary bladder - is empty Fatal Period Death occurs in 10-12 days if the person is deprived of both food and water If food only is withdrawn the life is prolonged by 6-8 weeks or even more Factors that Influence Fatal Period Age - Children suffer most Old people require less food; hence can survive the condition for sometime Sex - Females can withstand starvation for a longer period than males because they have more fat and consume less food Condition of body - Fatty healthy people survives more than the lean and weak person Environment of the body - Starvation is well tolerated by persons where activity is less Exertion during starvation hastens death 599 Index Index A Abandoning of Infants 598 Abdominal injuries 255, 299 Abetment of suicide (Sections 305, 306, IPC) 332 Abortion 30, 376 law in India 377 Abrasion 222, 281 Abrus precatorius 473 Absolute identity 65 Absorption 463, 468, 512, 514, 543, 550 Abstinence syndrome 498, 565 Academic autopsy 162 Accelerating injury 243 Acceptance of DNA evidence at legal forum 128 Accident 178, 294 register 335 Accidental exposure 327 hanging 205 Acid bath murder 186 Acid of sugar 455 Aconite 541 Action of hallucinogens in general 563 poisons 419 Activated charcoal 433, 527 Active cooling 310 principle 494, 537 Acts and apprehensions in medical profession 49 Acts of commission 64 omission 64 Actual case of poisoning 440 Acute cocaine poisoning 535 complication of overdose 498 fulminating type 463 intoxication 517 poisoning 460, 464, 495, 505, 515, 535, 551, 556 Adipocere formation 158 Administration of antidote 435, 551 Admission to psychiatric hospital 403 Adult respiratory distress syndrome (ARDS) 270 Adultery 30 Advantages of choking for shotgun 278 using DNA for identification 119 Aetiology of drug dependence 565 Age and identity 67 Age by closure of skull sutures 70 Age factor 225 Age of abrasion 223 bruise 226 finger-print 97 foetus 177 incised wounds 228 victim 238 Agonal artefacts 188 Agrochemicals 522 Air blast hurl injuries 299 disaster trauma 263 embolism 269 pollutants 425 Alavandar murder case 185 Alcohol 30, 502 addiction 507 cardiomyopathy 509 de-addiction therapy 510 detoxification therapy 510 heart 509 ketoacidosis 508 overdose 505 poisoning 505 seizures 508 Alcoholic hallucinosis 508 intoxication 505 psychoses 400 Algor mortis 143 Aliphatic hydrocarbons 555 Aluminium phosphide 529 Ammonia 553 Ammonium carbonate 456 Amniotic fluid embolism 269 Amount of air 180 Amyl nitrite therapy 551 Anaesthetic agents 59 deaths 59 Anal intercourse 371 Ancillary treatment 490 Anhydrous ammonia 456 Anoxia 194 Antemortem injuries 270 Anthropometry 109 Antivenom 489 reactions 489 serum 490 specificity 489 treatment 489 Aphasia 396 Apparent death 143 Appeal against disciplinary action 27 Appearance of Maggots 153 Applicability of psychological autopsy 191 Application of Act 48 Appreciation of artefacts 189 Arm-locks 208 Aromatic hydrocarbons 426, 558 Arson and incendiary fires 416 Artificial bruises 226 insemination 356 Asphyxia 60, 136, 137 Asphyxiants 545, 548 Aspirin 559 Atractaspidae 482 Atropine administration 527 Attendance in court 13 Atypical drowning 214 Authorisation order 163 Autolysis 149 Autopsy and organ transplantation 36 Autopsy evidences of cerebral compression 247 examination 36 case of anaesthetic death 61 of cases of firearm fatalities 292 on body of HIV infection 192 photography 182 procedure 61, 164, 189 Aversion therapy 510 Avulsed laceration 227 Azadirachta indica 480 B Bacterial action 149 food poisoning 561 Baptist church cellar murder 186 Barbiturate addiction 518 automatism 517 Barr and Davidson bodies 84 Basics of molecular biology 120 Battered baby syndrome 391 Beating heart donor 134 Bedside tests 444 Bees 492 Behaviour of doctor in court 21 Benzodiazepines 520 Benzyl-isoquinoline derivatives 495 Bertillon’s system 109 Bertillonage 109 Biomagnification in crops 522 food 522 water 522 Bipyridyl herbicides 428 Blast effect 280 injuries 297 601 Textbook of Forensic Medicine and Toxicology Bleeding into gastrointestinal tract 267 serous cavities 266 soft tissues 267 Blister beetle 491 gases 548 Blood alcohol concentration 503 group typing 369 per vagina 376 urine 438 Bloodless dissection of neck 202 Blow back effect 288 Blue film 375 vitriol 470 Blunt force trauma 222 Body of offence 65 Bone changes 459 impression fracture 238 Botanical insecticides 427 name 494, 541 Brain death 135 finger printing 113 injuries 242, 299 oedema severity score scale 252 Brainstem death 134 reflexes 135 Breach of duty 40 Breslau’s second life test 177 