Ebook Review of forensic medicine and toxicology (2/E): Part 1

Review of

Forensic Medicine and Toxicology

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Review of

Forensic Medicine and Toxicology
Including Clinical and Pathological Aspects
MCQs of Previous Years
PG Entrance Examinations Included

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Third Edition

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Gautam Biswas MD (UCMS)

Professor and Head
Department of Forensic Medicine and Toxicology
Dayanand Medical College and Hospital
Ludhiana, Punjab, India

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Forewords

George Paul

Satish K Verma

The Health Sciences Publisher
New Delhi | London | Philadelphia | Panama

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Review of Forensic Medicine and Toxicology
First Edition: 2010
Second Edition: 2012
Third Edition: 2015

 

ISBN 978-93-5152-864-7
Printed at

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With lots of love to my son Gaurav
&
All my students—past, present and future

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Foreword
This textbook, aimed for the medical undergraduate for preparing him/her for the various
long and short questions on the subject of Forensic Medicine and Toxicology as taught to
medical undergraduates all over India, as well as MCQs of nearly all the various entrance
test exams for postgraduation, is an extensive labor of love, in an attempt to present the
subject in a most systematic and organized manner. The approach is to make mining
down to fine details—either for a long essay question, or to organize one’s answer for a
short text answer, easier, and in that sense it has well succeeded.
All the various headings coming under the broad chapter of Forensic Medicine and
Toxicology have been broken down very clearly into sub-topics and subheadings. Where
the subject leads to some important questions and answers often required of the medical witness, they are
presented in addition, at the end of the chapter, as question and answers. The author has also put in a lot of

effort to cull from all possible sources, MCQs that have been made in the past on the various subjects – itemized
them with their source reference listed (i.e. the various entrance exams they have been used in), and given the
most appropriate answer to the question, based on the construction of the sentences, or the stem or statement.
However this book, being primarily a resource book for undergraduates and those graduates appearing in
various postgraduate and recruiting commission’s exams, is tailored to what is expected of the student from
the current set of forensic examiners, rather than updating all users of the textbook to the current concepts and
recent advances and norms in practice, of some of these topics. And one can hardly blame the author for this,
because, looking at the current MCQs listed at the end of chapters of toxicology and other sections, some of
these exam setters are still in the practice of forensic medicine and the knowledge of it thereof of the 50’s and
60’s rather than the new millennium. Antidotes are still entrenched in outdated clinical concepts of ‘universal
antidote’ and burnt toast for activated charcoal, and one cannot blame the author for it, for these various
entrance exams extensively feature knowledge of this in their selection MCQs. While the chapters on sexual
abuse cover the legal and medical features well, the emphasis in the chapter on detection of seminal stains for
establishing sexual intercourse with the victim is still stuck with outdated tests, which have been given up in
modern countries and replaced by their DNA and forensic labs test such as screening with PSA and Seminogelin
jointly and then progress to DNA markers using single-locus-probes or multi-loci probes.
Technology has advanced and some of it has found their place in Forensic Medicine. Forensic radiology—use
of radiological techniques (not the ubiquitous ‘virtopsy’) in assisting forensic work has resulted in a quite a few
clinical radiologists taking special interest and training in forensic radiology, as there are vast differences between
imaging and techniques possible in the living and dead. At an undergraduate level, textbooks of quality such
as these should incorporate key features where its techniques are now baseline for diagnosis or investigations
in some forms of sudden death, identification parameters, deaths from barotraumas—especially diving deaths,
etc. But I would not be surprised if the inclusion of these would get the candidates into trouble during their
exams, as many of the examiners are still anachronistic in their understanding of many of these topics, and
have never put any of them to use.
Modern concepts such as brain death—related to organ harvesting, is an important concept which will feature
quite a bit in clinical practice, as it is doing overseas. The young medical graduate should be brought onto a
sound basis on these by textbooks such as this.
Some of the well-presented chapters deserve mentioning. Thus the chapter on jurisprudence, injuries—their
medico-legal importance, firearms, thermal injuries, identification, especially the medico-legal importance of

age (which finds great significance in the MCQs—though in fact is just a legal interpretative part), pregnancy

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Review of Forensic Medicine and Toxicology

 





and delivery, sexual offences, forensic psychiatry, toxicological chapters such as mercury, cannabis, cocaine,
belladonna, cardiac poisons, carbon monoxide, agricultural poisons, aluminum phosphide, kerosene poisoning
and food poisoning are quite adequate for an undergraduate level and are well presented with good coverage
for even answering MCQs. There are good coverage of general concepts in the chapters on explosions and falls
from height, starvation deaths, torture, decompression sickness, infanticide and child abuse, specific topics in
toxicology such as corrosives, alcohol, opioids, medicinal drugs, snakebite, cyanide, drug dependence and war
gases, such that the candidate has a good overview of these topics.
All in all, this textbook is well organized. The layout makes breaking up and assimilating the various diverse
topics that come under its ambit – easy, and systematic, with an approach which makes it easy and effective
in organizing one’s knowledge and thoughts on each subject. For once, based on the chapters reviewed, I
would recommend this book as a good basic reference book for undergraduates, to prepare them both for their
university exams and entrance tests. I look forward to further amendments which would raise this textbook to
one of great current relevance through revisions on some of the small deficiencies that have been observed.
I wish Prof. Gautam Biswas great success in this 3rd edition of the Review of Forensic Medicine and Toxicology—
Including Clinical and Pathological Aspects, and congratulate him for single-handedly maintaining great standards
and depth of knowledge, as well as keeping up-to-date with the needs of the medical undergraduates all over
India, for preparing them for their respective university’s undergraduate and various postgraduate entrance
examinations.

