About the Book

Major changes and updation 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)
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)
Drug abuse and date rape drugs (PCP, date rape drugs)
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.
Enriched with colour plates comprising of common poisons discussed in Section II have been added.
Topic-wise MCQs from previous PG entrance examination (2006-15) are given at the end of each chapter.
Answers can be referred from the text given as superscripts.
Question banks I and II provide a list of important questions.
There are two separate categories, such as Must Know and Desirable to Know to prepare student for exam preparation.
This will help the reader to get insight of the subject and prepare for viva voce and subsequent PG entrance examinations.

About the Author

Gautam Biswas MD (UCMS)

Table of Contents:
1. Medical Jurisprudence and Ethics.................3 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 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 Section 1 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 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 4. Identification I ................................................ 56 Corpus Delicti 56 Race and Religion 56 Sex 58 Nuclear Sexing 59 Disorders of sexual development 60 Sex from Skeletal Remains 63 Age 64 Age from Ossification of Bones 71 Age Determination in Adults Over 25 years 73 Medico-legal Importance of Age 76 Stature 77 Scars 78 Tattoo Marks 78 Notes 80 5. Identification II ............................................... 84 Anthropometry (Bertillon system/Bertillonage) 84 Dactylography (Dactyloscopy) 84 Poroscopy 88 Lip prints (Cheiloscopy) 88 Hair 89 Contents Jurisprudence and Forensic Medicine xviii Review of Forensic Medicine and Toxicology Medico-legal Questions 89 Superimposition 93 Forensic Odontology 93 Miscellaneous Methods of Identification 96 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 7. Autopsy Room Hazards .............................. 122 Classification of Pathogens 122 Commonly Acquired Infections 122 Autopsy of Hazard Group 3 Patients 123 Autopsy and Disposal of Radioactive Corpse 125 8. Thanatology ................................................. 126 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 9. Signs of Death.............................................. 136 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 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 10. Asphyxia....................................................... 160 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 11. Injuries.......................................................... 188 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 12. Firearm Injuries ............................................209 Classification of Firearms 210 Rifled Firearms 210 Smooth Bore Firearms/Shotguns 211 Contents xix 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 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 14. Thermal Injuries........................................... 263 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 Judicial Electrocution 277 Lightning Stroke 277 15. Transportation Injuries................................ 281 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 16. Explosion Injuries and Fall from Height.... 289 Explosion Injuries 289 Mechanism of Action 289 Classification of Injuries 290 Medico-legal Aspects 291 Fall from Height 292 Injury Patterns 292 17. Medico-legal Aspects of Injuries................ 295 Simple Hurt/Injury 296 Grievous Hurt/Injury 296 Punishments 298 Causes of Death from Wounds 299 Medico-legal Questions 302 Injury Report 305 18. Decompression, Radiation and Altitude Sickness ....................................... 310 Decompression Sickness 310 Autopsy in Decompression Sickness 310 Ionizing Radiation Reactions 310 Altitude Illness 312 19. Starvation Deaths ........................................ 313 Mode of Starvation 313 Pathophysiology 313 Signs and Symptoms 313 Postmortem Findings 314 Medico-legal Questions 315 20. Anesthetic Deaths ....................................... 316 Death during Administration of Anesthesia (not due to anesthesia) 316 Deaths Directly Related to Administration of an Anesthetic 316 Postmortem Examination 318 21. Infanticide and Child Abuse........................ 320 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 xx Review of Forensic Medicine and Toxicology Signs of Dead-born 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 22. Abortion........................................................ 337 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 23. Impotence and Sterility ............................... 345 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 24. Virginity, Pregnancy and Delivery.............. 353 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 25. Sexual Offences I......................................... 366 Rape 367 Duties of a Doctor in case 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 Rape on Children 382 Medico-legal Questions 382 Indicators of Sexual Abuse 383 Examination of Rape Accused 384 Incest 385 Adultery 385 26. Sexual Offences II........................................ 388 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 27. Sexual Offences III....................................... 394 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 28. Postmortem Artifacts .................................. 