Additional Information
Book Details
Abstract
- Thoroughly revamped and revised edition carrying precise information in a concise manner.
- Radical changes have been effected in the chapters Death and Its Medicolegal Aspects: Forensic Thanatology; Sudden and Unexpected Deaths; Asphyxial Deaths; Deaths Associated with Surgery, Anaesthesia and Blood Transfusion; Custody Related Torture and/or Death; Medicolegal Examination of the Living; Injuries by Firearms; Complications of Trauma: Was Wounding Responsible for Death?; Consent to and Refusal of Treatment; Medical Negligence; and Intricacies of Forensic Toxicology.
- Enriched with photographs, drawings, sketches, flowcharts, and tables for easy and catchy understanding.
- Old cases have been replaced with new ones, making way for the readers to appreciate medicolegal implications.
- Reflects author’s personal experience of about three decades and the knowledge gathered from extensive reading, interactions, deliberations, etc. at various platforms.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover\r | Cover | ||
| Front matter\r | i | ||
| Copyright\r | iv | ||
| Dedication | v | ||
| Foreword | vii | ||
| Preface to the 5th Edition | ix | ||
| Acknowledgements | x | ||
| Contents | xi | ||
| Section 1 Forensic Medicine | 1 | ||
| Chapter 1 - Introduction to Forensic Medicine and Indian Legal System | 3 | ||
| Indian Legal System | 4 | ||
| Legal Procedure at an Inquest | 4 | ||
| Police inquest | 4 | ||
| Procedure | 4 | ||
| Magistrates inquest | 7 | ||
| Medical examiners system | 7 | ||
| Juvenile Justice Board | 7 | ||
| Medical Evidence | 7 | ||
| Documentary evidence | 7 | ||
| Oral evidence | 7 | ||
| Dying Declaration | 8 | ||
| Admissibility of dying declarationŠdifference between english and indian law | 8 | ||
| Eligibility of statements | 9 | ||
| Statements: written or verbal | 9 | ||
| Circumstances of transaction that resulted in death | 9 | ||
| Proximity between time of statement and that of death | 9 | ||
| Person to whom dying declaration should be made | 9 | ||
| More than one dying declarations | 9 | ||
| Incomplete dying declaration | 9 | ||
| Dying declaration need not be exhaustive | 9 | ||
| Evidentiary valueŠneed for corroboration | 10 | ||
| Procedure for Examination of a Witness in the Court | 10 | ||
| Summons | 10 | ||
| Attendance in Response to Summons | 10 | ||
| Oath taking | 11 | ||
| Perjury | 11 | ||
| Recording of evidence | 11 | ||
| Examination-In-Chief | 11 | ||
| Cross-Examination | 13 | ||
| Re-examination | 13 | ||
| Question(s) by the Court | 13 | ||
| Kinds of Witnesses | 13 | ||
| Common/ordinary witness | 13 | ||
| An expert witness | 13 | ||
| Doctor in the Witness Box | 14 | ||
| Punctuality and demeanour | 14 | ||
| Be fair and frank | 14 | ||
| Clarity of the subject matter | 14 | ||
| Speak clearly and coolly, but not coldly | 14 | ||
| Give direct answers wherever possible, and answer only the question asked | 15 | ||
| Use adjectives with care | 15 | ||
| Never lose temper | 15 | ||
| Volunteering a statement | 15 | ||
| In cases of malpractice | 15 | ||
| Chapter 2 - Medicolegal Autopsy, Exhumation, Obscure Autopsy, Anaphylactic Deaths and Artefacts | 17 | ||
| Medicolegal Autopsy | 17 | ||
| Objectives | 17 | ||
| Preliminaries to a medicolegal autopsy | 18 | ||
| Clothing | 18 | ||
| Examination of the body | 19 | ||
| External Examination | 19 | ||
| Internal Examination | 20 | ||
| Skull and Brain | 21 | ||
| Spine and Spinal Cord | 21 | ||
| Neck | 22 | ||
| Thorax | 22 | ||
| Heart: Dissection | 22 | ||
| Lungs | 22 | ||
| Abdomen | 23 | ||
| Stomach | 23 | ||
| Intestines | 23 | ||
| Liver | 23 | ||
| Pancreas | 23 | ||
| Spleen | 23 | ||
| Kidneys | 23 | ||
| Bladder | 23 | ||
| Prostate and Testes | 23 | ||
| Uterus | 23 | ||
| Ancillary investigations | 24 | ||
| Histological Examination | 24 | ||
| Microbiological Samples/Specimens | 24 | ||
| Biochemical Examination | 24 | ||
| Enzymatic Studies | 24 | ||
| For Suspected Virus | 24 | ||
| Vaginal/Anal Swabs and Smears | 24 | ||
| Urine and Faeces | 24 | ||
| Selection of Viscera in Cases of Suspected Poisoning | 24 | ||
| Instructions for Packing and Transmission | 24 | ||
| Embalming | 26 | ||
| Methods | 26 | ||
| Medicolegal Considerations | 26 | ||
| Disposal of the body | 27 | ||
| Examination of decomposed bodies | 27 | ||
| Exhumation | 27 | ||
| Objectives | 27 | ||
| Precautions | 28 | ||
| Procedure | 28 | ||
| Second autopsy | 28 | ||
| Obscure Autopsy | 29 | ||
| Natural diseases | 29 | ||
| Biochemical disturbances | 29 | ||
| Endocrine dysfunction | 29 | ||
| Concealed trauma | 29 | ||
| Poisoning | 29 | ||
| Miscellaneous | 29 | ||
| Anaphylactic Deaths | 29 | ||
| Anaphylactoid reactions | 30 | ||
| Autopsy findings | 30 | ||
| Diagnosis at autopsy | 31 | ||
| Medicolegal considerations | 31 | ||
| Artefacts | 31 | ||
| Therapeutic artefacts | 32 | ||
| Agonal artefacts | 32 | ||
| Postmortem artefacts | 32 | ||
| Artefacts Induced by Transportation/Storage/ Handling, etc. | 33 | ||
| Artefacts Induced by Embalming, Decomposition, etc. | 33 | ||
| Artefacts Induced by Predators or Deliberate Mutilation/Dismemberment by the Criminals | 33 | ||
| Artefacts Induced by Improper Autopsy Procedures | 33 | ||
| Heat Effects | 34 | ||
| Case: Dead Bodies Recovered from Railway Track? Appreciation of Artefacts | 34 | ||
| Chapter 3 - Identification | 35 | ||
| Medicolegal Aspects of Identity | 35 | ||
| Identification in the Living | 36 | ||
| Identification of the Dead | 37 | ||
| Age | 37 | ||
| Age of the Foetus and the Newborn Infant | 37 | ||
| Age of the Children and Young Adults Under 25 Years | 37 | ||
| General Physical Examination | 38 | ||
| Height and Weight | 38 | ||
| Dentition in Determining Age | 38 | ||
| Development and Eruption of Teeth | 38 | ||
| Spacing of Jaw | 38 | ||
| Period of Mixed Dentition | 39 | ||
| Estimation of Age (Beyond 25 Years) from Teeth | 40 | ||
| Other Information from Teeth | 40 | ||
| Age from Ossification Activity of the Bones | 41 | ||
| Age Determination in Adults Over 25 Years | 41 | ||
| Symphyseal Surface in Estimation of Age | 41 | ||
| Skull Sutures in Estimation of Age | 42 | ||
| Fontanelle | 42 | ||
| Metopic Suture | 42 | ||
| Suture Closure in the Skull | 42 | ||
| Sternum in Estimation of Age | 43 | ||
| Sacrum in Estimation of Age | 43 | ||
| General Observations Helping in Estimation of Age in the Older Years | 43 | ||
| Arcus Senilis | 43 | ||
| Skeletal Changes | 43 | ||
| Medicolegal Importance of Age | 44 | ||
| sex | 44 | ||
| Microscopic Study of Sex Chromatin (Nuclear Sexing) | 44 | ||
| Gonadal Biopsy | 44 | ||
| Concealed Sex | 44 | ||
| Intersex States | 44 | ||
| Gonadal Agenesis | 44 | ||
| Gonadal Dysgenesis | 44 | ||
| True Hermaphroditism | 44 | ||
| Pseudohermaphroditism | 44 | ||
| Sex from Skeletal Remains | 44 | ||
| Stature | 51 | ||