George Paul
Senior Consultant
Forensic Pathologist and Branch Director-Technical Capabilities
Forensic Medicine Division, Applied Sciences Group, Health Sciences
Authority, 11 Outram Road, Singapore 169078
and Senior Lecturer-Yong Loo Lin School of Medicine
National University of Singapore

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Foreword



It is indeed a moment of immense pleasure and sense of pride to write a foreword for a
book authored by one of my most sincere, hardworking and brightest students to whom
fortunately I introduced the art and science of the specialty of Forensic Medicine and
Toxicology, both as undergraduate and postgraduate at UCMS.
A teacher or a guide feels special and privileged, when his students excel in the field
initiated by him, the words are too timid to describe this feeling. The current book is 3rd
edition in the series of this title, Review of Forensic Medicine and Toxicology. I have no iota
of doubt about the success of this title and this will be rather loved more than the earlier
versions.
The current title contains 63 chapters covering the entire MCI undergraduate curriculum, presented in a
student friendly fashion. I have gone through, some of the chapters of this title and found them even more
informative and attractive than previous ones with lots of new information being added. Major changes and
updates have been provided in chapters such as: Medical jurisprudence and ethics (MCI, Declarations of WMA,
informed consent, euthanasia), Acts (POCSO Act, Sexual Harassment of Women at Workplace Act, Protection
of Women from Domestic Violence Act); and Identification, etc.
A special feature of the book is MCQs drawn from various PG entrance and other competitive examinations

at the end of each chapter making it more relevant to undergraduates even after passing 2nd Professional MBBS
examination.
By now Gautam (I usually call him by his first name due to my special love) has established himself as a
prolific author and I am sure that this edition will add another feather in his success story.
May God bless him…








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Satish K Verma

Professor
Department of Forensic Medicine and Toxicology
University College of Medical Sciences
Former Head
Department of Forensic Medicine (University of Delhi)

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Preface to the Third Edition











Forensic medicine and toxicology is a broad and evolving field in which many changes occur because of new
research in the field, new technology or new laws or regulations being implemented. The readers should be
aware of the current laws and regulations that apply within their own country. This edition aims to provide a
critical update of all the chapters that are affected by such changes.
Since the publication of first edition of Review of Forensic Medicine and Toxicology in the year 2009, there has
been considerable attention, and gradual recognition and liking by the students and faculty both. This book

has now become a standard textbook in many colleges (medical and ayurveda) of India. There are considerable
changes in content from previous edition, although the format and layout remains the same. Like previous
editions, the text is presented in a concise and lucid form with line-diagrams, boxes, tables, differentiations and
flow charts designed to make the book interesting-to-read, easy-to-comprehend, recollect and reproduce.
Although all the chapters have been updated and recent advances/changes have been incorporated wherever
needed, major changes and updates are provided in the following chapters—Medical jurisprudence and ethics
(MCI, Declarations of WMA, informed consent, euthanasia), Acts (POCSO Act, Sexual Harassment of Women at
Workplace Act, Protection of Women from Domestic Violence Act), Identification (Disorders of sexual development,
concept of third sex, ridgeology, edgeoscopy), Autopsy (T-shaped incision, hazardous groups autopsies), Signs
of death (Recent advances in estimating time since death), Asphyxia, Injuries (Bone contusion), Medico-legal
aspects of injuries, Infanticide, Sexual offences (Criminal Law Amendment Act, MOHFW guidelines, battered
wife syndrome), DNA fingerprinting (FTA card), Torture, General toxicology, Plant poisons (Oduvanthalai
poisoning, hunan hand), Animal poisons (ASV antidote, scorpion bite treatment), Alcohol (Field impairment
tests), Agricultural poisons (OPC, Alphos), and Drug abuse and date rape drugs (PCP, date rape drugs).
There has been a demand for color photographs of poisons. In this regard, color plates comprising of common
poisons discussed in Section II have been added in this edition.
The most unique feature of this book—topic-wise MCQs from previous PG entrance examination (2006-15) are
given at the end of each chapter. Answers can be referred in the text which are given as superscripts. This will
not only make the subject interesting, but also help the reader to get insight of that topic and prepare for vivavoce and subsequent PG entrance examinations. Question banks I and II provide a list of important questions,
which the students should prepare for the professional examination. There are two separate categories—must
know and desirable to know, the student may prepare according to the time they can devote to the subject.
It is my hope that this edition of the book will find favorable response from medical students like the previous
two editions and also offer significant help to medical practitioners, in-service doctors and forensic pathologists.
Any mistakes or misinterpretations are those of mine, and will happily receive comment and criticism on any
aspect of the content. If the reader comes across any such error (including typographical errors) or wants to
send any comment/suggestion, please do write or send an e-mail. It will be duly acknowledged in the next
edition.
Gautam Biswas
e-mail:

