textbook of ft forensic medicine, medical jurisprudence r ... · he officiated as dean, medical...
TRANSCRIPT
Dedicated to Education
GK SharmaGK Sharma
Sharm
aSha
rma
4819/XI, Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India [email protected], [email protected]; www.cbspd.com
New Delhi Bengaluru Chennai Kochi Kolkata MumbaiHyderabad Nagpur Patna
E-mail: Website:|| | | | |
| | | | Jharkhand Pune Uttarakhand
CBS Publishers & Distributors Pvt Ltd
De
dic
ate
d to
Ed
uca
tion
is an endeavour to provide student friendly and simplified textbook on forensic medicine, medical jurisprudence and toxicology. All the topics are given in an elaborate manner so that both undergraduate as well as postgraduate students can understand the intricacies of the subject and use their knowledge in forensic practice and while giving evidence in the court.
Simple and easy language for better understanding.Detailed description of important aspects.Point-wise presentation of text for easy comprehension.Clinical forensic medicine has been described in detail to facilitate medicolegal work in actual practice.Legal aspects of various issues have been incorporated in each chapter.Recent changes have been incorporated as advocated in the regulations of the MCI or Indian legal system.Some important historic poisoning instances have been mentioned so as to generate interest in the students.Multiple choice questions along with their answers have been added to facilitate students in postgraduate entrance examinations.
••••
••
•
•
GK Sharma MBBS, MD
is former Director-Professor and Head, Department of Forensic Medicine and Toxicology, Lady Hardinge Medical College (LHMC), New Delhi. He was Director, LHMC, from 2003 to 2010, and Additional Director General (Medical), DGHS, GoI.
He completed his postgraduation from Government Medical College, Patiala, Punjab. Since 1978, he has worked in teaching positions in various medical colleges in Delhi. He has taken active role in research and published many research articles in national and international journals. He officiated as Dean, Medical Faculty, University of Delhi, for two years, and was member of the ethics committee of Medical Council of India and member of Delhi Medical Council.
9 789386 478337
ISBN: 978-93-86478-33-7
Textbook ofTextbook of
Including Forensic PsychiatryIncluding Forensic Psychiatry
Forensic Medicine, Medical Jurisprudence and Toxicology
Forensic Medicine, Medical Jurisprudence and Toxicology
Textbook ofTextbook of
Including Forensic PsychiatryIncluding Forensic Psychiatry
Forensic Medicine, Medical Jurisprudence and ToxicologyForensic Medicine, Medical Jurisprudence and Toxicology
Textbo
ok o
fTextb
oo
k of
Forensic Medicine, Medical Jurisprudence and ToxicologyForensic Medicine, Medical Jurisprudence and Toxicology
Textbook of
Forensic Medicine,Medical Jurisprudence andToxicologyIncluding Forensic Psychiatry
CBS Publishers & Distributors Pvt Ltd
New Delhi • Bengaluru • Chennai • Kochi • Kolkata • MumbaiHyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand
Textbook of
Forensic Medicine,Medical Jurisprudence andToxicologyIncluding Forensic Psychiatry
GK Sharma MBBS, MD
FormerDirector-Professor and Head
Department of Forensic Medicine and Toxicology and
DirectorLady Hardinge Medical College and Associated Hospitals
New DelhiAdditional Director General of Health Services
Ministry of Health and Family WelfareDean, Faculty of Medical Sciences, University of DelhiMember, Ethics Committee, Medical Council of India
Member, Delhi Medical Council
ISBN: 978-93-86478-33-7
Copyright © Author and Publisher
First Edition: 2017
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means,electronic or mechanical, including photocopying, recording, or any information storage and retrieval systemwithout permission, in writing, from the author and the publisher.
Published by Satish Kumar Jain and Produced by Varun Jain for
CBS Publishers & Distributors Pvt Ltd4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India.Ph: 23289259, 23266861, 23266867 Fax: 011-23243014 Website: www.cbspd.com
e-mail: [email protected]; [email protected].
Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi 110 092
Ph: 4934 4934 Fax: 4934 4935 e-mail: [email protected]; [email protected]
Branches
• Bengaluru: Seema House 2975, 17th Cross, K.R. Road,Banasankari 2nd Stage, Bengaluru 560 070, KarnatakaPh: +91-80-26771678/79 Fax: +91-80-26771680 e-mail : [email protected]
• Chennai: 7, Subbaraya Street, Shenoy Nagar, Chennai 600 030, Tamil NaduPh: +91-44-26680620, 26681266 Fax: +91-44-42032115 e-mail: [email protected]
• Kochi: Ashana House, No. 39/1904, AM Thomas Road, Valanjambalam,Ernakulam 682 016, Kochi, KeralaPh: +91-484-4059061-65 Fax: +91-484-4059065 e-mail: [email protected]
• Kolkata: 6/B, Ground Floor, Rameswar Shaw Road, Kolkata-700 014, West BengalPh: +91-33-22891126, 22891127, 22891128 e-mail: [email protected]
• Mumbai: 83-C, Dr E Moses Road, Worli, Mumbai-400018, MaharashtraPh: +91-22-24902340/41 Fax: +91-22-24902342 e-mail: [email protected]
Representatives
• Hyderabad 0-9885175004 • Jharkhand 0-9811541605 • Nagpur 0-9021734563
• Patna 0-9334159340 • Pune 0-9623451994 • Uttarakhand 0-9716462459
Printed at: Shree Maitrey Printech Pvt. Ltd., Noida, UP, India
Textbok of
Forensic Medicine,Medical Jurisprudence andToxicologyIncluding Forensic Psychiatry
DisclaimerScience and technology are constantly changing fields. Newresearch and experience broaden the scope of information andknowledge. The author has tried his best in giving informationavailable to him while preparing the material for this book.Although all efforts have been made to ensure optimumaccuracy of the material, yet it is quite possible some errors mighthave been left uncorrected. The publisher, the printer and theauthor will not be held responsible for any inadvertent errors orinaccuracies.
Contributors
Dr Mukta Rani MD
Professor, Department of Forensic MedicineLady Hardinge Medical College and Associated HospitalsNew Delhi(Infanticide, Sexual Offences)
Dr SK Naik MD
Professor, Department of Forensic MedicineLady Hardinge Medical College and Associated Hospitals NewDelhi(History of Forensic Medicine)
Dr Arvind Kumar MD
Associate Professor, Department of Forensic MedicineLady Hardinge Medical College and Associated Hospitals NewDelhi(Forensic Toxicology)
Dr Sukhdeep Singh MD
Associate Professor, Department of Forensic MedicineLady Hardinge Medical College and Associated Hospitals NewDelhi(Medical Jurisprudence)
Foreword
It is indeed a great pleasure and honour to write a Foreword for the book Textbook of Forensic Medicine, Medical Jurisprudence and
Toxicology including Forensic Psychiatry, written by my senior colleagueProf Dr GK Sharma, who has more than four decades of rich experiencein the field of forensic medicine.
The book has been written in a lucid style, is up-to-date, and coversalmost every topic in forensic medicine and toxicology. I hope that itwill be immensely useful for both the undergraduate and postgraduatemedical students.
I wish Prof GK Sharma all the success in his endeavour.
Dr Atul MurariDirector-Professor
Department of Forensic Medicineand
Former DirectorLady Hardinge Medical College
New Delhi 110 001.
Foreword
This book from my long-time friend and colleague Dr GK Sharmacomes as no surprise for I have always known him to be
academically inclined and respected professionally, by all his peers.He has had a wide practical and teaching experience and hisparticipation in conferences and seminars has been appreciated andwell received.
The book by him covers the undergraduate syllabus on the subjectas prescribed by the Medical Council of India and followed ininstitutes beyond purview of the Medical Council. His clarity on theprinciples of the subject translates into simple and easy material for the undergraduate. I haveno doubt that this book will be popular with the students and teachers alike for being technicallycorrect, covering all the required areas with appropriate explanations and yet being crisp.
I congratulate Dr GK Sharma on this endeavour and hope the book becomes available tothe undergraduate students all over the country.
Dr BP DubeyFormer Dean and Professor and Head
Department of Forensic Medicine,Gandhi Medical College, Bhopal
Preface
It is an endeavor to provide a textbook on forensic medicine in a simplified and studentfriendly manner so that undergraduate medical students are able to understand the subject
both for clinical and examination purposes. Postgraduate students may also refer this book asa basic guide to buildup proper understanding of the subject.
The book covers the prescribed undergraduate MCI curriculum and the format helps thestudents to remember and reproduce the subject during examinations. There are variousupshots of this subject, especially in osteology, dentistry, crime scene visit, forensic pathology,firearm investigations and transport accident investigations, to name a few. Even though thesetopics have been discussed in the book but for postgraduate students, references from otherbooks may be required to advance their knowledge.