Bromine 461 Bruise 224 Buccal coitus 373 smear 85 Buggary 371 Bullet bruise 284 graze 284 slap 284 Burking 211 Burns 63, 174, 315, 316 injuries 299 C Cachexia 598 Cadaveric entomology 153 rigidity 146 spasm 148 temperature 143 Caffey syndrome 391 Calibre of gun 276 shotgun 277 Calotropis 477 Cannabis 532 addiction 533 preparations 532 psychosis 400 Cantharides 491 Capsicum annum 478 Carbamate insecticides 427 602 Carbamates 528 Carbolic acid 453 Carbon dioxide 547 monoxide 426, 545 Cardiac arrest 60 dysfunction 509 poisons 539 Cardiovascular effects 517 system 140, 497 Care of technical staff 189 Cartridge of gun 276 shotgun 278 Cases of vagal inhibition death 202 Castor oil plant 475 Cataleptic rigidity 148 Catharsis 434 Cathartics 527 Cause of death 60, 138, 155, 195, 211, 294, 315, 323, 389, 441, 451, 505 Cellular death 134 Centipedes 491 Central nervous system 497, 517, 551 Centroid method 415 Cephalic index 93 Cerbera thevetia 541 Cerebral compression 246 concussion 244 contusions 246 death 134 irritation 246 laceration 246 neurotoxics 494 oedema 251 Changes after death 142 Changes in biological fluids 157 gastrointestinal and urinary tract 157 heart 218 hymen after rupture 352 lungs 385 sacrum and vertebrae 79 Charaka’s Oath 23 Cheiloscopy 100 Chelating agents 436 Chemical analysis 62, 513 antidotes 436 asphyxiants 545 constituents in firearm ammunitions 275 state of poison 420 test 451, 466 Chemistry of fire 415 Cherry red discolouration 281 Chief judicial magistrate (CJM) Child abuse 382 sexual abuse 393 Chloral hydrate addiction 515 Chlorinated hydrocarbons 426, 523 Chlorine 461 Chloroform 514 Chlorophenoxy herbicides 427 Choking gases 548 Chop lacerations 232 wounds 232 Chronic alcohol poisoning 507 intoxication 518 poisoning 460-462, 470, 471, 515, 521, 546, 556 type 465 Circulatory arrest 143 Circumstances of poisoning 498 Civil malpractice 37 negligence 37 responsibilities 404 Classification of abrasions 222 bruises 224 burns 313 drowning 214 finger-print pattern 95 guns 276 hanging 195 laceration 227 poisons 419 rifled firearms 276 shotguns 278 skull fracture 238 snakes 482 strangulation 206 STRS 124 Clinical death 133 effects of asphyxia 195 features of asphyxia 136 fracture skull 241 management of poisoning 428 toxicology 419 Close shot range 281 Closing body 172 Cocaine 534 bugs 536 intoxication cases 535 psychoses 400 Cocainism 536 Code of medical ethics 25-27 modern medical ethics 23 Coitus per oris 373 Colchicum autumnale 480 Cold stiffening 148 turkey 498 Collecting foot-print impression left in soil 97 Collection of blood sample for chemical analysis 547 viscera 438 Colliquative putrefaction 153 Colour changes of skin 150 Colour of postmortem lividity 145 skin 225 Colour tests 444 Colubridae 482 Coma 137 Combination of methods 416 Crushed fracture 239 Crushing abrasion 223 CT scan features 252 Culpable homicide 330-332 Cut fracture 240 Cyanide 550 Cyanogen 550 Cytogenetics and DNA analysis 86 D Dactylography 94 Dactyloscopy 94 DAI and biochemical cascades 245 Dangerous weapon 330 Dangers of rape 362 tourniquets 488 Datura 530 Dead bodies recovered from railways track 189 born child 177, 383, 384 Dealing with conscious patients 429 unconscious patient 429 Death clutch 148 Death due to anaesthesia and anaesthetic agents 59 burns 313 factors other than anaesthesia 60 fire 313 Death from hanging 206 Death occurring within few days 315 hours 315 Death on operation table 63 Decelerating injury 243 Declaration of Tokyo 598 Declaration of Malta 598 Deeper bruises 226 Definition of asphyxia 194 death 133 torture 345 Deflagrating explosion 418 Defloration 354 Deformities 105 Degree of toxicity 485 Delayed deaths 546 Deliberate mutilation 189 Deliriant poisons 494 Delirium 396 tremens 508 Delivery 359 Delusion 396 Dementia 399 Demonstration of air embolism 179 pneumothorax 180 thrombi in calves 181 Dentition 68 Deoxyribose nucleic acid 119 Depressed fracture 238 Derivatives of phosphorus 459 Dermatoglyphics 94 Destruction by animals 156 Detection of DNA 130 semen 367 Determination of stature 104 Detonating explosion 418 Development of Y-chromosome specific STR systems 129 Diagnosis of brainstem death 135 mental illness and certification 401 paternity 360 poisoning 428, 437 syndrome 391 Diagnostic criteria 499 findings 373 formulation 402 Diaphoresis 435 Diastactic fracture 239 Diastasis 239 Diatom test 218 Diffuse axonal injury 245 neuronal injury 245 Direct restraint 403 Direction of firing 294 wound 228 Disadvantages of superimposition technique 112 Discharge certificate 336 Discharge