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Preface to the First Edition
During my undergraduate days, I felt that textbooks should contain necessary information, not have too many
details and should be understood easily, i.e. they should be comprehensive, clear and concise. Keeping this in
mind, this book is written, especially for undergraduates and for those preparing for the PG entrance test. The
entire concept of this book is to give information in as few words as possible without omitting necessary details.
Some topics (Identification, Injuries, Sexual Offences, Forensic Psychiatry and Toxicology) which are important
from PG entrance point of view, are in more details. All topics are updated and recent advances/changes have
been incorporated wherever needed.
Concise and lucid text (bullet’s format), line-diagrams, boxes, tables, differentiations and flow charts given
at appropriate places, are designed to make the book interesting-to-read, easy-to-comprehend, recollect and
reproduce.
The information given in boxes is ‘desirable to know’, that a student may skip if there is shortage of time
or if preparing for the professional examination. Rest of the information is ‘must know’, i.e. one should go
through it definitely.
In section two (Toxicology), all the poisons are given in the same format throughout so that the student is
able to understand and reproduce them during the examination. The section is up-to-date and some additional
topics have been added for the PG entrance test.
Topic-wise MCQs are given at the end of most of the chapters. They are based on the recall of students who
appeared in these exams, and will help the reader to get insight of that topic and prepare for the PG entrance.
It will also make preparation for viva-voce easy and interesting for the student.
Appendices I and II give a list of important questions, which the students should prepare for the professional
examination and are based on the latest MBBS curriculum prepared by Directorate General of Health Services
and Medical Council of India (MCI). There are two categories—must know and desirable to know, the student
may prepare according to the time and can devote to the subject.
It is my hope that this new book will find favorable response from medical students and also offer significant
help to medical practitioners, in-service doctors and forensic scientists.

It has been my endeavor to keep the book error-free, however, there may be some typographical errors. If
the reader comes across any such error or wants to send any comment/suggestion, please do write or send an
e-mail. It will be duly acknowledged in the subsequent edition.

Gautam Biswas

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Acknowledgments













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It is with immense gratitude that I acknowledge the blessings of my mentors and teachers, in particular late
Prof (Maj. Gen.) Ajit Singh, Prof SK Verma, Prof NK Aggarwal, Prof KK Banerjee, Prof AK Tyagi and Dr Anil

Kohli who taught me to inquire, think and persist; and late Prof BBL Aggarwal whose knowledge and humanity
inspires me still.
I express my deep gratitude to Dr George Paul (Senior Consultant Forensic Pathologist, Singapore) not only
for writing the oreword, but also for going through most of the text and suggesting changes wherever needed.
I deeply appreciate the invaluable suggestions of reputed experts in the field, viz. Dr Anil Kohli, Reader,
Forensic Medicine, UCMS and GTB Hospital and Dr Anil Aggrawal, Director-Professor, Forensic Medicine, MAMC,
New Delhi, whose immeasurable help and wisdom can never be appropriately or adequately acknowledged.
My colleague, Dr Virendar Pal Singh, deserves special mention for providing constant and friendly support in
this venture.
I sincerely acknowledge the positive feedback and changes suggested by Prof MB Rao, Sardar Vallabhbhai
Patel National Academy, Hyderabad; Dr Viswakanth B, PKDIMS, Kerala; and Dr Manivasagam M, Tirunelveli
Medical College, Tirunelveli.
I also express my thanks to Prof JS Dalal and Dr Mukul Awasthi (CMC, Ludhiana), Prof AU Sheikh and
Prof CS Gupta (ASCOMS, Jammu), Prof Bhupesh Khajuria (GMC, Jammu), Prof B Khurana (SGRD, Amritsar),
Prof Farida Noor (GMC, Srinagar), Prof Rifat Fazili (SKIMS, Srinagar), Prof SK Dhattarwal (PGI, Rohtak), Prof
PK Tiwari (GMC, Kota), Prof Dasari Harish (GMC, Chandigarh), Dr AD Aggarwal (GMC, Patiala), Prof Parmod
Goel (AIMS, Bhatinda), Prof Mukesh Yadav (Siddhant Institute of Medical Sciences & Hospital), Prof Swapnil
Agarwal (Pramukhswami Medical College and Shree Krishna Hospital, Gujarat), Prof Sobhan Das (RG Kar
Medical College, Kolkata), Prof Uday Basu (MMC and Hospital, West Bengal), Prof TK Bose (Calcutta National
Medical College, Kolkata), Dr(Col) Mrinal Jha (KPC Medical College, Kolkata), Prof Rajiv Joshi (GMC, Faridkot),
Prof Ashok Chanana (GMC, Amritsar), Dr Bagga (FH Medical College, Tundla), Prof RK Bansal (SGRRI,
Dehradun), Prof Vijay Arora (GMC, Tanda), Prof Anju Gupta (PIMS, Jalandhar), Prof Gaurav Jain (VMMC, New
Delhi), Prof Pradeep Kumar MV (Rajarajeswari Medical College and Hospital, Bengaluru), Dr Sandeep Singh
(LN Medical College, Bhopal) and Dr Prateek Rastogi (KMC, Mangalore) for their wholehearted support and
valuable suggestions.
Mr Prem Kumar Gupta, Secretary, Managing Society, DMCH and Prof Sandeep Puri, Principal, DMCH
deserves special mention for their continuous support, inspiration, encouragement and invaluable suggestions.
I would also like to express my thanks to Prof Praveen Sobti, Department of Pediatrics, CMC, Ludhiana for
her help in first edition which ultimately shaped up this book. I am thankful to Dr Rahul Setia, Demonstrator,
FMT, DMCH for going through the MCQs and Mr Ramesh Kumar for secretarial assistance.

I cannot find words to express my gratitude to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi,
India for their patience, encouragement and professionalism during the entire process. I am especially grateful to
Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing),
Mr Mohit Bhargava (Production Executive), Mr Rajesh Sharma (Production Coordinator), Mr Ankush Sharma
(Senior Graphic Designer) and Mr Gopal Singh (Typesetter) for shaping up of this book and making all the
changes, without any complaints.
This work would not have been possible without the blessings of my family. I would like to thank my parents
and my in-laws for their unconditional love, support and encouragement throughout my life. I would like to
express my earnest gratitude and love for my wife Anupama, for her constant support and encouragement. Last
but not least, I wish to offer my apologies to all my colleagues and friends whose names have been omitted
inadvertently, for without their constant support, encouragement and well-wishes, the book would not have
been completed.