| Stature from a Dismembered Body Part | 51 | ||
| Stature from Bones | 51 | ||
| Secondary characteristics in identification | 52 | ||
| Facial Appearance | 52 | ||
| Personal Effects | 52 | ||
| Hair | 53 | ||
| Age, Sex and Race from Hair | 54 | ||
| Situation/Site of the Body | 54 | ||
| Evidences about Crime | 55 | ||
| Time Since Death from Hair | 55 | ||
| Case: Neutron Activation Analysis (NAA) of Hair | 55 | ||
| Scar | 55 | ||
| Examination of Scar | 56 | ||
| Characters of Scar | 56 | ||
| Age of the Scar | 56 | ||
| Erasure/Disappearance of Scar | 56 | ||
| Tattoo Marks | 57 | ||
| Natural Disappearance of Tattoo Mark | 57 | ||
| Revealing Latent Tattoo Mark | 57 | ||
| Artificial Removal or Alteration of Tattoo Mark | 57 | ||
| Medicolegal Importance of Tattoo Marks | 57 | ||
| Occupational Stigmata | 58 | ||
| Race, Religion and Nationality | 58 | ||
| Race | 58 | ||
| Clothing | 58 | ||
| Complexion | 58 | ||
| Eyes | 58 | ||
| Hair | 58 | ||
| Various Indices Related to Bones | 59 | ||
| Religion | 59 | ||
| Comparative data/techniques for identification | 59 | ||
| Dental Patterns and Restorations | 59 | ||
| Nature of Bite Mark | 60 | ||
| Medicolegal Considerations | 61 | ||
| Dental Charting | 61 | ||
| Dactylography (Dermatoglyphics/ Galton System/Fingerprint Study, etc.) | 62 | ||
| History | 62 | ||
| Principle | 63 | ||
| Classification | 63 | ||
| Recording of Fingerprints | 63 | ||
| Advantages | 63 | ||
| Removal or Alteration of Fingerprints | 64 | ||
| Superimposition Technique for Identification | 64 | ||
| Reconstruction of Facial Contour from the Skull | 64 | ||
| Neutron Activation Analysis | 64 | ||
| Anthropometry (Bertillon System) | 65 | ||
| Other Fortuitous Comparisons | 65 | ||
| Trace Evidence Comparisons | 65 | ||
| Blood as Trace Evidence | 65 | ||
| Whether the Stain is of Blood or Not | 65 | ||
| Whether the Blood is of Human or Animal Origin | 66 | ||
| Age of the Stain | 66 | ||
| Whether Arterial or Venous | 66 | ||
| Whether of Antemortem or Postmortem Origin | 66 | ||
| Source of Blood | 67 | ||
| Distribution Pattern of Blood | 67 | ||
| Sexing of the Blood Stain | 67 | ||
| Grouping of the Blood Stains | 67 | ||
| Medicolegal Importance of Blood Examination | 69 | ||
| Mass Disaster | 69 | ||
| Classification | 69 | ||
| Management | 69 | ||
| Isolation, Demarcation and Protection | 69 | ||
| Identification and Investigation | 70 | ||
| Management of Survivors | 70 | ||
| The Tsunami Disaster | 70 | ||
| Collection and preservation of biological material for dna-profiling | 72 | ||
| Chapter 4 - Death and Its Medicolegal Aspects (Forensic Thanatology) | 74 | ||
| Brain Death | 74 | ||
| Transplantation of human organs act | 75 | ||
| Medicolegal considerations of brain death | 76 | ||
| Somatic and Molecular Deaths | 76 | ||
| Suspended Animation (Apparent Death) | 76 | ||
| Mode, Manner, Mechanism and Cause of Death | 77 | ||
| Estimation of Time Since Death | 78 | ||
| Importance of time since death | 78 | ||
| Immediate signs of death | 78 | ||
| Early changes after death | 78 | ||
| Facial Pallor and Changes in the Skin | 78 | ||
| Primary Flaccidity of the Muscles | 79 | ||
| Changes in the Eye | 79 | ||
| Algor Mortis (Postmortem Cooling) | 79 | ||
| Factors Influencing the Cooling of the Body | 81 | ||
| Nomogram Method for Estimating Time Since Death | 81 | ||
| Livor Mortis (Postmortem Hypostasis) | 82 | ||
| Time of Appearance | 82 | ||
| Extent and Distribution | 82 | ||
| The Socalled 'Fixation of Postmortem Staining | 83 | ||
| Colour of the Hypostasis | 83 | ||
| Distinction between Hypostasis and Bruising | 83 | ||
| Hypostasis in the Internal Organs | 83 | ||
| Medicolegal Significance of Hypostasis | 84 | ||
| Rigor Mortis (Postmortem Stiffening) | 84 | ||
| Pathophysiology of Rigor Mortis | 85 | ||
| Time of Onset and Duration | 86 | ||
| Order of Appearance and Disappearance | 86 | ||
| Rigor Mortis in the Involuntary Muscles | 86 | ||
| Factors Influencing Onset and Duration | 86 | ||
| Other Forms of Stiffening | 87 | ||
| Heat Stiffening | 87 | ||
| Cold Stiffening | 87 | ||
| Cadaveric Spasm (Instantaneous Rigor) | 87 | ||
| Medicolegal Significance of Instant Rigor | 88 | ||
| Late changes after death | 88 | ||
| Putrefaction or Decomposition | 89 | ||
| Autolysis | 89 | ||
| Bacterial Action | 89 | ||
| Site of Appearance and the Colour Changes | 89 | ||
| Development of FoulŒsmelling Gases | 89 | ||
| Skeletonisation | 91 | ||
| Putrefaction of Internal Organs | 91 | ||
| Circumstances Influencing the Onset and Progression of Putrefaction | 91 | ||
| Exogenous Factors | 92 | ||
| Endogenous Factors | 93 | ||
| Contents of Stomach, Intestines and Bladder in Estimating Time Since Death | 94 | ||
| Adipocere | 95 | ||
| Formation | 95 | ||
| Properties | 95 | ||
| Distribution | 95 | ||
| Time Required for Adipocere Formation | 95 | ||
| Medicolegal Importance | 95 | ||
| Mummification | 96 | ||
| Formation | 96 | ||
| Properties and Distribution | 96 | ||
| Medicolegal Importance | 96 | ||
| A Case of Mummification Reported as Spiritual Coma | 96 | ||
| Postmortem destruction by predators(Fig. 4.8) | 96 | ||
| Entomology of the Cadaver and the Postmortem Interval | 97 | ||
| Collection, Preservation and Dispatch of the Specimens | 99 | ||
| Chapter 5 - Sudden and Unexpected Death | 100 | ||
| Sudden Death and Heart Diseases | 100 | ||
| Morbid anatomy of the heart and its blood vessels | 100 | ||
| Blood supply | 100 | ||
| Types of occlusion | 101 | ||
| Simple Atheroma | 101 | ||
| Ulcerative Atheroma | 101 | ||
| Subintimal Haemorrhage | 101 | ||
| Coronary Thrombosis | 101 | ||
| Periarteritis Nodosa | 101 | ||
| Sequelae of coronary occlusion (fig. 5.2) | 101 | ||
| Sudden Death | 101 | ||
| Myocardial Infarction | 101 | ||
| Medicolegal considerations | 102 | ||
| Approaching the cause of death | 103 | ||
| Historical Data | 103 | ||
| Autopsy Documentation | 103 | ||
| Interpretations | 103 | ||
| Postmortem demonstration of myocardial infarction | 104 | ||
| Macroscopic Appearances | 104 | ||
| Microscopic Appearances | 104 | ||
| Frozen Section Histochemistry | 104 | ||
| Hypertensive heart disease | 105 | ||
| Cardiomyopathies | 105 | ||
| Nonatherosclerotic coronary artery disease | 105 | ||
| Some Other Causes of Sudden Death Having Medicolegal Significance | 106 | ||
| Diseases of the central nervous system | 106 | ||
| Meningitis | 106 | ||
| Cerebral Tumours | 106 | ||
| Epilepsy | 106 | ||
| Diseases of the gastrointestinal system | 107 | ||
| Diseases of the endocrine system | 107 | ||
| Pulmonary embolism | 107 | ||
| Vagal inhibition | 107 | ||
| Autopsy | 108 | ||
| Sudden Death in Infancy | 108 | ||
| Incidence | 108 | ||
| Pathophysiology | 108 | ||
| Autopsy | 109 | ||
| Chapter 6 - Asphyxial Deaths | 110 | ||
| Asphyxial Stigmata | 111 | ||
| Suffocation | 112 | ||
| Carbon Monoxide | 112 | ||