Concerned portions of the Indian law has been incorporated in various chapters to makethem more relevant in their application in providing evidence in the courts. Advance scientifictechniques and histopathology may help the practitioners of forensic medicine to interpretchanges seen during crime investigations.
At the end of the book Multiple Choice Questions are given for revision of the topics as wellas for postgraduate entrance examinations.
I am indebted to Dr KS Rai, Professor of Forensic Medicine, Govt Medical College, Patiala,for initiating me in this subject; Dr Bishnu Kumar, Professor of Forensic Medicine, and Dr BNReddy, Associate Professor, Maulana Azad Medical College, New Delhi, for making meunderstand the intricacies of practical aspects of forensic medicine, and all my friends andcolleagues for helping me in compiling this textbook.
I am thankful to CBS Publishers & Distributors. I would like to put on record the sincereefforts of Mr YN Arjuna and his team, comprising Mrs Ritu Chawla, Mr Sanjay Chauhan(Sanju), Mr Parmod Kumar and Mr Mukund Kumar, for bringing out the book in the presentform.
I welcome comments, suggestions and corrections from the readers.
GK Sharma
Contents
Contributors vForeword by Dr Atul Murari viiForeword by Dr BP Dubey ixPreface xi
SECTION 1 FORENSIC MEDICINE
1. Introduction 3–5
History of Legal Medicine 3
2. Legal Procedures 6–10
Inquest 6Courts of Law 8Conduct Money 9Recording of Evidence 9Perjury 9Medical Evidence 9
3. Identification 11–34
Race and Religion 12Complexion and Features 19Hair 19Anthropometry (Bertillon’s System) 21Dactylography (Galton’s System) Including Poroscopy (Locard’s System) 22Teeth (Odontology) 25Deformities 28Birthmarks 29Tattoo Marks 29Occupational Marks 29Handwriting 29Gait 30Manner and Habits 30Mental Power and Memory 30Height and Weight 30Cloths and Personal Effects 30Superimposition Technique 30DNA Fingerprinting 31Miscellaneous Methods 33
4. Thanatology 35–52Somatic Death 35Molecular Death 37
Forensic Medicine, Medical Jurisprudence and Toxicologyxiv
Modes of Death 37Changes After Death 38Time Since Death 46Embalming 46Exhumation 47The Transplantation of Human Organs Act, 1994 47
5. Sudden and Unexpected Death 53–57
Causes of Sudden and Unexpected Deaths 53
6. Mechanical Injuries 58–64
Injury 58Hurt: (Section 319 IPC) 58Mechanical Injuries 59Bruise/Contusion 60Lacerations 61Incised Wound 63Chop Wounds 63Stab Wounds 63Defence Wounds 64Fabricated Injuries 64
7. Firearm Injuries 65–74
Interior Ballistic 65Types of Firearm 65Exterior Ballistics 69Terminal Ballistics 70
8. Blast Injuries 75–77
Injuries from Explosion 75Postmortem Findings 76
9. Medicolegal Aspects of Injuries 78–87
Nature of Injuries 78Causes of Death from Injuries 81Age of Injuries 84Whether the Injuries are Antemortem or Postmortem 86Whether Injuries are Suicidal, Accidental or Homicidal in Nature 86Power of Volitional Acts After Sustaining a Fatal Injury 87Which of the Several Injuries Resulted in Death? 87Which Injury was Received First? 87
10. Regional Injuries 88–97Head Injuries 88Injuries to Other Parts of the Body 95Fall From Height 96
11. Transportation Injuries 98–103
Road Traffic Accidents 98Railway Injuries 101Aviation Accidents 102
Contents xv
12. Dysbarism and High Altitude Sickness 104–107Dysbarism 104Altitude Sickness 106
13. Role of Forensic Expert in Mass Disaster 108–110Types of Mass Disasters 108Primary Aims of the Postmortem Examinations 109
14. Thermal Injuries 111–118Effects of Cold 111Heat Injuries 112Degree of Burns 114Burnt Area Calculations 115Causes of Death in Burns 116
15. Electricity and Lightning 119–123Factors Responsible for the Production of Electric Injuries 119Electrocution Injuries 120Postmortem Findings 121Lightning Injuries 122