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Contents
Section 1

1. Medical Jurisprudence and Ethics.................3

The Pre-conception and Prenatal Diagnostic
Techniques Act, 1994 (Amendment 2002) 36
The Protection of Children from Sexual Offences
(POCSO) Act, 2012 37
The Mental Health Act, 1987 39
.

3. Legal Procedure............................................. 43

 

 

 

 

 

 

 

Medical Council of India (MCI) 3
Functions of MCI 4
State Medical Council (SMC) 5
Duties of a Doctor 6
Privileged Communication 10
Medical Malpractice 11
Unethical Acts 11
Professional Misconduct (Infamous Conduct) 12
Erasure of Name 13
Red Cross Emblem 13
Types of Physician-Patient Relationship 14
Professional Negligence 14

Preventing Medical Litigation 16
Defenses Against Negligence 18
Doctrine of Res ipsa loquitur 19
Calculated Risk Doctrine 19
Doctrine of Common Knowledge 19
Doctrine of Avoidable Consequence Rule 19
Novus Actus Interveniens
(Unrelated Intervening Action) 20
Contributory Negligence 20
Corporate Negligence 20
Products Liability 20
Medical Maloccurrence 20
Therapeutic Misadventure/Hazard 20
Vicarious Liability/Respondeat Superior 21
Consent 22
Medical Records 25
Malingering (Shamming) 25
Euthanasia (Mercy Killing) 26

 

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Jurisprudence and Forensic Medicine

 

 

 

 

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Anthropometry (Bertillon system/Bertillonage) 84
Dactylography (Dactyloscopy) 84
Poroscopy 88
Lip rints (Cheiloscopy) 88
Hair 89
p

5. Identification II ............................................... 84

 

 

 

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Corpus Delicti 56
Race and Religion 56
Sex 58
Nuclear Sexing 59
Disorders of exual evelopment 60
Sex from Skeletal Remains 63
Age 64
Age from Ossification of Bones 71
Age Determination in Adults Over 25
Medico-legal Importance of Age 76
Stature 77
Scars 78
Tattoo Marks 78
Notes 80

2. Acts Related to Medical Practice ................. 30
The Transplantation of Human Organs Act, 1994
(Amendment 2011, 2014) 30
The Consumer Protection Act, 1986 (CPA)
(Amendment in 1991, 1993, 2002) 32
The Workmen’s Compensation Act, 1923 34
The Medical Termination of Pregnancy (MTP) Act,

1971 34

.

4. Identification I ................................................ 56




 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inquest 43
Police Inquest 44
Magistrate Inquest 44
Courts of Law 45
Subpoena or Summons 47
Conduct Money 48
Medical Evidence 48

Types of Witness 50
Recording of Evidence 51
Conduct and Duties of a Doctor in the Witness
Box 52

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Review of Forensic Medicine and Toxicology

Heat Stiffening 145
Cold Stiffening 145
Decomposition/Putrefaction 147
Decomposition of Submerged Body 150
Floatation of a Dead Body on Water 150
Entomology 150
Adipocere (Saponification) 151
Mummification 152
Estimation of Time Since Death (TSD) or
Postmortem Interval (PMI) 152
Preservation of Dead Bodies 156
Presumption of Survivorship 156
Presumption of Death 156

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6. Medico-legal Autopsy .................................... 98

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purpose/Objectives of Autopsy 98
Procedure for Medico-legal Autopsies 99
Instruments for Autopsy Examination 100
External Examination 100
Internal Examination (Evisceration) 102
Skin Incisions 102
Evisceration Methods 103
Examination Proper 104
Chest 105
Heart 106
Neck 108
Skull and Brain 108
Description of an Organ 110
Report 111
Demonstration of Pneumothorax 111
Demonstration of Air Embolus 112
Collection of Samples 112
Preservation of Viscera 113
Preservation of Samples 114
Samples for Laboratory Investigations 115
Obscure and Negative Autopsy 116
Second Autopsy 116
Examination of Decomposed, Mutilated and
Skeletonized Remains 117
Medico-legal Questions 117
Exhumation 119
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7. Autopsy Room Hazards .............................. 122


 

 

 

 

 

 

 

 

11. Injuries .......................................................... 188




 

Brain/Brainstem Death 126
Cause, Mechanism and Manner of Death 128
Cause of Death 129

Modes of Death (Proximate Causes of Death) 129
Anoxia 130
Sudden Death 131
Coronary Atherosclerosis 132

 

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Classification of Wounds/Injuries 188
Abrasion 189
Bruise/Contusion 191
Lacerated Wound 195
Incised Wound (Cut/Slash/Slice) 197
Chop Wounds 200
Stab Wound/Punctured Wound 200
Defense Wounds 205
Therapeutic or Diagnostic Wounds 205
Fabricated/Fictitious/Forged Wounds 206
 



Classification of Firearms 210
Rifled Firearms 210
Smooth Bore Firearms/Shotguns 211

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12. Firearm Injuries ............................................209

 

 

 

 

 

 

 

 

 

 

 

Immediate Changes (Somatic Death) 136
Suspended Animation (Apparent Death) 137
Early Changes (Molecular Death) 137
Cooling of the Dead Body (Algor Mortis) 138
Postmortem Staining (Livor Mortis) 140
Rigor Mortis 141
Cadaveric Spasm (Instantaneous Rigor/Rigidity,
Cataleptic Rigidity) 144