| Medicolegal considerations | 113 | ||
| Autopsy | 114 | ||
| Carbon Dioxide | 114 | ||
| Smothering | 115 | ||
| Suicide, accident or homicide | 115 | ||
| Suicide By Smothering | 115 | ||
| Accidental Smothering | 115 | ||
| Homicidal Smothering | 115 | ||
| Autopsy findings in smothering | 115 | ||
| Case: significance of circumstantial evidence in death due to smothering | 116 | ||
| Gagging | 116 | ||
| Case: death of a 'chowkidar by gagging | 116 | ||
| Choking | 117 | ||
| Accidental choking | 117 | ||
| Suicidal choking | 117 | ||
| Homicidal choking | 117 | ||
| Tolerance of foreign body in the air passages | 117 | ||
| Cause of death in choking | 118 | ||
| Traumatic Asphyxia | 118 | ||
| Autopsy findings | 118 | ||
| Postural Asphyxia | 118 | ||
| Burking | 119 | ||
| Death by Compression of the Neck | 119 | ||
| Mechanism of death by compression of the neck | 119 | ||
| Hanging | 120 | ||
| Types of hanging (Fig. 6.4) | 120 | ||
| On the Basis of Position of the Knot | 120 | ||
| On the Basis of Degree of Suspension | 120 | ||
| Cause of death in hanging | 120 | ||
| Fatal period | 121 | ||
| Autopsy findings | 122 | ||
| General External Findings | 122 | ||
| Face | 122 | ||
| Eyes | 122 | ||
| Tongue | 122 | ||
| Saliva | 123 | ||
| Neck | 123 | ||
| Hands | 123 | ||
| Genitals | 123 | ||
| Postmortem Staining | 123 | ||
| Cyanosis | 123 | ||
| Local External Findings | 123 | ||
| Composition of the Ligature Material | 123 | ||
| Mode of Application of the Ligature | 124 | ||
| Position of the Knot | 124 | ||
| Course of Ligature Around the Neck | 124 | ||
| Period and Degree of Suspension | 124 | ||
| Slipping of the Ligature | 124 | ||
| Weight of the Body of the Deceased | 124 | ||
| Ligature Mark may not be Evident | 124 | ||
| General Internal Findings | 124 | ||
| Local Internal Findings | 124 | ||
| Damage to the Hyoid Bone and Larynx | 125 | ||
| Whether the hanging is antemortem or postmortem | 127 | ||
| Suicide, accident or homicide | 127 | ||
| Suicidal Hanging | 127 | ||
| Accidental Hanging | 127 | ||
| Homicidal Hanging | 128 | ||
| Lynching | 129 | ||
| Case: death of mother and child from hanging | 129 | ||
| Strangulation | 129 | ||
| Ligature strangulation | 129 | ||
| Cause of Death | 129 | ||
| Autopsy Findings | 130 | ||
| General External Findings | 130 | ||
| Local External Findings | 130 | ||
| General Internal Findings | 131 | ||
| Local Internal Findings | 131 | ||
| CASE: Strangulation by Using Insulating Tape and Maxi | 131 | ||
| Manual strangulation (Throttling) | 132 | ||
| Cause of Death | 132 | ||
| Autopsy Findings | 132 | ||
| Findings upon the Neck | 132 | ||
| Suicide, accident or homicide | 133 | ||
| Suicidal Or Self-Strangulation | 133 | ||
| Accidental Strangulation | 133 | ||
| Homicidal Strangulation | 133 | ||
| Strangulation by means other than ligature or manual strangulation | 134 | ||
| Mugging (Arm-Locks) | 134 | ||
| Garrotting | 134 | ||
| Bansdola | 134 | ||
| Palmar Strangulation | 134 | ||
| Drowning | 134 | ||
| Types of drowning | 134 | ||
| Wet Drowning (Typical Drowning) | 134 | ||
| Dry Drowning (Atypical Drowning) | 134 | ||
| Vagal Inhibition due to Submersion (Immersion Syndrome) (Also Known as Hydrocution in Europe) | 135 | ||
| Laryngeal Spasm due to Submersion | 135 | ||
| Submersion of the Unconscious (Shallow Water Drowning) | 135 | ||
| Post-immersion Syndrome or Secondary Drowning or Near-drowning | 135 | ||
| Medium of drowning | 135 | ||
| Mechanism of drowning | 135 | ||
| Pathophysiology of drowning | 136 | ||
| Fatal period | 136 | ||
| Criticism | 136 | ||
| Diagnosis of death by drowning | 137 | ||
| External Signs | 137 | ||
| Internal Signs | 140 | ||
| Histological Contributions to Diagnosis of Death by Drowning | 141 | ||
| Changes in the Heart and Blood Vessels | 141 | ||
| Stomach Contents in Drowning | 141 | ||
| Haemorrhages in the Middle Ears | 141 | ||
| Biochemical and Biophysical Tests for Drowning | 141 | ||
| Analysis of Diatomaceous Material | 142 | ||
| Method for Demonstrating Diatoms | 143 | ||
| Floatation of body in water | 144 | ||
| Suicide, accident or homicide (Fig. 6.17) | 144 | ||
| Chapter 7 - Infanticide and Foeticide | 146 | ||
| Infanticide | 146 | ||
| The law | 146 | ||
| Primary Issues | 147 | ||
| Secondary Issues | 151 | ||
| Autopsy to establish cause of death | 154 | ||
| Internal Examination | 154 | ||
| Head | 154 | ||
| Neck | 154 | ||
| Thorax | 154 | ||
| Abdomen | 154 | ||
| Other Viscera | 154 | ||
| Genitals | 155 | ||
| Limbs and Sternum | 155 | ||
| Cause of Death | 155 | ||
| Acts of commission | 155 | ||
| Smothering | 155 | ||
| Strangulation | 155 | ||
| Head Injuries | 155 | ||
| Multiple Injuries | 156 | ||
| Drowning | 156 | ||
| Poisoning | 156 | ||
| Live Burial | 156 | ||
| Acts of omission | 156 | ||
| Abandoning of child | 156 | ||
| Development of the Foetus | 157 | ||
| Foeticide | 157 | ||
| Laws Difficulty in Dealing with Foetus | 158 | ||
| Chapter 8 - Thermal Deaths | 159 | ||
| Systemic Hyperthermia ( Flowchart 8.1) | 159 | ||
| Burns | 160 | ||
| Burns by x-rays and ultraviolet rays | 160 | ||
| Burns by electricity and lightning | 161 | ||
| Burns by corrosives | 161 | ||
| Burns by dry heat (Flowchart 8.1) | 161 | ||
| Epidermal | 161 | ||
| Dermo-epidermal | 161 | ||
| Deep | 162 | ||
| Rule of nines | 162 | ||
| Causes of Death in Burns | 162 | ||
| Immediate causes of death | 162 | ||
| Shock | 162 | ||
| Suffocation | 162 | ||
| Accident/Injuries | 163 | ||
| Delayed causes of death | 163 | ||
| Toxaemia | 163 | ||
| Inflammatory Complications | 163 | ||
| Fatal Period | 163 | ||
| Nature of burn injuries in the absence of death (fig. 8.2 ) | 163 | ||
| Age of the Burn Injury | 163 | ||
| Autopsy Findings | 163 | ||
| External findings | 164 | ||
| Internal findings | 164 | ||
| Medicolegal considerations | 165 | ||
| Identity of the Deceased | 165 | ||
| CASE: Burns vis-a-vis IdentificationŠGravity towards Criminality thereof (Vide Communication from Dr. Manpreet Kaul et al.) | 165 | ||
| Antemortem and Postmortem Nature of Burns | 166 | ||
| Presence of smoke in the air passages | 166 | ||
| Evidence of thermal injury of the respiratory tract by fumes/hot gases | 166 | ||
| Elevated blood carboxyhaemoglobin levels | 166 | ||
| Presence of other toxic gases in the blood | 167 | ||
| Cutaneous reaction to heat and flame | 168 | ||
| Presence of Vital Reaction (Red Flare/Red Line) | 168 | ||
| Vesication (Blisters) | 168 | ||
| Suicide, Accident or Homicide | 168 | ||
| Suicidal burns | 168 | ||
| Accidental burns | 168 | ||
| Homicidal burns | 168 | ||
| Some Legal Provisions in Relation to Dowry Death | 169 | ||
| 304b: dowry death | 169 | ||
| 498a: a husband or relative of husband of a woman subjecting her to cruelty | 169 | ||
| 113a: presumption as to abetment of suicide by a married woman | 169 | ||
| 113b: presumption as to dowry death | 169 | ||