of mentally ill from psychiatric hospital 403 Disciplinary control 28 enquiry 28 Dishwashing powders and granules 558 Dismemberment by criminals 189 Disorder of mind and behaviour 398 perception 397 Posession of thought 398 thought 396 Disposal of body 139 Disruptive injuries 299 Dissecting cranial cavity 164 thoracic and abdominal cavities 167 Dissection of brain 166 heart 171 Distance blast injuries 300 Distant shot range 282 Disturbance of perception 397 DNA fingerprinting 113 profiling 369 Doctor and law scene of crime 21 Doctrine of emergency 35 informed consent 34 locoparentis 35 therapeutic privilege 35 Documentary evidence 18 Domestic poisons 555 violence 342 Dose schedule 490 Dowry death (Section 304 B, IPC) 333 Driving, drunkenness and law 512 Drowning 174, 179, 211 Index Combined fracture 240 Comminuted fracture 239 Common abstinence syndrome 507 mishaps in anaesthetic practice 62 Commotio cerebri 244 Complications of bad trip 564 fracture skull 241 injuries 333 spinal cord 254 Concealed firearm wound 287 sex 87 Concealment of birth 598 Concentration of poison 420 Concept of death 134 living and cadaver donors 52 Concussion of spinal cord 252 Condition of body 153 Conditions influencing putrefaction 153 resembling rigor mortis 148 Conduct money 14 Confirmation as human hair 102 Confirmation by radiograph picture 159 Confirmation of hair 102 ossification pattern 76 tube in stomach 432 Confirmatory tests 368 Confusional state psychoses 400 Consent for autopsy 162 Consent in medical practice 33 Constitutional effects 323 Contact abrasion 223 shot range 281 Contractual obligations 512 Contraindications to antivenom 489 Contrecoup injury 243 Copper 470 subacetate 471 sulphate 471 Coroner’s court Corporate negligence during surgery 64 Corpus delicti 65 Corrosive poisons 450 Cortical death 134 Costal cartilage calcification pattern 85 Cot death 392 Counting of sex material within nucleus 86 Coup injury 243 Court procedures in criminal courts 13 questions 18 Crash accident injuries 263 Crib death 392 Cricoid cartilage 203 Crime scene 130, 296 Criminal abortion 174, 377, 378 domestic violence prosecutions 343 malpractice 37 procedural code 441 Croton tiglium 476 Crown-heel length 383 603 Textbook of Forensic Medicine and Toxicology Drug abuse 563, 565 addiction 565 and Cosmetics Act, 1940 442 and Cosmetics Rules, 1945 442 and magic remedies Act, 1954 442 control Act, 1950 442 dependence 563, 565 habituation 565, 566 induced psychoses 400 Drunkenness and criminal responsibility 512 disorderly conduct 512 medical practice 512 medicolegal importance 511 Dry drowning 214 Dum dum bullet effect 286 Duration of exposure 425 office 26, 27 Duties and powers of coroner Duties of doctor in general 25 poisoning case 429 witness box 21 Duties of doctors to each other 25 sick 25 Duties of registered medical practitioner 29 Dying declaration 18 deposition 19 E Ear injury 298 prints 99 Earlier testimony from Dallas doctors 289 Ecotoxicology 424 Ectopic bruises 225 Effects of burns 313 cold and heat 307 domestic violence on children and teenagers 339 injury 266 prolonged consumption 564 radiation 326 Elapidae 482 Electrical shorting 416 Electrocardiogram (ECG) 101 Electrocution 63, 320 Elementary ballistics 275 Elevated fracture 239 Elimination of tattoo marks 107 Elongated X-shaped incision 168 Emaciation 598 Embalming 159, 190 Emergency management options 301 Emesis 433 Employment issues 343 Energy method 417 Enforcement 343 English law 55 Entomology of cadaver and postmortem interval 190 Entrapment 209 604 Entry of venom on snake bite 485 Envenomation 485 Environmental considerations 425 poisons 425 pollutants 428 suffocation 209 toxicology 424 Enzyme typing 369 Eonism 374 Epidemiology of poisoning 422 snake bite 482 Erectile dysfunction (ED) 354 Erosions 224 Essence of crime 65 Estimate alcohol in blood 503 Ethanol 502 Ether 515 Ethics of medical practice 23 Ethyl alcohol 502 Ethylene glycol 514 Etiology of asphyxia 194 Eucalyptus globus 480 Euthanasia 45 Examination of accused 369 alleged woman 379 bones 184 bruise 224 case of criminal abortion 379 sexual assault 362 sodomy 371 cervical spine for whiplash injury 182 clothing 292 CSA case 394 decomposed bodies 187 incised wound 227 material alleged to have been expelled out 379 mental status/conditions 402 mutilated bodies or fragments 184 scene 362 skid marks 417 skull and brain 175 spinal cord 173 thorax and abdomen 175 wound 229, 233, 293 Excoriation of skin by excreta 224 Explosions 418 Explosives and explosive injuries 296 External autopsy findings 