 

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9. Signs of Death.............................................. 136

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8. Thanatology ................................................. 126

 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Etiology of Asphyxia 160
Clinical Effects of Asphyxia 161
Hanging 161
Autopsy of Neck (Asphyxial Deaths) 163
Postmortem Findings in Hanging 164
Medico-legal Questions 166
Lynching 167
Judicial Hanging 167
Strangulation 167

Ligature Strangulation 168
Postmortem Examination 168
Medico-legal Questions 169
Throttling or Manual Strangulation 171
Postmortem Examination 171
Medico-legal Questions 172
Hyoid Bone Fractures 173
Suffocation 173
Café-coronary 174
Drowning 177
Postmortem Examination 179
Medico-legal Questions 183
Sexual Asphyxia (Autoerotic Asphyxia/
Hypoxyphilia, Asphyxiophilia) 184

Classification of Pathogens 122
Commonly Acquired Infections 122
Autopsy of Hazard Group 3 Patients 123
Autopsy and Disposal of Radioactive Corpse 125



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10. Asphyxia ....................................................... 160

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Medico-legal Questions 89
Superimposition 93
Forensic Odontology 93
Miscellaneous Methods of Identification 96

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Contents

Judicial Electrocution 277
Lightning Stroke 277

 

 

 

 

 

 

 

 

 

 

Explosion Injuries 289
Mechanism of Action 289
Classification of Injuries 290

Medico-legal Aspects 291
Fall from Height 292
Injury Patterns 292

 

 

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17. Medico-legal Aspects of Injuries ................ 295


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16. Explosion Injuries and Fall from Height .... 289




 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pedestrian Injuries 281
Injuries Sustained by Vehicle Occupants 284

Role of Seat Belts and Air Bags 286
Motorcycle and Cycle Injuries 286
Postmortem Examination 287
Alcohol, Drugs and Trauma 287
Railway Injuries 288

13. Regional Injuries .......................................... 232
Craniocerebral Injuries 232
Biomechanics of Head Injury 232
Soft Tissue Injury 233
Skull Fractures 234
Brain Injury 237
Cerebral Concussion 238
Diffuse Axonal Injury (DAI) 239
Cerebral Contusion and Laceration 239
Coup and Contrecoup Injury 241
Intracranial Hematoma 242
Extradural/Epidural Hematoma (EDH) 243
Subdural Hematoma (SDH) 244
Subarachnoid Hematoma (SAH) 246
Intracerebral Hematoma (ICH) 248
Diffuse Injury to the Brain 250
Facial Injuries 251
Spinal Cord 251
Neck 253
Vertebral Column 253
Chest 253
Lungs 254
Heart 254
Abdomen 255

Kidneys 256
Bones and Joints 257

.

15. Transportation Injuries ................................ 281




 

 

 

 

 

Bore (Gauge/Caliber) 211
Bullet 212
Cartridge 213
Gunpowders (Propellant Charge) 215
Mechanism of Discharge of Projectile 215
Wound Ballistics and Mechanism of Injury 216
Firearm Wounds 216
Characteristics of Shotgun Wounds 218
Characteristics of Rifled Firearms Wounds 219
Firearm Wounds on Skull 221

Exit Wounds 222
Peculiar Effects of Firearms 222
Postmortem Examination 224
Preservation and Marking of Exhibits 225
Medico-legal Questions 225
Detection of Gunshot Residues (GSR) 229
Notes 229

.



18. Decompression, Radiation and
Altitude Sickness ....................................... 310
 

 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

Simple Hurt/Injury 296
Grievous Hurt/Injury 296
Punishments 298
Causes of Death from Wounds 299
Medico-legal Questions 302
Injury Report 305

.

19. Starvation Deaths ........................................ 313

 

 

 

 

 

 

 

 

 

Decompression Sickness 310
Autopsy in Decompression Sickness 310
Ionizing Radiation Reactions 310
Altitude Illness 312

 

 

 

 

 

 

 

Death during Administration of Anesthesia
(not due to anesthesia) 316
Deaths Directly Related to Administration
of an Anesthetic 316
Postmortem Examination 318

 

.



 

 

Postmortem Examination of Infants 320
Age of Fetus 322
Rule of Hasse 322
Demonstration of Centers of Ossification 324
Viability of Fetus/Infant 324

Live-Born/Dead-Born/Stillborn 324
Postmortem Findings 324
 

 

 

 

 

 

 

21. Infanticide and Child Abuse........................ 320

 

 

 

 

 

 

 

Cold Injury 263
Heat Injury 265
Heat Hyperpyrexia / Heat Stroke 265
Burns 267
Postmortem Examination 270
Medico-legal Questions 272
Scalds 274
Electrical Injuries (Electrocution) 275



.

 

14. Thermal Injuries ........................................... 263




.