| Burns by Moist Heat (Scalds) (Flowchart 8.1) | 169 | ||
| Features of scalding (Table 8.6) | 169 | ||
| Circumstances of scalding | 170 | ||
| Hypothermia (Exposure To Cold) (Flowchart 8.1) | 170 | ||
| Pathophysiology of hypothermia | 170 | ||
| Circumstances of hypothermia | 171 | ||
| Mechanism of death | 171 | ||
| Autopsy findings | 171 | ||
| External findings | 172 | ||
| Internal Findings | 172 | ||
| Chapter 9 - Starvation and Neglect | 173 | ||
| Fatal Period | 173 | ||
| Autopsy Findings | 173 | ||
| External Appearances | 173 | ||
| Internal Appearances | 174 | ||
| Circumstances of Death | 174 | ||
| Malnutrition | 174 | ||
| Chapter 10 - Death by Electrocution | 175 | ||
| Factors Involved in Electrocution | 175 | ||
| Factors related to the nature of electric supply | 175 | ||
| Voltage (Tension) | 175 | ||
| Amperage (Intensity) | 175 | ||
| Form of Current (Whether AC/DC) | 176 | ||
| Factors related to the victim | 176 | ||
| Resistance of the Body Tissues | 176 | ||
| Area of Contact of the Body | 176 | ||
| Duration of contact | 176 | ||
| Earthing/Insulation | 176 | ||
| Other factors | 177 | ||
| Mortality and Mechanism of Death by Electric Shock | 177 | ||
| Ventricular fibrillation | 177 | ||
| Spasm of the respiratory muscles (tetanic asphyxia) | 177 | ||
| Paralysis of the respiratory centre | 177 | ||
| Secondary causes | 177 | ||
| Autopsy Findings | 178 | ||
| Findings in deaths due to low- or medium-tension currents | 178 | ||
| Histological appearances | 179 | ||
| Findings in deaths due to high-tension currents (exogenous burns) | 179 | ||
| Internal findings | 179 | ||
| Circumstances of Electrocution | 179 | ||
| Accidental electrocution | 179 | ||
| Suicidal electrocution | 180 | ||
| Homicidal electrocution | 180 | ||
| Iatrogenic electrocution | 180 | ||
| Judicial electrocution | 180 | ||
| Lightning | 181 | ||
| Mechanism of injury by lightning | 181 | ||
| Blast effects | 181 | ||
| Diagnosis of death by lightning stroke | 181 | ||
| Circumstances of lightning stroke | 182 | ||
| Chapter 11 - Deaths Associated with Surgery, Anaesthesia and Blood Transfusion | 183 | ||
| Respiratory Embarrassment | 184 | ||
| Cardiac Embarrassment | 184 | ||
| Hypovolaemia and Other Factors | 185 | ||
| Regional and Spinal Anaesthesia | 185 | ||
| Instruments and Instrumentation | 185 | ||
| Unforeseeable Problems | 186 | ||
| Precautions for Autopsy | 186 | ||
| Autopsy | 186 | ||
| For histological purposes | 186 | ||
| For the purposes of toxicological examination | 187 | ||
| Extraneous specimens | 187 | ||
| Medicolegal Considerations | 187 | ||
| Blood TransfusionŠHazards and Risks | 187 | ||
| Immunological complications | 188 | ||
| Nonimmunological complications | 188 | ||
| Investigation of transfusion reactions | 189 | ||
| Haematological Examination | 189 | ||
| Urine Examination | 189 | ||
| Serological Examination | 189 | ||
| Bacteriological Examination | 189 | ||
| Death due to Periprocedural Complication | 189 | ||
| Chapter 12 - Custody Related Torture and/or Death | 191 | ||
| CustodyŠMeaning Thereof | 191 | ||
| Torture | 191 | ||
| Methods of Torture | 192 | ||
| Physical torture | 192 | ||
| Beating and Severe Beating | 192 | ||
| Falanga | 192 | ||
| Ear Torture | 192 | ||
| Finger Torture | 192 | ||
| Hair Torture | 192 | ||
| Suspension | 192 | ||
| Forced Position | 192 | ||
| Electric Torture | 192 | ||
| Suffocation | 193 | ||
| Burning or Heat Torture | 193 | ||
| Cold Torture | 193 | ||
| Psychological torture | 193 | ||
| Deprivation Techniques | 193 | ||
| Witness Torture | 193 | ||
| Threats and Humiliation | 193 | ||
| Pharmacological Techniques | 193 | ||
| Sexual torture | 193 | ||
| Circumstances of Death | 193 | ||
| Deaths resulting during confrontation with police | 194 | ||
| Deaths from physical restraint | 194 | ||
| Deaths from chemical restraint | 194 | ||
| Case: death of a suspect resulting from injuries received while being chased by the police | 194 | ||
| Case: death of a suspect within a couple of days after his release from the custody | 195 | ||
| Role of Autopsy Surgeon | 195 | ||
| Chapter 13 - Injuries: Medicolegal Considerations and Types | 197 | ||
| Was the Wound Inflicted During Life or After Death? | 197 | ||
| Haemorrhage | 197 | ||
| Retraction of wound edges | 199 | ||
| Signs of inflammation or of repair | 199 | ||
| Wound Healing | 199 | ||
| Healing by first intention (primary union) | 199 | ||
| Healing By Second Intention (Secondary Union) | 200 | ||
| Healing Of A Fracture | 200 | ||
| Diagnosis of Fracture | 200 | ||
| Stages of Healing | 200 | ||
| Stage of Haematoma Formation | 201 | ||
| Stage of Subperiosteal and Endosteal Proliferation | 201 | ||
| Stage of Callus (Woven Bone) Formation | 201 | ||
| Stage of Consolidation | 201 | ||
| Stage of Remodelling | 201 | ||
| Has a Bone ever been Fractured? | 201 | ||
| Fabricated Wounds | 203 | ||
| Important Sections Related to Offences Against Human Body | 203 | ||
| Homicide | 203 | ||
| Lawful Homicide (Flowchart 13.1) | 203 | ||
| Excusable Homicide | 203 | ||
| Justifiable Homicide | 204 | ||
| Unlawful Homicide | 204 | ||
| Culpable HomicideŠSection 299 | 204 | ||
| MurderŠSection 300 | 204 | ||
| Culpable Homicide and Murder Distinguished | 205 | ||
| Culpable Homicide by Causing Death of a Person Other than the Person Whose Death was IntendedŠSection 301 | 206 | ||
| Punishment for MurderŠSection 302 | 206 | ||
| Punishment for Culpable Homicide not Amounting to MurderŠSection 304 | 206 | ||
| Causing Death by Rash or Negligent ActŠSection 304A | 206 | ||
| Dowry DeathŠSection 304b | 206 | ||
| Abetment of SuicideŠSection 306 | 206 | ||
| Attempt to MurderŠSection 307 | 206 | ||
| Attempt to Commit Culpable HomicideŠSection 308 | 207 | ||
| Attempt to Commit SuicideŠSection 309 | 207 | ||
| HurtŠSection 319 | 207 | ||
| Grievous HurtŠSection 320 | 207 | ||
| Emasculation | 207 | ||
| Injuring Eyesight | 207 | ||
| Causing Deafness | 208 | ||
| Privation of Any Member or Joint | 208 | ||
| Permanent Impairing Powers of Any Member or Joint | 208 | ||
| Permanent Disfiguration of the Head or Face | 208 | ||
| Fracture or Dislocation of a Bone or Tooth | 208 | ||
| Hurt Endangering Life or Causing Severe Pain orRefraining from Ordinary Pursuits | 209 | ||
| AssaultŠSection 351 | 210 | ||
| Assault or Criminal Force to a Woman with Intent to Outrage Her ModestyŠSection 354 | 210 | ||
| AdulteryŠSection 497 | 210 | ||
| Enticing Or Taking Away Or Detaining With Criminal Intent A Married WomanŠSection 498 | 210 | ||
| Criminal IntimidationŠSection 503 | 210 | ||
| Word, Gesture or Act Intended to Insult the Modesty of a WomanŠSection 509 | 211 | ||
| Misconduct in Public by a Drunken PersonŠSection 510 | 211 | ||
| Attempts to Commit OffencesŠSection 511 | 211 | ||
| Differentiating Kidnapping and Abduction | 211 | ||