385 ballistics 275 examination 174 findings 441 haemorrhage 266 Extra-axial haemorrhage 248 Extracorporeal techniques 435 Extradural haemorrhage (EDH)38 248 Extragenital signs 351 Extraneous specimens 62 Extrauterine means 377 Eye changes 144 F Fabricated wounds 226 Facial distortion effects 280 injuries 235 Factors affecting bruising 225 multiplication factor (MF) 105 rigor mortis 149 stature variation 104 Factors controlling rate of cooling 144 establishing personal identity 66 influencing action of poison 419 Factors modifying effect of burns 313 cold 308 Fainting 135 Fake firearm wounds 296 Fallacies 175, 386 Falling from speeding train 261 Fasting prisoner 598 Fat embolism 269 Fatal concentration 547 dose 421, 462, 521, 535, 546 period 462, 521, 528, 546 Fault with intravenous equipment 63 Faults in anaesthetic machine 63 Fauna of cadaver 153 Feature of non-venomous snakes 483 snakes in general 482 venomous snakes 483 Feigned rape 370 Fellatio 373 Female homosexuality 373 Fetishism 374 Findings in child victim 364 deflorated woman victim 364 face 197, 215 hands 215 neck 199 other parts of body 201 skin 215 virgin victim 363 Findings on clothing 326 Finger-print records 96 study 94 Finger-prints and scaring trauma 97 Firearm injuries 174, 178, 222, 294 wounds 279 Firearms and explosive injuries 272 First aid 310, 487 Fissured fracture 238 Fixation 145 Fixation of brain 182 Flight accident injuries 264 Floatation test 175, 385 Flying missile injuries 299 Foetal autopsy 174 development of epidermal rings 97 Foeticide 376, 382, 390 Food poisoning and poisonous foods 561 Footprint of newborn infants 98 Footprint ratio (FPR) 85 G Gagging 211 Galton system 94 Garden poisons 558 Garroting 208 Gas chromatography 446 embolism 269 stiffening 148 Gashes ruptures 226 Gastric lavage 431, 527 Gastroenteritis type 465 Gastrointestinal system 141 tract 497 Genital signs 351 Gonadal biopsy 84 Gordon’s classification of anoxia 195 hypothesis 136 Grades of maceration 388 Grain alcohol 502 Gravity shifting of blood 225 Grazes 222 Grease collar 281 Greek love 371 Grievous hurt 329, 330, 332 Growth of hair and nails 157 Gunpowder residues tests 293 Guns 276 Gunshot wounds 279 Gustafson’s method 70 Gutter fracture 240, 286 H Haematoma 224 Haemopericardium 266 Haemorrhage 218, 266 in petrous temporal and mastoid bone 218 Haemotoxic venom 485 venomous snake bite 486 Hair and fibers 116 identity 104 poisoning 104 Halogenated aliphatic hydrocarbons 426 Handling case of anaesthetic mishap 63 Hanging 179, 195 Hashish insanity 533 Hazard 424, 522 Hazards of transfusion of blood and body fluids 62 Head injury 234, 252 Heart changes 387 Heat collapse 310 combustion effects 280 cramps 310 effects 189 exhaustion 310 hyperpyrexia 310 prostration 310 stiffening 148 stroke 310 syncope 310 Height and weight data 79 Herbicides 427 Heroin 400 Hinge fracture 241 Hippocratic Oath 23 Histology of lung 386 Historical aspects of ammunitions 273 guns 273 machine guns 274 muskets 273 revolvers 273 rifles 273 History of present illness 401 Hit by speeding train 262 Hole fracture 240 Homicidal hanging 204 smothering 210 Homicide 294, 330 Hornets 492 Hospital discharge certificate 336 Household poisons 555 Human error 63 organ transplantation 52 Hydrocarbons 530, 555 Hydrochloric acid 450 Hydrocution 215 Hydrofluoric acid 453 Hydrophiidae 482 Hydrostatic test 175, 385 Hymen 351 examination 352 Hyoid bone 202 Hyperpyrexia 309 Hyperthermia 309 Hypostasis of visceral organs 145 Hypothermia 307 Index Foramen magnum 241 Forced feeding 598 Forensic anatomy of brain membranes 248 hyoid bone and larynx 202 meninges 241 scalp 234 skull 236 Forensic DNA profiling 119 duties 440 engineering 414 entomology 153 genetics 119 identity 65 medicine in India psychiatry 395 radiology 408 toxicology 419 Formaldehyde 462 Formalin 462 Former terminologies Formic acid 455 Formylic acid 455 Foul smelling gases 150 Fracture dislocation of hyoid bone 203 Fracture of anterior cranial fossa 241 base of skull 240 middle cranial fossa 241 posterior cranial fossa 241 Fracture skull 286 Fractures ala signature 238 Fractures of vault of skull 238 Frangible bullet effect 286 Freezing 160 Fresh water drowning 213 Friction abrasion 223 Front seat occupants 260 Frostbite 307, 309 Frostnip 307 Fugue 397 Full thickness burns 314 FY-shaped incision 168 I Iatrogenic causes 142 Identification of dead 65 deceased 163 living 65 Identity by other factors 91 Idiosyncrasy 420 Immersion syndrome 215 Impact abrasions 223 Impact of moving object 221 virtually non-moving object on actively