20. Anesthetic Deaths ....................................... 316




 

 

 

 

 

 

 

 

 

 

 

Mode of Starvation 313
Pathophysiology 313
Signs and Symptoms 313
Postmortem Findings 314
Medico-legal Questions 315

/>

xx

Review of Forensic Medicine and Toxicology

 

 

Rape on Children 382
Medico-legal Questions 382
Indicators of Sexual Abuse 383
Examination of Rape Accused 384
Incest 385
Adultery 385
 

Sodomy 388
Examination of Passive Agent of Sodomy 388
Opinion 390
Examination of Active Agent of Sodomy 390
Tribadism/Lesbianism 391
Bestiality/Zoophilia 391
Buccal Coitus 392
 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

29. Forensic Psychiatry..................................... 403




 

 

 

 

 

 

 

 

 

Artifacts due to Postmortem Changes 399
Third Party Artifacts 400
Environmental Artifacts 401
Other Artifacts 402

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Delusion 403
Hallucination 404
Illusion 405
Impulse 405
Obsession 405
Lucid Interval 406
Role of Forensic Psychiatrist 407
Psychiatric Assessment 407
Classification of Mental and Behavioral Disorders
(ICD-10) 409
Organic Mental Disorders 409
Schizophrenia 410
Mood (Affective) Disorders 411
Neurotic and Somatoform Disorders 412

Behavioral Syndromes 413
Mental Retardation 414
Mental Disorder and Responsibility 415
.



Bloodstain Pattern Analysis 422
Presumptive Tests for Blood 422

/>
 



30. Bloodstain Analysis..................................... 422
 

 

 

 

 

 

 

 

 

 

 

 

 

c

 

 

 

.

 

25. Sexual Offences I ......................................... 366




.

 

28. Postmortem Artifacts .................................. 399






24. Virginity, Pregnancy and Delivery .............. 353

.





 

Sadism/Algolagnia 394
Masochism/Passive Algolagnia 394
Transvestic Fetishism/Eonism 395
Voyeurism/Scoptophilia 395
Exhibitionism 395
Fetishism 396
Frotteurism/Toucherism 396
Pedophilia 396

Masturbation/Onanism 396
Indecent Assault 397

Causes of Impotence and Sterility in Males 345
Causes of Impotence and Sterility in Females 346
Examination of a Person in an Alleged Case of
Impotence and Sterility 347
Sterilization 348
Artificial Insemination (AI) 350
Surrogate Mother 351

Rape 367
Duties of a Doctor in ase of an Alleged Survivor/
Victim of Rape 369
Examination of the Rape Survivor/Victim 370
Examination 374
Specimens Preserved for Laboratory
Examination 378
Opinion 379
Corroborative Signs of Rape 380
Rape on Deflorate/Sexually Active Woman 381

.





 

 

 

27. Sexual Offences III ....................................... 394

23. Impotence and Sterility ............................... 345

Normal Female Anatomy (in Virgins) 353
Medico-legal Aspects 354
Pregnancy 354
Presumptive Signs/Symptoms 355
Probable Signs of Pregnancy 356
Positive/Conclusive Signs of Pregnancy 358
Pseudocyesis (Spurious/False/Phantom
Pregnancy) 359
Superfecundation 359
Superfetation 359
Legitimacy and Paternity 360
Signs and Symptoms of Recent Delivery in
Living 360
Signs of Remote Delivery in Living 362
Medico-legal Aspects of Pregnancy and Delivery 363
Nullity of Marriage and Divorce 363

.



26. Sexual Offences II ........................................ 388

 

Classification of Abortion 337
Criminal Abortion 338
Complications of Criminal Abortion 340
Duties of a Doctor in Suspected Criminal
Abortion 341
Examination of a Woman with Alleged History of
Abortion 341
Postmortem Examination 342
Trauma and Abortion 343



.

22. Abortion ........................................................ 337




 

 

 

 

 

 

 

 

b

Signs of Dead- orn Fetus 328
Signs of Stillborn Fetus 328
Infant Death 329
Battered Baby Syndrome 331
Sudden Infant Death Syndrome [SIDS, Cot Death
(UK) or Crib Death (US)] 333


xxi

Contents

Uses of DNA Fingerprinting 443
Limitations of DNA Testing 444
.

33. Torture and Custodial Deaths ..................... 446

 

 

 

 

 

Confirmatory Tests for Blood 424
Species Identification 425
Genetic Markers in Blood 426
Medico-legal Application of Blood (Groups) 427
Medico-legal Questions 429

 

31. Seminal Stains and Other
Biological Samples ...................................... 431
.

HIV Testing Policy 451
Health Care Workers and HIV Infection 451
Partner Notification (Contact Tracing, Partner
Counseling) 452
Clinical Trials and HIV 453
Blood Donation and HIV 453
Polygraph 454

Brain Fingerprinting (Brain Mapping) 454
Narco-Analysis 455

.

 

32. DNA Fingerprinting ...................................... 438


.

35. Newer Techniques and Recent Advances . 454




 

 

 

 

 

 

 

 

 

 

 

Purpose of Seminal Identification 431
Examination of Seminal Stains 432
Confirmatory Tests 433
Individualization of Seminal Stains 435
Medico-legal Questions 436
Identification of Biological Samples and Body
Fluids 436



.

34. Medico-legal Aspects of HIV ....................... 451

 

 

 

 

Types of Torture 446
Medical Practitioner and Torture 449
Custodial Deaths 449

 

 

 

 

RFLP 438
PCR 440
Specimen Selection and Preservation 442



 

Question Bank-I.......................................................................457

Section 2
36. General Toxicology ...................................... 465

 

Treatment 490
Postmortem Findings 491
Chronic Arsenic Poisoning (Arsenicosis/
Arsenicism) 491
Postmortem Findings 492
Postmortem Imbibition of Arsenic 492

 

 

 

 

Chronic Lead Poisoning (Plumbism/Saturnism) 500
Signs and Symptoms 500
Treatment 503
Postmortem Findings 503

 

 

.

.