| Classification of Injuries | 212 | ||
| Chapter 14 - Injuries by Blunt Force | 213 | ||
| Skin Anatomy and Its Forensic Aspects | 213 | ||
| Epidermis | 213 | ||
| Dermis | 213 | ||
| Abrasions | 214 | ||
| Types of abrasions | 214 | ||
| Scratches or Linear Abrasions | 214 | ||
| Grazes (Sliding/Tangential/Brush Abrasions) | 214 | ||
| Pressure Abrasions (Crushing Abrasions/ Imprint Abrasions) | 215 | ||
| Patterned Abrasions | 215 | ||
| Atypical Abrasions | 215 | ||
| Age (fate) of an abrasion | 215 | ||
| Antemortem/postmortem abrasions | 216 | ||
| Differential diagnosis | 216 | ||
| Erosion of the Skin Produced by Insects, Ants, etc. | 216 | ||
| Excoriation of the Skin by Excreta | 216 | ||
| Medicolegal considerations | 216 | ||
| Contusions (Bruises) | 216 | ||
| Factors influencing the prominence of a bruise | 217 | ||
| Amount of Force | 217 | ||
| Peculiarities of the Victim | 217 | ||
| Vascularity of the Area | 217 | ||
| Resiliency of the Area | 217 | ||
| Deep/delayed/migratory bruises | 217 | ||
| Patterned bruising | 218 | ||
| CaseŠTramline Bruising by Beating with a Cane | 218 | ||
| Age (fate) of a bruise | 218 | ||
| Circumstances where external evidence Of bruising may be absent | 219 | ||
| Antemortem/postmortem bruising | 219 | ||
| Medicolegal considerations | 219 | ||
| Lacerations | 220 | ||
| Types of lacerations | 220 | ||
| Split Laceration | 220 | ||
| Stretch Lacerations | 220 | ||
| Grinding Compression or Avulsion Lacerations | 221 | ||
| Tears | 221 | ||
| Features of lacerations | 221 | ||
| Patterned lacerations | 221 | ||
| Antemortem/postmortem lacerations | 221 | ||
| Medicolegal considerations | 222 | ||
| Associations of Abrasions, Contusions and Lacerations | 222 | ||
| Case: blunt force impacts upon the chest | 222 | ||
| Falls | 222 | ||
| Chapter 15 - Injuries by Sharp Force | 225 | ||
| Incision/Cut/Slash | 225 | ||
| Features of incised wounds | 225 | ||
| Margins | 225 | ||
| Length | 225 | ||
| Breadth | 225 | ||
| Depth and Direction | 225 | ||
| Shape | 226 | ||
| Haemorrhage | 226 | ||
| Bevelled Cuts | 226 | ||
| Hesitation Cuts | 226 | ||
| Chopping Wounds | 226 | ||
| Stab/Punctured Wounds | 227 | ||
| Features of a stab wound | 228 | ||
| Length | 228 | ||
| Breadth | 228 | ||
| Depth and Direction | 228 | ||
| Margins | 230 | ||
| Shape (Configuration) | 230 | ||
| Factors Attributable to the Weapon | 230 | ||
| Factors Attributable to Victim and the Assailant | 231 | ||
| Amount of Force Required to Inflict Any Particular Stab Wound | 231 | ||
| Wounds by blunt penetrating/dull instruments | 231 | ||
| Wounds by glass | 231 | ||
| Concealed/obscure puncture wounds | 232 | ||
| Accident, suicide or homicide | 232 | ||
| Chapter 16 - Injuries by Firearms | 234 | ||
| Types of Firearms | 234 | ||
| Rifled firearms | 234 | ||
| Smoothbore firearms | 235 | ||
| Bore/Diameter | 235 | ||
| Miscellaneous types | 236 | ||
| Air-Powered Weapons | 236 | ||
| Cattle Guns/Humane Guns (Captive Bolt Devices) | 236 | ||
| Stud Guns | 236 | ||
| Bang Sticks | 236 | ||
| Improvised/Country-Made Firearms | 236 | ||
| Ammunition | 236 | ||
| Cartridge | 237 | ||
| Cartridge Case | 237 | ||
| Percussion Cap | 237 | ||
| Propellant Charge | 237 | ||
| Black Powder (Gunpowder) | 237 | ||
| Smokeless Powder | 238 | ||
| Projectile | 239 | ||
| Rifled Weapons | 239 | ||
| Dum Dum Bullets | 239 | ||
| Explosive Bullets | 239 | ||
| Frangible Balls | 239 | ||
| Baton Round | 240 | ||
| Armour-Piercing Bullet | 240 | ||
| Incendiary Bullets | 240 | ||
| Tracer Bullet | 240 | ||
| Smoothbore Weapons | 240 | ||
| Wad | 240 | ||
| Blank cartridge | 241 | ||
| General Makeup of a Firearm (Fig. 16.2 ) | 241 | ||
| Stock or butt | 241 | ||
| Barrel | 241 | ||
| Breach mechanism | 241 | ||
| Mechanism of Bullet Wound Production | 241 | ||
| Shape, size and velocity of the missile | 241 | ||
| Character of motion in the flight | 243 | ||
| Density of the tissues | 243 | ||
| Hydrostatic forces | 243 | ||
| Energy transmission rate | 243 | ||
| Wounds Produced by Rifled Firearms | 243 | ||
| Contact wounds | 244 | ||
| Muzzle Imprint | 245 | ||
| Blow Back into the Barrel | 245 | ||
| Close-Range wounds | 245 | ||
| Skin Burning and Hair Singeing | 245 | ||
| Soot or Smoke Soiling/Blackening | 245 | ||
| Powder Tattooing | 245 | ||
| Fouling | 246 | ||
| Intermediate/short-range wounds | 246 | ||
| Medium-range wounds | 247 | ||
| Abrasion Collar (Marginal Abrasion) | 247 | ||
| Grease or Dirt Ring | 247 | ||
| Extreme-range wounds | 248 | ||
| Concealed entrance wounds | 248 | ||
| Exit wounds | 248 | ||
| Wounds Produced by Smoothbore Weapons | 249 | ||
| Contact wounds | 249 | ||
| Close-range discharge of a shotgun | 250 | ||
| Intermediate/short-range discharge of a shotgun (Within About A Yard Or So) | 251 | ||
| Medium-range discharge of a shotgun (1-5 Yards Or So) | 251 | ||
| Distant-range discharge of a shotgun | 251 | ||
| Shotgun exit wounds | 252 | ||
| Unusual Circumstances Encountered in Firearm Injuries | 252 | ||
| Atypical wound of entrance | 252 | ||
| Ricochetting of bullet | 252 | ||
| Single entrance and multiple exits | 254 | ||
| Multiple wounds of entrance and exit from a single shot | 254 | ||
| Entrance wound present, bullet absent | 254 | ||
| Tandem (piggy back) bullet | 254 | ||
| Souvenir bullets | 254 | ||
| Bullet embolism | 255 | ||
| Firearm Residues | 255 | ||
| Firearm residues on suspects hands | 255 | ||
| Neutron Activation Analysis | 255 | ||
| Faas | 256 | ||
| Sem-edx | 256 | ||
| Firearm residue on the victim associated with the wound of entrance | 256 | ||
| Carbon monoxide | 256 | ||
| Direction Of Fire | 256 | ||
| Rifled weapons | 256 | ||
| Smoothbore weapons | 257 | ||
| Autopsy | 257 | ||
| Clothing | 258 | ||
| X-Ray examination | 258 | ||
| Pertinent findings regarding injuries | 259 | ||
| Internal Evidence of Injuries (Track of Wound) | 259 | ||
| Collection, preservation and dispatch of exhibits | 260 | ||
| Cause of death | 260 | ||
| Suicide, Accident or Homicide? | 260 | ||
| Circumstances showing design (Need to be Examined by the Officials of FSL) | 261 | ||
| Evidence from weapons position relative to the body (Need To Be Examined By The Officials Of Fsl) | 261 | ||
| Evidence from the site of entrance wound(s) | 261 | ||
| Evidence from the several wounds | 262 | ||
| Evidence from the direction of the internal track | 262 | ||
| Evidence from range of firing | 262 | ||
| Evidence from clothing | 262 | ||
| Surgical Artefacts in Firearm Wounds | 263 | ||
| Cases | 263 | ||
| Bullet entered through forehead found embedded in scalp | 263 | ||
| Accidentally discharged cartridge hitting another cartridgeŠdual effects being driven into the body of the victim | 264 | ||
| Setback to the scientific evidence due to nonconsent of the victim | 265 | ||
| Chapter 17 - Injuries By Explosives | 266 | ||
| Disruptive Effects | 266 | ||