399 Artifacts due to Postmortem Changes 399 Third Party Artifacts 400 Environmental Artifacts 401 Other Artifacts 402 29. Forensic Psychiatry..................................... 403 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 30. Bloodstain Analysis..................................... 422 Bloodstain Pattern Analysis 422 Presumptive Tests for Blood 422 Contents xxi 36. General Toxicology...................................... 465 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 37. Corrosive Poisons....................................... 482 Mineral/Inorganic Acids 482 Vitriolage (Vitriol Throwing) 484 Chemical colitis 484 Oxalic Acid (Acid of Sugar, C2H2O4) 485 Carbolic Acid (Phenol, C6H4OH) 486 Strong Alkalis (Caustic Alkalis) 487 38. Inorganic Metallic Irritants—Arsenic ......... 489 Signs and Symptoms (Acute Poisoning) 490 Treatment 490 Postmortem Findings 491 Chronic Arsenic Poisoning (Arsenicosis/ Arsenicism) 491 Postmortem Findings 492 Postmortem Imbibition of Arsenic 492 39. Inorganic Metallic Irritants—Mercury ........ 494 Signs and Symptoms (Acute Poisoning) 495 Treatment 495 Postmortem Findings 496 Chronic Mercury Poisoning (Hydrargyrism) 496 40. Inorganic Metallic Irritants—Lead.............. 499 Chronic Lead Poisoning (Plumbism/Saturnism) 500 Signs and Symptoms 500 Treatment 503 Postmortem Findings 503 41. Inorganic Metallic Irritants—Copper.......... 505 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 poisoning) 508 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 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 32. DNA Fingerprinting...................................... 438 RFLP 438 PCR 440 Specimen Selection and Preservation 442 Uses of DNA Fingerprinting 443 Limitations of DNA Testing 444 33. Torture and Custodial Deaths..................... 446 Types of Torture 446 Medical Practitioner and Torture 449 Custodial Deaths 449 34. Medico-legal Aspects of HIV....................... 451 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 35. Newer Techniques and Recent Advances. 454 Polygraph 454 Brain Fingerprinting (Brain Mapping) 454 Narco-Analysis 455 Question Bank-I.......................................................................457 Section 2 Toxicology xxii Review of Forensic Medicine and Toxicology Treatment 509 Postmortem Findings 509 43. Other Inorganic Metallic Irritants ............... 510 Cadmium 510 Barium 511 Zinc 512 Metal Fume Fever (MFF) 512 Methemoglobinemia inducing Agents 513 44. Non-Metallic and Mechanical Irritants ....... 514 Phosphorus 514 Postmortem Findings 515 Chronic Phosphorus Poisoning 516 Mechanical Irritants 516 45. Organic Irritants—Plant .............................. 517 Ricinus Communis (Castor) 517 Croton Tiglium (Jamalgota) 518 Abrus Precatorius (Rati, Gunchi, Jequirity) 519 Suis 519 Semecarpus Anacardium 520 Capsicum Annuum 521 Calotropis (‘Rubber bush’) 521 Ergot 522 46. Organic Irritants—Animal ........................... 524 Snakes 524 Signs and Symptoms of Ophitoxemia 527 Management 529 Postmortem Findings 532 Cantharides (Spanish Fly) 533 Scorpions 534 Bees and Wasps 534 47. Somniferous Poisons (Narcotic Poisons). 537 Opium 537 Signs and Symptoms 538 Treatment 539 Postmortem Findings 539 Chronic Morphine Poisoning (Morphinism) 541 48. Inebriants—Alcohol..................................... 542 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 Isopropyl Alcohol 556 Ethylene Glycol 556 49. Sedative-hypnotic—Barbiturates............... 559 Signs and Symptoms 559 Treatment 560 Postmortem Findings 560 Barbiturate Automatism (Self-poisoning) 561 50. Deliriants—Dhatura/Datura......................... 562 Dhatura/Datura 562 Signs and Symptoms 563 Treatment 563 Postmortem Findings 564 51. Deliriants—Cannabis................................... 566 Signs and Symptoms 567 Treatment 567 Run-amok 567 52. Deliriants—Cocaine..................................... 569 Signs and Symptoms 569 Treatment 570 Cocainism (Cocainomania/Cocainophagia) 571 53. Spinal and Peripheral Nerve Poisons........ 572 Strychnos nux-vomica (Kuchila) 572 Peripheral Nerve Poisons 574 Conium maculatum (Hemlock) 575 54. Cardiac Poisons........................................... 576 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 55. Hydrocyanic Acid......................................... 582 Signs and Symptoms 582 Treatment 583 Postmortem Findings 584 Judicial Execution 585 56. Asphyxiants ................................................. 586 Carbon Monoxide (CO) 586 Carbon Dioxide (CO2) 588 Hydrogen Sulfide (H2S) 589 57. War Gases and Biological Weapons.......... 591 War Gases 591 Types of Chemical Warfare Agents (CWAs) 591 Biological Weapons 592 Types of Biological Warfare Agents 593 58. Agricultural Poisons.................................... 595 Organophosphorus Compounds (OPCs) 595 Signs and Symptoms 597 Contents xxiii Superscripts in the text refer to answers of the MCQs given at the end of the chapters. Treatment 598 Postmortem Findings 600 Endrin 601 Naphthalene 602 Paraquat 603 Pyrethrins and Pyrethroids 604 59. Alphos (Aluminum Phosphide) .................. 606 Signs and Symptoms 606 Treatment 607 Postmortem Findings 609 60. Medicinal Poisons ........................................611 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 61. Drug Dependence and Date Rape Drugs... 618 Patterns of Drug Use Disorders 618 Psychoactive Substances 619 Complications of Drug Abuse 623 Postmortem Findings 623 Date Rape Drugs 624 62. Kerosene Oil Poisoning ............................. 627 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 Index .............................................................................637