40. Inorganic Metallic Irritants—Lead .............. 499




 

 

 

 

 

 

 

 

Signs and Symptoms (Acute Poisoning) 495
Treatment 495

Postmortem Findings 496
Chronic Mercury Poisoning (Hydrargyrism) 496

37. Corrosive Poisons ....................................... 482

 

Signs and Symptoms (Acute Poisoning) 505
Treatment 506
Postmortem Findings 506
Chronic Copper Poisoning 506
 

 

 

 

 

.

­



42. Inorganic Metallic Irritants—Thallium........ 508

/>

 

Signs and Symptoms (Acute oisoning) 508
p

.

 

Signs and Symptoms (Acute Poisoning) 490



 

38. Inorganic Metallic Irritants—Arsenic ......... 489




.



41. Inorganic Metallic Irritants—Copper .......... 505

 

c

 



 

 

Mineral/Inorganic Acids 482
Vitriolage (Vitriol Throwing) 484
Chemical olitis 484
Oxalic Acid (Acid of Sugar, C2H2O4) 485
Carbolic Acid (Phenol, C6H4OH) 486
Strong Alkalis (Caustic Alkalis) 487

.

39. Inorganic Metallic Irritants—Mercury ........ 494




 

 

 

 

 

 

 

 

 

Medico-legal Aspects of Poisons 465
Classification of Poisons 466
Factors Modifying the Action of Poisons 467
Poisoning in the Living 467
Diagnosis of Poisoning in Dead 468
Failure to Detect Poison 470
Duties of a Doctor in a Case of Suspected
Poisoning 470
Management of Poisoning Cases 471
Removal of Unabsorbed Poison 472
Administration of Antidotes 475
Elimination of Poison by Excretion 476
Samples Preserved for Toxicological Analysis 477
Notes 478

 

.

Toxicology


xxii

Review of Forensic Medicine and Toxicology

Treatment 509
Postmortem Findings 509

 

Signs and Symptoms 559
Treatment 560
Postmortem Findings 560
Barbiturate Automatism (Self-poisoning) 561

 

.

Signs and Symptoms 567
Treatment 567
Run-amok 567
 

.

45. Organic Irritants—Plant .............................. 517

.

53. Spinal and Peripheral Nerve Poisons ........ 572




 

 

 

 

 

 

 

Signs and Symptoms 569
Treatment 570
Cocainism (Cocainomania/Cocainophagia) 571

n

 

.

54. Cardiac Poisons........................................... 576




 

m

 

Snakes 524
Signs and Symptoms of Ophitoxemia 527
Management 529
Postmortem Findings 532
Cantharides (Spanish Fly) 533
Scorpions 534
Bees and Wasps 534

 

.

46. Organic Irritants—Animal ........................... 524

 

Strychnos ux-vomica (Kuchila) 572
Peripheral Nerve Poisons 574
Conium aculatum (Hemlock) 575

 

b

.

52. Deliriants—Cocaine ..................................... 569




 

 

 

 

 

Ricinus Communis (Castor) 517
Croton Tiglium (Jamalgota) 518
Abrus Precatorius (Rati, Gunchi, Jequirity) 519
Suis 519
Semecarpus Anacardium 520
Capsicum Annuum 521
Calotropis (‘Rubber ush’) 521
Ergot 522

.

51. Deliriants—Cannabis................................... 566




 

 

 

 

 

 

 

Phosphorus 514
Postmortem Findings 515
Chronic Phosphorus Poisoning 516
Mechanical Irritants 516

.



50. Deliriants—Dhatura/Datura ......................... 562
Dhatura/Datura 562
Signs and Symptoms 563
Treatment 563
Postmortem Findings 564

44. Non-Metallic and Mechanical Irritants ....... 514






 

i

 

 

 

 

 

 

 

 

Cadmium 510
Barium 511
Zinc 512
Metal Fume Fever (MFF) 512
Methemoglobinemia nducing Agents 513



.

49. Sedative-hypnotic—Barbiturates ............... 559




.

43. Other Inorganic Metallic Irritants ............... 510




 

 

 

Isopropyl Alcohol 556
Ethylene Glycol 556

.

 

47. Somniferous Poisons (Narcotic Poisons) . 537

55. Hydrocyanic Acid......................................... 582
.



 

Opium 537
Signs and Symptoms 538

Treatment 539
Postmortem Findings 539
Chronic Morphine Poisoning (Morphinism) 541







 

 

 

 

 

 

 

 

 

 

Aconite 576
Nicotiana Tabacum (Tobacco) 577
Digitalis Purpurea (Foxglove) 578
Nerium Odorum (White Oleander, Kaner) 579
Cerbera Thevetia (Yellow Oleander, Pila Kaner) 579
Quinine 580

.



56. Asphyxiants ................................................. 586
Carbon Monoxide (CO) 586
Carbon Dioxide (CO2) 588
Hydrogen Sulfide (H2S) 589

.

57. War Gases and Biological Weapons .......... 591




 

 

 

 

 

 

 

Signs and Symptoms (Acute Poisoning) 544
Treatment 545
Chronic Alcoholism (Systemic Effects) 546
Delirium Tremens 547
Alcoholic Hallucinosis 547
Wernicke’s Encephalopathy 548
Korsakoff’s Psychosis 548
Drunkenness 548
Diagnosing a Case of Drunkenness 549
Laboratory Investigations 553
Collection of Samples in Living 554
Methyl Alcohol (Methanol) 554



.

48. Inebriants—Alcohol ..................................... 542

 

.