| Air Blast (Shock Wave) | 266 | ||
| Effects of Blast Wave/Shock Wave | 266 | ||
| Burns | 267 | ||
| Flying Missiles | 267 | ||
| Falling Masonry | 268 | ||
| Fumes | 268 | ||
| Autopsy in Explosion Deaths | 268 | ||
| Identification Of The Victim(S) | 268 | ||
| Enlisting the injuries | 268 | ||
| Cause of death | 268 | ||
| Medicolegal considerations | 269 | ||
| Explosive Force Declines Rapidly | 269 | ||
| Explosive Force is Extremely Directional | 269 | ||
| Case: Assassination of Rajiv Gandhi and the Birth of 'Human Bomb | 269 | ||
| Chapter 18 - Regional Injuries | 270 | ||
| Head Injuries | 270 | ||
| Scalp injuries | 270 | ||
| Forensic Aspects of Anatomy of the Scalp | 270 | ||
| Scalp Abrasions | 271 | ||
| Scalp Bruises | 271 | ||
| Scalp Lacerations | 272 | ||
| Incised Wounds of the Scalp | 272 | ||
| Skull injuries | 273 | ||
| Forensic Aspects of Anatomy | 273 | ||
| Skull Fractures | 273 | ||
| Mechanism of Skull Fracture | 273 | ||
| Types of Skull Fractures | 274 | ||
| Basilar Fractures | 274 | ||
| Linear Fractures | 274 | ||
| Depressed Fractures | 274 | ||
| Comminuted Fractures | 275 | ||
| Pond or Indented Fractures | 275 | ||
| Gutter Fracture | 275 | ||
| Ring Fracture | 275 | ||
| Separation of Suture (Diastatic Fractures) | 275 | ||
| Expressed Fractures | 275 | ||
| Contrecoup Fractures | 275 | ||
| Meningeal haemorrhages | 275 | ||
| Forensic Aspects of Anatomy of the Coverings of the Brain | 275 | ||
| Extradural (Epidural) Haemorrhage | 276 | ||
| Cause and Source | 276 | ||
| Subdural Haemorrhage | 276 | ||
| Acute Subdural Haematoma | 277 | ||
| Chronic Subdural Haematoma (Pachymeningitis Interna Haemorrhagica) | 277 | ||
| Organisation of Subdural Haemorrhage | 277 | ||
| Medicolegal Considerations | 278 | ||
| Subarachnoid Haemorrhage | 278 | ||
| Acute Nontraumatic (Spontaneous) Subarachnoid Haemorrhage | 278 | ||
| Acute Traumatic Subarachnoid Haemorrhage | 280 | ||
| Cerebral injuries | 281 | ||
| Mechanism of Cerebral Injury | 281 | ||
| Coup and Contrecoup Damage to the Brain | 281 | ||
| Case: Medicolegal Importance of Contrecoup Injuries | 282 | ||
| Cerebral Concussion (Commotio Cerebri) | 282 | ||
| Diffuse Axonal Injury | 283 | ||
| Cerebral Contusions | 284 | ||
| Cerebral Lacerations | 284 | ||
| Intracerebral Haemorrhage | 284 | ||
| Head injuries in boxers | 285 | ||
| Cerebral swelling/oedema | 286 | ||
| Raised intracranial pressure: pathophysiology and sequelae | 286 | ||
| Spinal Injuries | 286 | ||
| Concussion of spine | 287 | ||
| Injuries to the upper cervical spine | 287 | ||
| Middle and lower cervical injuries (hyperextension and hyperflexion injuries) | 287 | ||
| Thoracic and lumbar spinal injuries | 287 | ||
| Injury to the spinal cord | 287 | ||
| Pathology of Spinal Cord Injury | 288 | ||
| Penetrating Injuries of the Spinal Cord | 288 | ||
| Medicolegal Considerations of Spinal Injuries | 288 | ||
| Trauma | 289 | ||
| Facial trauma | 289 | ||
| Cervical trauma | 290 | ||
| Thoracic trauma | 290 | ||
| Abdominal trauma | 292 | ||
| Chapter 19 - Transportation Injuries | 296 | ||
| Mechanisms of Vehicular Injury | 296 | ||
| Injuries to the driver | 297 | ||
| Injuries to the front seat occupants | 298 | ||
| Injuries to the rear seat occupants | 298 | ||
| Ejection crash injuries | 298 | ||
| Injuries to the Pedestrians | 298 | ||
| Primary impact injuries | 298 | ||
| Secondary impact injuries | 298 | ||
| Secondary injuries | 299 | ||
| Crush injuries | 299 | ||
| Injuries to the Motorcyclists | 300 | ||
| Injuries to the Pedal Cyclists | 300 | ||
| Aircraft Accidents | 300 | ||
| Types of injuries | 301 | ||
| Railway Accidents | 301 | ||
| Vehicular Conflagration | 302 | ||
| Medicolegal Aspects of Transport Injuries | 302 | ||
| Chapter 20 - Medicolegal Examination of the Living | 304 | ||
| Medicolegal Examination in Assault Cases | 304 | ||
| Consent | 304 | ||
| History | 304 | ||
| General physical examination | 305 | ||
| Examination of specific area | 305 | ||
| Reference to a specialist | 305 | ||
| Opinion | 305 | ||
| Nature of injuries | 305 | ||
| Approximate duration of injuries | 305 | ||
| Kind of weapon | 305 | ||
| Dispatch of specimens/articles | 305 | ||
| Examination of exhibits | 305 | ||
| Weapon | 305 | ||
| Foreign Bodies | 306 | ||
| Clothing | 306 | ||
| Medicolegal Examination in Sexual Offences | 306 | ||
| Rape | 306 | ||
| Section 375 (Rape) | 306 | ||
| Section 376 (Punishment for Rape) | 306 | ||
| Mechanism of Erection and Orgasm | 307 | ||
| General Considerations | 308 | ||
| Changes in the Law | 309 | ||
| Pre-requisites for the Examination of Victim | 309 | ||
| History Taking of Victim | 310 | ||
| General History | 310 | ||
| Specific History | 310 | ||
| Examination of Victim | 310 | ||
| General Examination | 310 | ||
| Skin | 310 | ||
| Bite Marks | 312 | ||
| Specific Examination | 312 | ||
| Pubic Hair | 312 | ||
| Tops of Thighs, Vulva, and the Perineum | 312 | ||
| Hymen | 313 | ||
| Sexually Transmitted Diseases (STDs) | 314 | ||
| Opinion | 314 | ||
| Rape Trauma Syndrome | 316 | ||
| Accidents Following Rape | 316 | ||
| Examination of the Man Suspected of Committing Rape | 317 | ||
| General Examination | 317 | ||
| Specific Examination | 317 | ||
| History Taking of Alleged Assailant | 317 | ||
| Identification of the Alleged Assailant | 319 | ||
| Opinion | 319 | ||
| Incest | 319 | ||
| Indecent assault | 319 | ||
| Unnatural sexual offences | 319 | ||
| Sodomy | 320 | ||
| Examination of the Passive Agent | 320 | ||
| Pre-requisites | 320 | ||
| History | 320 | ||
| General | 320 | ||
| Specific | 320 | ||
| Examination | 320 | ||
| Signs of Habitual Anal Intercourse | 321 | ||
| The Opinion | 321 | ||
| Buccal coitus (oral coitus or sin of gomorrah) | 322 | ||
| Homosexuality | 322 | ||
| Bestiality | 322 | ||
| Medicolegal Aspects of Semen | 322 | ||
| Structure of spermatozoa | 323 | ||
| Collection, preservation and despatch of specimens | 323 | ||
| Seminal identification | 324 | ||
| Physical Examination | 324 | ||
| Chemical Examination | 324 | ||
| Confirmatory tests for semen | 324 | ||
| Microscopic Examination | 324 | ||
| Proof of Semen | 325 | ||
| DNA Testing | 325 | ||
| Diagnosis of Pregnancy | 325 | ||
| Medicolegal Importance Of Pregnancy | 325 | ||
| Diagnosis | 326 | ||
| Presumptive Signs Of Pregnancy | 326 | ||
| Amenorrhoea | 326 | ||
| Morning Sickness | 326 | ||
| Salivation and Changes in Disposition | 326 | ||
| Irritability of the Bladder | 326 | ||
| Changes in the Skin | 326 | ||
| Changes in the Breasts | 326 | ||
| Bluish Discolouration of the Vagina | 327 | ||
| Quickening | 327 | ||
| Probable Signs Of Pregnancy | 327 | ||
| Hegar Sign | 327 | ||
| Braxton Hicks Sign | 327 | ||
| Ballottement | 327 | ||
| Uterine Changes | 327 | ||
| Uterine Souffle | 327 | ||
| Enlargement of Uterus | 328 | ||
| Pregnancy Tests | 328 | ||