moving victim 222 Important terms 272 Imprint abrasion 223 In vitro fertilisation 357 Incidence of burns 313 Incised wound 227 Incorrect positioning of patient 62 Indecent assault 375 Indented fracture 240 Indian doctor’s view point 47 Indian Evidence Act (IEA) 441 Indian law on euthanasia 46 Indian Medical Council 26, 27 Indian Penal Code (IPC) 441 Indications for antivenom 489 inspection 27 Inebriant poisons 494 Infamous conduct 29 Infant whiplash-shake injury syndrome 253 Infanticide 382 Infection and septicaemia 268 Infectious type 561 Informed consent 34 Initial ballistics 275 Injuries due to antipersonnel landmines 300 falling masonry 299 Injuries of medicolegal importance 333 Injuries to chest 254 ears 236 eyes 236 facial bones 236 hair 103 lips 236 meninges 241 neck 254 nose 236 teeth 236 thoracic structures 254 thorax 254 vital organs 268 605 Textbook of Forensic Medicine and Toxicology Injury and embolism 269 Injury of skull fracture 241 Inorganic acids 450 irritants 458 Insecticide 426, 522 Insects 491 Instantaneous rigor 148 Insulin 560 Integrationist response 56 Intelligence quotient (IQ) 397 Intentional exposure 327 Interior ballistics 275 Internal autopsy examination 293 findings 385 Internal ballistics 275 changes 153 examination 164, 175 findings 441 genital tract 86 haemorrhage 266 organs 145 International code of medical ethics 25 Intersex 88 Intoxication 265 Intra-axial haemorrhage 248 Intracerebral haemorrhage 250 Intracranial haemorrhage 247, 266 pressure 252 vascular lesions 141 Intrauterine life (IUL) 67 Intraventricular haemorrhage 250 Introduction of tube 432 Investigation and examination of case of anaesthetic death 61 Investigation in case of death of newborn and infant 382 Investigation of damage due to fire 414 Iodine 462 Ionising radiation (IR) 327 IPC sections relevant to trauma 329 IPC sections 317 and 318 598 Iron 472 Irritant poisons 458, 459 Isopropanol 513 Isopropyl alcohol 513 Issuing of death certificate 139 J Joint injuries 257 Judicial hanging 206 magistrates 8, Justifiable abortion 377 K Kidneys changes 460 Kinds of firearms 294 Knife wounds 179 L 606 Laboratory diagnosis of chronic lead poisoning 470 investigation 511 tests to confirm poisoning 518 Laceration 226, 254 Lachrymators 548 Large atypical entrance wound 283 Larynx 203 Later government investigations 290 Latest therapy 552 Lavaging stomach 432 Lawful homicide 330 Laws in relation to sexual offences in India 376 Laws of poisons in India 441 Lead 468 Legal classification 221 definition 361 formalities 163, 174 identity 65 presumption of death 139 safeguards for permanent sterilisation 357 Legitimacy 361 Lesbian love 373 Lesbianism 373 Lethal dose 421 Ligature strangulation 206 Limb injury 301 skeletal bone injuries 256 Lip prints 100 Liquid metal 466 Live birth 177 born child 177, 383 Liver changes 459 Locard’s principle of exchange 114 Longitudinal fracture 241 LSD psychoses 400 Lung changes 460 findings 217 irritants 548 Lust murder 75 Lynching 206 Lytta 491 M Maceration 158 Machine guns 274 Magic bullet 287 Magistrate’s court Magnan’s symptom 536 Maintenance of equipments 63 Malnutrition 598 Mandibular canine index 85 Manner of death 138 Manual strangulation 207 Marasmus 598 Marbling of skin 150 Mass casualties predictor 301 spectrometers 447 Masturbation 375 Mechanical antidotes 436 Mechanism of choking 210 cooling 143 death 138, 214 drowning 212 drug addiction 565 habituation 566 fracture 203 hanging 195 injuries 297 injury to skull 236 sleep and unconsciousness 247 Medical and legal aspects 59, 338 Medical aspects of domestic violence 338 certificates 18 complications 499 duties 440 etiquette 25 evidence 18 examination of sexual assault 369 victim 362 household poisons 558 indemnity insurance 42 management options 304 negligence 37 records 57, 58 termination of pregnancy 377 Medicolegal and ethical aspects of torture 349 Medicolegal appearances 514 Medicolegal aspects of hanging 204 poisoning 440 strangulation 208 Medicolegal autopsy guidelines 163 case 334 Medicolegal importance of abrasions 224 age 81 bullet 296 death 139 defloration 354 facial trauma 236 finger-print 96 hallucinogens 564 negative 174 placenta 380 postmortem changes 142 lividity 146 sex identity 87 virginity 353 Medicolegal purposes 36 Meningeal injury 242 Mental elements in culpable homicide 332 Mental Health Act, 1987 395 Mentally abnormal offender 405 Meperidine 500 Mercury 466 Mercy killing 45 Mescaline 563 Metallic irritant poisons 463 Methanoic acid 455 Methods of examination 417 inducing MTP 377 taking finger-prints 