58. Agricultural Poisons.................................... 595
Organophosphorus Compounds (OPCs) 595
Signs and Symptoms 597

/>
 

 

 

 

 

 

 

 

 

 

 

 

War Gases 591
Types of Chemical Warfare Agents (CWAs) 591
Biological Weapons 592
Types of Biological Warfare Agents 593

 





 

 

 

 

 

 

 

 

Signs and Symptoms 582
Treatment 583
Postmortem Findings 584
Judicial Execution 585


xxiii

Contents

 

 

 

 

 

 

 

 

Signs and Symptoms 627
Treatment 627
Postmortem Findings 628
.

63. Food Poisoning............................................ 629

 

 

 

 

 

Bacterial Food Poisoning 629
Botulism (Allantiasis) 630
Lathyrus Sativus (‘Kesari Dhal’) 631
Mushrooms 632
Argemone Mexicana (Prickly Poppy) 632
.

Question Bank—II ........................................................635

 

 

 

 

 

 

 

 

Paracetamol (Acetaminophen) 611
Iron 612
Antipsychotic Drugs (Tranquilizers) 612
Antihistamines 613
Tricyclic Antidepressants (TCAs) 614
Benzodiazepines (BZDs) 614
Acetylsalicylic Acid (Aspirin) 615
Chloral Hydrate 616



.

60. Medicinal Poisons ........................................611


.

62. Kerosene Oil Poisoning ............................. 627

.

59. Alphos (Aluminum Phosphide) .................. 606




 

 

 

 

 

 

 

 

 

Patterns of Drug Use Disorders 618
Psychoactive Substances 619

Complications of Drug Abuse 623
Postmortem Findings 623
Date Rape Drugs 624

Signs and Symptoms 606
Treatment 607
Postmortem Findings 609

Index .............................................................................637
.



.

61. Drug Dependence and Date Rape Drugs... 618




 

Treatment 598
Postmortem Findings 600
Endrin 601
Naphthalene 602
Paraquat 603
Pyrethrins and Pyrethroids 604

Superscripts in the text refer to answers of the MCQs given at the end of the chapters.

/>

Forensic Medicine has

h

History
umble and ancient origins

 Law-medicine problems are found written in records in Egypt, Sumer, Babylon, India and China
dating 4000-3000 BC.
 Manu (3102 BC) was the first traditional king and lawgiver in India. Manusmriti was a famous
treatise where rules for marriage, punishment for adultery, incest and sexual offences were formulated.
 Code of Hammurabi specified by King of Babylon (about 2200 BC) is the oldest known medicolegal code.
 Hippocrates (460-377 BC), Father of Western medicine discussed the lethality of wounds and
contributed to the field of ethics.
 First descriptions of examination of injuries were found carved on pieces of bamboo dating back
to the Qin dynasty in China, from about 220 BC.
 First medico-legal autopsy in history was conducted by the Roman physician Antistius who
examined the body of Julius Caesar after his assassination in 44 BC.
 Agnivesa Charaka Samhita was the first treatise on Indian medicine which dates back to 7th
BC.
 Shusruta, Father of Indian Surgery gave the Shusruta Samhita in 200-300 AD.
 During the 6th century, Justinian law called medico-legal experts to testify in cases of rape,
criminal abortion and murder.
 Chinese publication in the 13th century titled 'Hsi Yuan Lu' or 'Instructions to the Coroner'
dealt with findings in cases of infanticide, drowning, hanging, poisoning and assault.

 In Germany, during the 16th century, the code of Bamburg brought about a requirement for
medical testimony in forensic cases. This code also allowed the opening of bodies to examine
the depth of and damage caused by wounds.
 In 1602, first book on forensic medicine was published by Italian physician, Fortunato Fedele.
 The first recorded medico-legal autopsy performed in India was by Dr Edward Bulkley in 1693
at Chennai on a suspected case of arsenic poisoning.
 The first publication on forensic medicine in UK was by William Hunter in the 18th century.
His essays were on injuries found on murdered bastard children.
 In the 18th century, Italian anatomist Giovanni Morgagni (1682-1771) dissected the bodies of
the dead and compared the alterations in their organs with the symptoms of the diseases that
had caused death. He published a book in 1761 on 640 postmortem he had conducted.
 The three great pioneers of forensic medicine born in the 18th century were Johann Casper (17961864), Mathieu Orfila (1787-1853) and Marie Devergie (1798-1879). They devoted their life in the
study and development of forensic medicine as we understand it today.
Dr CTO Woodford is regarded as the first Professor of Medical Jurisprudence in India.

/>

313
316
320
337
345
353
366
388
394
399
403
422









a

/>
iv

N

Starvation Deaths
Anesthetic Deaths
Infanticide and Child Abuse
Abortion
Impotence and Sterility
Virginity, Pregnancy and Delivery
Sexual Offences I
Sexual Offences II
Sexual Offences III
Postmortem Artifacts
Forensic Psychiatry
Bloodstain Analysis
Seminal Stains and Other Biological
Samples
32. Dn Fingerprinting
33. Torture and Custodial Deaths
34. Medico-legal Aspects of H
35.
ewer Techniques and Recent Advances
Question Bank-I


310

19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.









3
30
43
56
84
98
122
126

136
160
188
209
232
263
281
289
295

Medical Jurisprudence and Ethics
Acts Related to Medical Practice
Legal Procedure
Identification I
Identification II
Medico-legal Autopsy
Autopsy Room Hazards
Thanatology
Signs of Death
Asphyxia
Injuries
Firearm Injuries
Regional Injuries
Thermal Injuries
Transportation Injuries
Explosion Injuries and Fall from Height
Medico-legal Aspects of Injuries
Decompression, Radiation and
Altitude Sickness

1.

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

Jurisprudence and
Forensic Medicine

431
438
446
451
454
457