| Laboratory Tests | 328 | ||
| Bioassay | 328 | ||
| Immunoassay | 328 | ||
| ELISA Test | 329 | ||
| Positive signs of pregnancy | 329 | ||
| Palpation of the Foetal Parts | 329 | ||
| Auscultatory Signs | 329 | ||
| Radiological Diagnosis | 329 | ||
| Ultrasonography | 329 | ||
| Medicolegal implications of duration of pregnancy | 329 | ||
| Differential Diagnosis Of Pregnancy | 330 | ||
| Pseudocyesis (False Or Spurious Pregnancy) | 330 | ||
| Superfoetation and Superfecundation | 330 | ||
| Surrogate motherhood | 330 | ||
| Trauma and pregnancy | 331 | ||
| Child Abuse | 331 | ||
| Historical background | 331 | ||
| Points for suspicion | 332 | ||
| Types of abuse | 332 | ||
| Range of injuries | 332 | ||
| Chapter 21 - Complications of Trauma: Was Wounding Responsible for Death? | 335 | ||
| Primary/Immediate/Direct Causes | 335 | ||
| Primary/Neurogenic Shock (Vasovagal Shock Or Reflex Cardiac Arrest) | 335 | ||
| Injury to vital organ(s) | 336 | ||
| Haemorrhage | 336 | ||
| Stages of Haemorrhagic Shock | 337 | ||
| Nonprogressive Stage (Compensated/ Reversible) | 337 | ||
| Progressive Stage | 337 | ||
| Decompensated Stage (Irreversible) | 337 | ||
| Severe Adult Respiratory Distress Syndrome (Ards) | 337 | ||
| Air Embolism | 338 | ||
| Autopsy | 339 | ||
| Medicolegal Considerations | 340 | ||
| Wounds Indirectly Fatal/Delayed Causes of Death | 340 | ||
| Secondary shock | 340 | ||
| Wound infection | 341 | ||
| Pulmonary thromboembolism | 341 | ||
| Dating of the Deep Vein Thrombi and Pulmonary Emboli | 342 | ||
| Fat and bone marrow embolism | 342 | ||
| Autopsy Findings | 343 | ||
| Medicolegal Considerations | 343 | ||
| Crush syndrome | 343 | ||
| Supervention of separate pathological state | 343 | ||
| Exacerbation of a pre-existing disease | 344 | ||
| Operation and/or anaesthesia | 344 | ||
| Neglect of/by the injured | 344 | ||
| Chapter 22- Medical Education vis-à-vis Medical Practice | 346 | ||
| Codes of Medical Ethics | 347 | ||
| The Declaration of Geneva (1948) | 347 | ||
| Medical Councils | 347 | ||
| Indian Medical Council Act, 1933 | 347 | ||
| Indian Medical Council Act, 1956 | 347 | ||
| Constitution of the Indian Medical Council | 347 | ||
| Functions of the Indian Medical Council | 348 | ||
| Chapter 23 - Medical Negligence | 361 | ||
| Elements of Negligence | 361 | ||
| Duty | 361 | ||
| Duty Depends Upon Reasonable Foreseeability Of Injury | 362 | ||
| Dereliction | 362 | ||
| Mistaken diagnosis | 363 | ||
| Direct causation | 363 | ||
| Damage suffered by the patient | 363 | ||
| Proof of Negligence | 363 | ||
| Rebuttal of presumption of negligence | 364 | ||
| Some instances of 'Res Ipsa Loquitur | 364 | ||
| Retention of swabs, packs, instruments, drains, etc. | 364 | ||
| Operation on the Wrong Patient or on the Wrong Part of a Patient | 365 | ||
| Administration of the Wrong Substance | 365 | ||
| Contributory Negligence | 365 | ||
| Vicarious Liability | 365 | ||
| Liability for Injury to the Third Parties | 365 | ||
| Medical Product Liability | 366 | ||
| Criminalisation of Negligence | 366 | ||
| Consumer Protection Act and Medical Negligence | 367 | ||
| Failure to Take X-rayŠWhether Amounts to Negligence | 368 | ||
| Chapter 24 - Consent to and Refusal of Treatment | 370 | ||
| Types of Consent | 370 | ||
| Doctrine of Extension and Proportionality | 371 | ||
| Doctrine of Informed Consent | 371 | ||
| Who Discloses? | 372 | ||
| Hospitals Role | 372 | ||
| Ability to Consent | 372 | ||
| Exceptions to Material Disclosure | 372 | ||
| Evidentiary Proof of Adequate Disclosure | 373 | ||
| Sections 53, 53A and 164A of CrPC in Relation to Consent | 373 | ||
| Section 53: Examination of accused by medical practitioner at the request of police officer | 373 | ||
| Section 53A: Medical examination of accused of rape | 373 | ||
| Section 164A: Medical examination of the victim of rape | 374 | ||
| Euthanasia | 374 | ||
| Aid in dying, doctor-assisted suicide and euthanasia | 374 | ||
| Chapter 25 - Acquired Immunodeficiency Syndrome: Medical, Social, Ethical and Legal Implications | 376 | ||
| Introduction | 376 | ||
| Healthcare Workers with HIV Infection | 377 | ||
| Criminalisation of HIV Transmission | 377 | ||
| Aids And Autopsies | 378 | ||
| Risk/Benefit doctrine | 378 | ||
| Autopsy preparation | 378 | ||
| Precautions in the autopsy room and Laboratory | 378 | ||
| Universal Blood and Body Fluid Precautions | 378 | ||
| After completion of autopsy | 379 | ||
| Disinfectants | 379 | ||
| Chapter 26 - Abortion and Delivery | 380 | ||
| Abortion | 380 | ||
| Medical termination of pregnancy act (1971) | 380 | ||
| MTP and duration of pregnancy | 380 | ||
| Place for MTP | 381 | ||
| Experience and training of a doctor | 381 | ||
| Up to 12 Weeks of Gestation | 381 | ||
| Up to 20 Weeks of Gestations | 381 | ||
| Role of consent | 381 | ||
| Ethical and medicolegal considerations | 382 | ||
| Methods of inducing abortion under the MTP Act (Flowchart 26.1) | 382 | ||
| During the First Trimester | 382 | ||
| During the Second Trimester | 383 | ||
| Criminal abortion | 383 | ||
| Methods for Inducing Criminal Abortion (Flowchart 26.1) | 383 | ||
| Abortifacient Drugs | 383 | ||
| Mechanical Violence | 384 | ||
| General Violence | 384 | ||
| Local Violence | 384 | ||
| Causes of Death and Dangers of Criminal Abortion (Fig. 26.2) | 385 | ||
| Immediate Complications | 385 | ||
| Delayed Complications | 386 | ||
| Penal Provisions Relating to Criminal Abortion | 387 | ||
| Examination of the Woman Who has Allegedly Aborted | 387 | ||
| In the living | 388 | ||
| In the dead | 388 | ||
| External Examination | 388 | ||
| Internal Examination | 388 | ||
| Findings in the Uterus | 388 | ||
| Ovaries | 389 | ||
| Heart | 389 | ||
| Examination of Aborted Material | 389 | ||
| Hasses Rule | 389 | ||
| Important Foetal Ages Related To Abortion | 389 | ||
| Delivery | 389 | ||
| Signs of recent delivery in the living | 390 | ||
| Signs of recent delivery in the dead | 391 | ||
| Signs of remote delivery in the living | 391 | ||
| Signs of remote delivery in the dead | 391 | ||
| Chapter 27 - Impotence, Sterility, Sterilisation and Artificial Insemination | 393 | ||
| Examination of a case of impotency | 393 | ||
| Opinion | 394 | ||
| Examination of a case of sterility | 394 | ||
| Causes of Impotence and Sterility in Males | 394 | ||
| Age | 394 | ||
| Malformations | 394 | ||
| Hypospadias | 394 | ||
| Epispadias | 394 | ||
| Local diseases or injuries | 394 | ||
| General diseases | 395 | ||
| Psychogenic causes | 395 | ||
| Case: Presence/absence of virilityŠ largely inferential within usual limits of age | 395 | ||
| Causes of Impotence and Sterility in Females | 395 | ||
| Age | 395 | ||
| Malformations | 396 | ||
| Local diseases or injuries | 396 | ||
| General diseases | 396 | ||
| Psychogenic causes | 396 | ||
| Sterilisation | 396 | ||
| Types | 396 | ||