16. Clinical Forensic Medicine 124–126
Medicolegal Case 124Responsibilities of a Doctor in Medicolegal Case 124Late MLC 126Cases Required to be Labelled as MLC 126Record Maintenance 126
17. Asphyxial Deaths 127–140
Hypoxia or Anoxia 127Asphyxia 128Death by Hanging 130Death by Strangulation 133Death by Suffocation 135Death by Drowning 136Sexual Asphyxia 140
18. Operation Theater Mishaps 141–143
Common Causes of Surgical Operation Related Mishaps 141
19. Forensic Osteology 144–157Human or Animal Bones 144Time Since Death 145Sex Determination 146Age Determination 150Race 154Stature 155Skeletal Remains Belong to how Many Individuals? 156
20. Torture and Medical Ethics 158–161Reasons for Torture 159Methods of Torture 159Signs and Symptoms 160
Forensic Medicine, Medical Jurisprudence and Toxicologyxvi
Management of Torture Victims 160Custodial Deaths 160Causes of Custodial Deaths 161Postmortem Features 161
21. Criminal Interrogation Techniques 162–164
Traditional Third Degree Methods 162Reid Technique 162The Good Cop and Bad Cop Method 162The Peace Method 162Kinesic Interview Method 162Modern Medical Techniques 162
22. Blood and Other Body Fluid Stains 165–173
Collection of Bloodstains 165Screening tests for Blood 165Confirmatory Test 166Age of the Stains 167Species Identification 167Source of Blood 168Blood Grouping 168Stains of Other Body Fluids 170Paternity Determination 171Doubtful Maternity 173
23. Blood Transfusion Mishap 174–176
Acute Complications of Transfusion 174Delayed Complications of Transfusion 175
24. Medicolegal Autopsy 177–186
Aims and Objectives 177Evisceration Techniques 181
25. Aids and Medicolegal Aspects of Aids 187–189
Medicolegal Aspects of AIDS 187Precautions for Health Care Workers 189Precautions During Conduct of Postmortems 189
26. Starvation 190–192Energy Generation in Fasting 190Medicolegal Issues 191
27. Role of Forensic Pathologist at Scene of Crime 193–195
Duties of a Doctor at the Scene of Crime 193Advantages of Presence of a Doctor at Scene of Crime 193Crime Scene Examination Kit 195Difficulties in Visiting Scene of Crime by a Doctor 195
28. Sexual Offences 196–213
Natural Sexual Offences 196Medical Examination of Victim of Sexual Assault 200
Contents xvii
Examination of the Accused in Sexual Assault 207Adultery 207Sexual Perversions 209Miscellaneous Sexual Offences 210Sexual Harassment of Women at Work Place 211Trafficking of Person: (Section 370 IPC) 211The Protection of Children from Sexual Offences Act (POCSO Act) 2012 212
29. Impotency and Sterility 214–217
Causes of Male Impotence or Erectile Dysfunction 214Examination of a Male for Impotency 215Causes of Impotency and Sterility in Females 216Examination of a Female 217
30. Verginity, Pregnancy and Delivery 218–225
Signs of Virginity 218Pregnancy 220Delivery 224
31. Abortion 226–233
Natural Abortions 226Therapeutic or Legal Abortions 227The Medical Termination of Pregnancy Act, 1971 227Illegal or Criminal Abortions 228Preconception and Prenatal Diagnostic Techniques (Prohibition of
Sex Selection) Act, 1994 (PCPNDT Act) 231
32. Fetal and Infant Deaths 234–249
Infanticide 234Whether the Child was Stillborn, Dead Born or Live Born 235Whether Death was Due to Natural Causes or due to any Act of
Omission or Commission 243Child Abuse 245Sudden Infant Death Syndrome 247Munchausen Syndrome by Proxy 249
SECTION 2 MEDICAL JURISPRUDENCE
33. Medical Jurisprudence 253–281
The Indian Medical Degrees Act, 1916 253Medical Council of India (MCI) 254The Indian Medical Council Act, 1956 255State Medical Councils (SMCs) 255Medical Malpractice (Medical Malpraxis) 268Consent 275Consumer Protection Act, 1986 276Euthanasia or Mercy Killing 280