96 torture 346 Methyl alcohol 512 aldehyde 462 isocyanate 550 Methylene oxide 462 Microsatellites 123 N Nail prints 101 Naphthalene 529 Narcotic Drugs and Psychotropic Substance Act, 1985 (NDPS Act) 442 Nasal irritants 549 Natural abortion 376 sexual offences 361 Near drowning syndrome 215 Neck structures 254 Necrophagia 375 Necrophilia 375 Negative autopsy 174 Neglect 598 Negligent homicide(Section 304 A) 332 Nerium odourum 541 Nerve and blood poisons 549 Nerve gas poisoning 550 gases 549 Neurosis 397 Neurotoxic venom 485 Nicotine 543 withdrawal symptoms 543 Nitric acid 450 Nitrogen oxides 426 Nongenerative tissues 52 Non-metallic irritants 459 Nonspecific amplification peaks 127 Nonvenomous snakes 485 Nose prints 99 Nymphomaniac 375 O Oath taking 15 Obscure autopsy 174 Occupational stigma 110 toxicology 424 Office of Indian Medical Council 26 State Medical Council 27 Official findings of autopsy 289 Onset of putrefaction 149 rigor 148 sexual perversion 374 Opening abdominal cavity 169 dura mater 164 thoracic cavity 169 Ophitoxaemia 485 Opiate overdose 498 Opioid abuse 498 dependence 498, 499 intoxication 496 withdrawal 498 Opium (Afim) derivatives 494 Organ transplantation 36, 134, 139 Organic animal irritant poisons 482 dementia 400 irritants 458 solvent 564 Organochlorines 523 Organophosphorous insecticides 426, 525 Ossification of bones 75 Overdose of anaesthetic agents 60 Oxalic acid 455 Ozone 426 P Padarasa 466 Palato prints 99 Palmar strangulation 208 Pap smear 85 Paracetamol 559 Paradoxical undressing 308 Paralysants 549 Paranoid status 401 Parenchymatous haemorrhage 250 Parenteral emetics 433 Partial or incomplete identity 65 Partial thickness burns 313 Passage of electricity 321 Passive cooling 310 Pathophysiology of asphyxia 194 cold 308 drowning 212 hyperthermia 309 Pattern of hospital use 304 injury 300 rifling 276 Patterned abrasion 223 bruises 225 Penal erasure 28 Penalty 49, 341 Perforating fracture Perforation of airway 63 Pericardial sac 266 Peripheral blood smear 85 neurotoxics 494 Pesticides 522 Pethidine 500 Pharmacological torture 348 Pharmacy Act, 1948 442 Phenanthrine derivatives 495 Phenol 453 Phobia 398 Phosphorus 459 Phylogenetic value of Y-chromosome specific STRS 129 Physical examination 83, 402, 511 properties 502, 512, 550, 553, 556 state of poison 421 torture 346 violence 338 Pigments used 107 Pithing 254 Place of performing autopsy 163 practice 13 Plant description 480, 541 varieties and descriptions 539 Plaquet’s test 385 Poison 419 Poison Act, 1919 442 Poisoning by therapeutic substances 559 Poisoning case 173 Police inquest 13 intimations 334 Polymerase chain reaction (PCR) 122 Polyvalent antivenom 490 Pond fracture 240 Pontine haemorrhage 251 Poroscopy 97 Position of patient 432 weapon 296 Positional asphyxia 211 Positive signs of pregnancy 358 Postcoital interval (PCI) 369 Postmortem abrasion 223 appearance 206, 457, 461, 507, 513, 521, 530,542, 552, 562 artefacts 188 bruising 226 caloricity 144 changes 142, 468, 470 cooling 143 decomposition 149 destruction by predators 187 examination 162 features of lightning death 326 findings of drowning 215 hanging 204 Index Microscopic examination findings of DAI 245 Middle ear findings 218 Mild poisoning 543 Minisatellites 122 Miscarriage 376 Miscellaneous causes17,21,27 142 data 79 information from hair 104 war gases 550 Mode of action 529, 555, 559 administration 490 death 135 Modified Y-shaped incision 168 Moist heat 311 Molecular death 134 Moles and naevi 106 Momentum method 417 Monitoring of vital signs 63 Morbidity 517, 300 Morphine psychoses 400 Morphinism 498 Morphinomania 498 Mortality 517, 300 Mosaic fracture 239 Mothballs 529 Motive for criminal abortion 377 Motor cyclist’s fracture 241 vehicle accident 417 MTP act rules 1975 377 Mugging 208 Mummification 158 Murder 178, 331, 332 Mushrooms 562 Muskets 273 Mydriatic test 532 Myotoxic venom 485, 487 607 Textbook of Forensic Medicine and Toxicology 608 injuries 224, 270 interval 148, 150, 157 lividity 145, 226 reports 13 room 189 suspension 204 Potassium 456 hydroxide 456 Powdered glass 492 Power of discrimination 130 judicial magistrates Pralidoxime administration 527 Precautions at exhumation 11 Precautions during consent 34 treatment 528 Precautions in examining scalp wound 235 Pregnancy 357, 517 Presence of mixtures 425 Preservation and dispatch of specimens 190 Pressure abrasion 223 sores 224 Presumption in favour of legitimacy 361 Preventing anaesthetic mishaps 63 Prevention of antipersonnel mine injuries 301 spread of venom 487 Procedure of serving summons 13 taking foot-print 97 Process of collecting biological samples 367 preserving dead body 159 Procurator fiscal 13 Professional misconduct 29 Properties of adipocere 158 Protection of Women from Domestic Violence Act, 2005 339 Rules, 2005 341 Prussic acid 550 Pseudoabrasions 224 Psychedelics 563 Psychiatric patients 141 Psychological abuse 338 aspect 374 autopsy 190 torture 346 Psychomotor automatism 398 Psychosis 398 Psychotherapy 509 Pugilistic attitude 148 Pulmonary air embolism 269 effects 517 irritant asphyxiants 545 Punctured fracture 240 wound 229 Punishment for culpable homicide not amounting to murder (Section 304, IPC) 331 hurt and grievous hurt 330 rape 362 Purpose of Act 48 rifling 276 Putrefaction in water 156 Putrefying gas collection 153 Pyrolysis gas chromatography 446 Q Qualitative analytical tests 444 Qualities of ideal war gas 547 Quantitative analytical methods 444 R Radiating fracture 239 Radiography and smuggling 411 Radiology and asphyxial death 411 battered child 411 firearm injuries 411 trauma 410 Railway disaster trauma 261, 263 Range of firing 294 Rape 361, 370 Rape and law 362 Rapidly putrefying organs 153 Rash and negligent act 332 Rate of cooling 143 Rayalaseema phenomenon 286 Reception after judicial inquisition 403 Reception of escaped mentally ill 403 mentally ill criminal 403 Reception order on petition 403 Recognition of foreign medical degrees 27 Recording of evidence 15 Referring injury case to second hospital 337 Reflex anal dilation test 394 vagal stimutation 60 Regional injuries 234 Regulation of hospitals 53 Relevance of consent in medical practice 34 Relevant sections in laws on abortion in India 380 Religious factors in establishing racial identity 94 Removal of human organs 53 jaw for dental identification 182 spinal cord by anterior approach 182 Removing abdominal and thoracic viscera 169 brain 164 skull cap 164 Requirements of euthanasia 46 Respiration in lungs 385 Respiratory arrest 142 failure 61 system 140 tract 266 Response to antivenom 489 Responsibilities of insane 404 Restraint of mentally ill 402 Restrictions of removal and transplantation of human organs 53 Retain parts of body 36 Reversible cerebral concussion 244 Revolvers 273 Ricinus communis 475 Ricochet bullet 284 Rifled firearms 276, 279 Rifles 273 Rifling of gun 276 Rights and privileges of registered medical practitioner 29 Rights granted to women 340 Rights of consumer 49 Rigor mortis 146, 148 Ring fracture 241 Road traffic accidents 174 Role of meninges and CSF 243 physician 46 poison centres 449 Rope burns 223 Routes of administration 419 absorption 453, 539, 542 exposure 425 Routine medicolegal practice 249 Rugoscopy 99 Rule of consent 34 full disclosure 34 summons 14 Rupture of hymen 352 Ruxton case 186 S Sacrum 79 Sadomasochism 375 SAH of spontaneous origin 250 traumatic origin 250 Salicylic acid 456 Salt water drowning 213 Satyriasis 375 Scalp incision 164 injuries 234 Scars 108 Schedule of treating cyanide poisoning 551 Schizoma 400 Schizophrenia 400 Scope of forensic radiology 408 Scorpions 491 Scratches 222 Screening tests 368 Scuba diving 269 Secondary drowning 215 flaccidity 148 impact injuries 259 Section 323, IPC 330 324, IPC 330 325, IPC 330 326, IPC 330 336, IPC 332 337, IPC 332 338, IPC 332 Selection of viscera 438 Semen bank 357 Semicarpus anacardium 477 Senile dementia 400 Standardisation of STR nomeclature and technique 128 Starvation 598 State Medical Council 27, 28 Stellate fracture 239 Stereotactical theory 243 Sterility in males 354 Stillborn child 177, 383 Stomach bowel test 177 Storage and transport of DNA evidence 130 STR analysis and automation 125 mutational mechanisms 124 resolution techniques 125 Strangulation and suffocation 179 Stretch laceration 227 Strong alkalies 456 Structure and basics 446 Structure of firearms in general 275 Strychnine 537 Stunning brain shock 244 Stupor 398, 497 Subacute poisoning 468 type 465 Subarachnoid haemorrhage (SAH) 249 Subdural haemorrhage (SDH) 249 Sudden death 139 infant death syndrome 392 natural death 139 Suffocation 209 Suicidal hanging 204 smothering 210 Suicide 178, 294 Sulphur dioxide 426 Sulphuric acid 450 Summons 13 Sunstroke 310 Superficial bruises 224 burns 313 Suprarenal haemorrhage 270 Supreme court Surrogate mother 357 Surrounding atmosphere 156 Suspended animation 143 Suture line fracture 239 Symptomatic line of treatment 437 Symptoms of mental illness 396 Syncope 135 Syrup of ipecac 527 Systemic air embolism 269 asphyxiants 545 death 133 hyperthermia 310 T Tandemly repetitive DNA 122 Tangential