Forensic Medicine, Medical Jurisprudence and Toxicologyxviii
SECTION 3 FORENSIC PSYCHIATRY
34. Forensic Psychiatry 285–294
Mental Health Act 1987 285Discharge and Leave of Absence 287The Mental Health Care Bill 2013 287Mental Disorders 289
SECTION 4 FORENSIC TOXICOLOGY
35. General Toxicology 297–310Poison 297Forensic Toxicology 297Nature of Poisoning 298Medicolegal Aspects of Poisoning 298Laws Related to Poisons 299Duties of a Medical Practitioner in a Case of Suspected Poisoning 301Factors Influencing the Actions of a Poison in the Body 302General Principles of Management 303
36. Corrosive Poisons 311–319
Corrosive Agents 311Sulphuric Acid (H2SO4) (Oil of Vitriol or Battery Acid) 312Hydrochloric Acid (HCl) (Muriatic Acid, Hydrogen Chloride Solution or
Spirits of Salt) 314Nitric Acid (HNO3) (Aqua Fortis) 315Hydrofluoric Acid (HF) 316Carbolic Acid (Phenol) 316Oxalic Acid (Acid of Sugar) 317Alkalis 318
37. Metallic Poisons 320–331
Inorganic Metallic Irritants 320Arsenic 320Mercury 324Lead 326Copper 329Thallium 331
38. Nonmetallic Irritant Poisons 332–334
Phosphorus 332Poisoning by Phosphine Gas 333Iodine 334Mechanical Irritant Poisons 334
39. Organic Irritant Poisons of Vegetable Origin 335–339
Ricinus Communis (Castor Plant or Arandi) 335Croton Tiglium (Jamal Ghota) 336Abrus Precatorius (Rati Seeds, Rosary Peas, Gunchi) 337Semicarpus Anacardium (Marking Nut) 338Calatropis Gigentea and Calatropis Procera (Madar, Aak or Akdo) 338Capsicum Annum (Lal Mirch) 339
Contents xix
40. Organic Irritant Poisons of Animal Origin 340–349
Snakes 340Scorpion 347Spiders 347Insect Bite 348Cantharidin 349
41. Cerebral Poisons 350–354
Somniferous group 350Opium 350
42. Inebriants 355–362
Alcohol 355How to Examine a Case of Alcohol Intoxication 359
43. Hypnotic and Sedatives 363–366
Barbiturate Poisoning 363Barbiturate Automatism 365
44. Deliriant Poisons 367–371
Datura (Thorn Apple) 367Atropa Belladonna 369Cannabis (Indian Hemp) 369
45. Hallucinogens 372–374
Lysergic Acid Diethylamide (LSD) 372Phencyclidine (PCP) 373
46. Cardiac Poisons 375–378
Digitalis 375Aconite 376Quinine 377Nicotine 378
47. Spinal Poisons 379–381
Strychnos Nux Vomica (Kuchila) 379
48. Peripheral Neurotoxic Poisons 382
Curare 382
49. Asphyxiants 383–388
Carbon Monoxide 383Carbon Dioxide 384Hydrogen Sulphide 385Hydrocyanic Acid 386
50. Insecticides and Weed Killers 389–392
Classification Based on the Toxicity 389Classification Based on Chemical Structure of Compounds 389Organophosphorus Compounds 389Carbamates 391Chlorinated Hydrocarbons 391Paraquat 392
Forensic Medicine, Medical Jurisprudence and Toxicologyxx
51. Common Household Poisons 393–397
Paracetamol 393Salicylic Acid 394Hydrocarbons 396Kerosene (Lamp Oil, Coal Oil) 396
52. Drugs of Abuse and Date Rape Drugs 398–404
Reasons for Nonmedical Use of Drugs 398Drugs Used for Drug Dependence 399Heroin Dependence 399Amphetamines 400Cocaine 401Date Rape Drugs (Predator Drugs) 403
53. Chemical, Biological, Radiological and Nuclear Warfare Agents 405–410
War Gases (Chemical Warfare Agents, CWA’s) 405Biological Warfare Agents (BW) 407Radiological and Nuclear Weapons 409
54. Food Poisoning 411–413
Types of Food Poisoning 411Infective Bacterial Food Poisoning 411Mushrooms Poisoning 412
Multiple Choice Questions 414–440
Legal Procedure 414Identification 415Thanatology 417Injuries 420Medicolegal Importance of Injuries 422Regional Injuries 423Thermal Injuries 424Asphyxia 426Impotency, Sterility and Pregnancy 427Rape 428Delivery 429Infanticide 430Torture 431Medical Jurisprudence 431Forensic Psychiatry 432General Toxicology 433Corrosives 433Irritants 434Somniferous and Inebrients 436Delirients 438Answers to MCQs 440
Index 441–449