abrasion 222 Tattoo mark 106 Taxidermy 160 Taxonomy of explosives 296 Tear gases 548 Teeth 68 Teeth in determining age 69 Terminology forensic medicine Tertiary impact injuries 259 Test tube baby 357 Testing for rigor in cadaver 148 Thambe 470 Thanatology 133 Therapeutic abortion 377 artefacts 188 dose 510 exposure to IR 327 Thermic fever 310 Thin layer chromatography (TLC) 446 Thrombotic embolism 270 Thyroid cartilage 203 Tickling of throat 433 Time of death 135 fusion of sutures 72 onset 145 Tobacco 543 Torture and forensic experts 349 human rights 349 medical profession 345 Torture victims 349 Toxic compounds 466 gases in bomb blast 300 part 494, 537, 543 principles in snake venom 483 type 561 Toxicity rating 497, 528, 555 Toxicology 419 Trace evidence factors 114 Transplantation of human organs act, 1994 52 Transportation injuries 259 Transverse fracture 241 Transvestism 374 Trauma in road traffic accidents 259 Trauma sustained by cyclist 259 occupants of vehicles 260 pedestrians 259 Traumatic asphyxia 211 brain injury 242, 243 Treating chronic barbiturate poisoning 519 Treatment of acute and subacute poisoning 469 addiction 566 chronic alcohol poisoning 509 poisoning 500 snake bite 487 withdrawal syndrome 510 Trench foot 307 Tribadism 373 Trichloroacetaldehyde 515 Troilism 375 Twilight state 398 Type of blast injuries 298 bone fractures 256 chokes 278 consent 33 dementia 400 euthanasia 45 firearms 276 hymen 351 Index Sequelae of torture 348 Sequence of skull injuries 238 Session’s court Severity of opioid dependence 499 Sex and identity 83 Sex chromatin 84 determination in dead body 86 factor 225 Sexual abuse 338 deviations 361, 373 jurisprudence 351 offences 361 perversions 361, 373 torture 347 Sharp force trauma 222 Shisha 468 Short tandem repeat DNA profiling 123 Shotgun 277 wounds 287 Signature fracture 238 Signs of criminal abortion 379 death 142 recent delivery in dead 360 living 359 remote delivery in dead 360 living 360 virginity 351 Simple asphyxiants 545 Site of injury on skull 237 origin of hair 103 Skeletal examination 86 Skeletonisation 156 Skid marks 417 Skin changes 145 Skull injuries 236 Slang names 516 Slowly putrefying organs 153 Smooth bore firearms 277, 287 Snake bites 482 venom 483 Sodium carbonate 456 hydroxide 456 Sodomy 371 Soiling of wound 280 Somatic death 133 Somniferous poisons 494 Sources of IR injurious to human health 327 Spanish fly 491 Spectrophotometers 448 Spider’s web fracture 239 Spinal neurotoxics 494 Spine and spinal cord injuries 252 Split laceration 227 Spontaneous abortion 376 Stab wounds 229 Stage of coma 506 depression 497 excitement 497 narcosis 497 609 Textbook of Forensic Medicine and Toxicology 610 injury to foot 300 inquest 12 oral evidence 19 physical torture 346 radiation exposure 326 sexual perversions 373 snake venoms 484 tissue 225 water inhaled 213 witness 20 Typical aconitine poisoning 542 drowning 214 U Unburnt and burnt skeletal remains 184 Unnatural sexual offences 361, 371 Urinary alkalization 435 Use of allelic ladders 126 computer system for finger-print study 97 forensic radiology 412 organophosphorus (OP) compounds 525 Usual fatal dose 553 V Vagal inhibition 215, 268 Vaginal epithelial cell 85 Variants of hymen 352 Vegetable and organic animal irritant poisons 473 Venomous snakebite 485 snakes 482 Violent asphyxia 195 asphyxial death 194 Viperidae 482 Virginity 351 Viscera and chemical examination 438 Visualisation of DNA 121 Volitional activities 230 Voluntary euthanasia 47 Vomiting 433 gases 549 W War gases 547 Warehouse 416 Warning notices 27 Warrant 14 Wasps 492 Weighted centroid method 416 Wernicke-Korsakoff syndrome 509 Whiplash injury 253 Widmark’s formula 503 Withdrawal symptoms 565 syndrome 498 Witness 14, 19 World Medical Association (WMA) 598 Wound ballistics 279 Wound of entry 281, 287 exit 282 Wound report 335 Written informed consent 34 Y Y STR multiplexing strategies 129 Y-chromosome polymorphisms 129 ... Jurisprudence and Toxicology for Courtroom and Classroom (6th edn) CBS Publishers: Mumbai, 20 02 12 Rao NG Forensic Pathology (6th edn) HR Publication Aid: Manipal, 20 02 13 Rao NG Clinical Forensic Medicine, ... law Presented in 12th national psychiatry congress 23 -27 September 20 02, Cape Town 22 News Update Mental disorders affect one in four people Tropical Doctor, 20 02; 32: 187-9 23 Steadman HJ Critically... Guharaj’s Forensic Medicine Orient Longman: India, 20 04 Rao NG Practical Forensic Medicine (3rd edn) Jaypee brothers medical Publishers Ltd, New Delhi, 20 07 Nandy A Principles of Forensic Medicine,