| Voluntary | 396 | ||
| Compulsory | 396 | ||
| Methods | 396 | ||
| Permanent | 396 | ||
| Temporary | 397 | ||
| Guiding principles | 397 | ||
| Medicolegal aspects | 397 | ||
| Artificial Insemination | 397 | ||
| Types | 397 | ||
| Artificial Insemination Homologous (AIH) | 397 | ||
| Artificial Insemination Donor (AID) | 397 | ||
| Artificial Insemination Homologous Donor (AIHD) | 397 | ||
| Procedure | 398 | ||
| Indications | 398 | ||
| Guiding principles | 398 | ||
| Legal problems of artificial insemination | 398 | ||
| In Vitro Fertilisation (Test Tube Baby) | 399 | ||
| Indications | 399 | ||
| Cryopreservation of embryos and gametes | 399 | ||
| 'Wrongful Birth and 'Wrongful Life Cases | 399 | ||
| Chapter 28 - Nullity of Marriage, Divorce and Legitimacy | 400 | ||
| Void and Voidable Marriages | 400 | ||
| Circumstances for a void marriage | 400 | ||
| Circumstances for voidable marriage | 400 | ||
| Nonconsummation of Marriage Owing to Impotence of the Respondent | 400 | ||
| Unsoundness of Mind | 401 | ||
| Consent by Force, Fraud or Misrepresentation | 401 | ||
| Pregnancy of the Respondent at the Time of Marriage | 401 | ||
| Legitimacy of children of void and voidable marriages | 401 | ||
| Divorce | 401 | ||
| Adultery | 401 | ||
| Cruelty | 402 | ||
| Desertion | 402 | ||
| Apostasy | 402 | ||
| Unsoundness of mind | 402 | ||
| Leprosy and venereal disease | 403 | ||
| Renouncing the world | 403 | ||
| Additional grounds for wife | 403 | ||
| Divorce by mutual consent | 403 | ||
| Alternate relief in divorce proceedings | 403 | ||
| Legitimacy | 403 | ||
| Legal Consequences of Fecundation Ab Extra | 404 | ||
| Chapter 29 - Forensic Psychiatry | 405 | ||
| Mental Health Act, 1987 | 405 | ||
| Various Signs/Symptoms with Medicolegal Importance | 406 | ||
| Signs/Symptoms related to disturbances of consciousness and higher cerebral functions | 406 | ||
| Consciousness | 406 | ||
| Signs/Symptoms related to disturbances of thinking | 407 | ||
| Retarded Thinking | 407 | ||
| Accelerated Thinking | 407 | ||
| Form of Thinking | 407 | ||
| Content of Thinking | 407 | ||
| Delusional Disorders | 407 | ||
| Persecutory and Litigious Subtypes | 408 | ||
| Medicolegal Aspects | 408 | ||
| Hypochondriacal Subtype | 408 | ||
| Jealousy Subtype | 409 | ||
| Chapter 30 - Basic Considerations in Drugs/Chemicals | 429 | ||
| Routes of Administration | 429 | ||
| Pharmacokinetics (What the Body does to the Drug/Chemical) | 431 | ||
| Pharmacodynamics (What a Drug/ Chemical does to the Body) | 432 | ||
| Mechanisms of Action of Drugs/ Chemicals | 433 | ||
| Receptor mediated mechanism | 433 | ||
| Nonreceptor mediated mechanism | 433 | ||
| Analytical Methods Used in Toxicology | 434 | ||
| Qualitative assays | 434 | ||
| Quantitative assays (Flowchart 30.3) | 435 | ||
| Classification of Poisons | 437 | ||
| Accidental poisoning | 437 | ||
| Chapter 31 - Intricacies of Forensic Toxicology | 438 | ||
| Forensic Toxicology | 438 | ||
| A Viewpoint | 438 | ||
| Concept and Scope of Toxicology | 439 | ||
| Statutes on Drugs/Poisons in India | 440 | ||
| Drugs and cosmetics act (1940) | 440 | ||
| Cognisance of Offences | 440 | ||
| Penalty for Manufacture or Sale of Drugs in Contravention to Legal Provisions | 441 | ||
| Drugs and magic remedies (objectionable advertisement) act (1954) | 441 | ||
| Narcotic drugs and psychotropic substances act (1985) | 441 | ||
| Offences and Penalties | 441 | ||
| Related legal provisions | 442 | ||
| Factors Modifying the Action of Poisons | 442 | ||
| Factors attributable to the poison itself | 442 | ||
| Quantity | 442 | ||
| Physical Form | 442 | ||
| Chemical Form | 442 | ||
| Concentration/Dilution | 443 | ||
| Route of Administration | 443 | ||
| Cumulative Action of the Poison | 443 | ||
| Drug Interactions | 443 | ||
| Factors attributable to victim | 443 | ||
| Condition of the Stomach | 443 | ||
| Condition of the Body | 443 | ||
| Concept of Fatal Dose | 444 | ||
| Evidence of Poisoning in the Living | 444 | ||
| Evidence of Poisoning in the Dead | 445 | ||
| Technique of Obtaining Autopsy Samples | 445 | ||
| Interpretation of Results | 446 | ||
| Relative Toxicity of Drugs/Chemicals | 447 | ||
| Chapter 32 - Duties of a Doctor in Cases of Suspected Poisoning | 448 | ||
| General Management of Poisoning | 449 | ||
| Basic principles of poisoning management | 449 | ||
| Removal of Unabsorbed Poison | 449 | ||
| Inhaled Poisons | 450 | ||
| Injected Poisons | 450 | ||
| Contact Poisons | 450 | ||
| Ingested Poisons | 450 | ||
| Administration of Milk or Water | 450 | ||
| Induction of Emesis | 450 | ||
| Activated Charcoal | 450 | ||
| Gastric Lavage (Stomach Wash) | 450 | ||
| Whole Bowel Irrigation | 451 | ||
| Cathartic Salts | 451 | ||
| Endoscopic or Surgical Removal of Poisons | 451 | ||
| Hastening Elimination of Absorbed Poison | 451 | ||
| Interruption of Enterohepatic Circulation | 451 | ||
| Enhancing Urinary Excretion | 451 | ||
| Dialysis | 451 | ||
| Administration of Antidotes | 451 | ||
| Physical or Mechanical Antidote | 452 | ||
| Chemical Antidote | 452 | ||
| Weak Noncarbonate Alkalies (for Acids) | 452 | ||
| Weak Vegetable Acids (for Alkalies) | 452 | ||
| Potassium Permanganate | 452 | ||
| Physiological or Pharmacological Antidote | 452 | ||
| Universal Antidote | 452 | ||
| Chelation Therapy | 452 | ||
| Dimercaprol (2,3-dimercaptopropanol) | 453 | ||
| Ethylenediaminetetraacetic Acid (EDTA) | 453 | ||
| Penicillamine (Cuprimine) | 453 | ||
| Desferrioxamine | 453 | ||
| Immunotherapy | 453 | ||
| Treatment of General Symptoms | 453 | ||
| Chapter 33 - Corrosive Poison | 454 | ||
| Mechanism of Action | 456 | ||
| Diagnosis and Management | 456 | ||
| Radiology | 456 | ||
| Endoscopy | 456 | ||
| Treatment | 456 | ||
| Medicolegal Aspects | 456 | ||
| Organic Acids | 457 | ||
| Carbolic acid (phenol/phenic acid) | 457 | ||
| Fatal Dose | 457 | ||
| Fatal Period | 457 | ||
| Clinical Features | 457 | ||
| Diagnosis | 458 | ||
| Management | 458 | ||
| Postmortem Appearances | 458 | ||
| Externally | 458 | ||
| Internally | 458 | ||
| Materials to be Preserved | 458 | ||
| Medicolegal Aspects | 458 | ||
| Oxalic acid (acid of sugar) | 458 | ||
| Different Sources | 458 | ||
| Mechanism of Action | 459 | ||
| Fatal Dose | 459 | ||
| Fatal Period | 459 | ||
| Clinical Features | 459 | ||
| Management | 459 | ||
| Postmortem Appearances | 459 | ||
| Externally | 459 | ||
| Internally | 459 | ||
| Medicolegal Aspects | 460 | ||
| Salicylic acid | 460 | ||
| Clinical Features | 460 | ||
| Fatal Dose | 460 | ||
| Fatal Period | 460 | ||
| Management | 460 | ||
| Postmortem Appearances | 461 | ||
| Medicolegal Aspects | 461 | ||
| Vitriolage | 461 | ||
| Chapter 34 - Nonmetallic and Metallic Irritants | 463 | ||
| Nonmetallic Irritants | 463 | ||
| Phosphorus | 463 | ||
| Mechanism of Action | 463 | ||
| Acute Poisoning | 463 | ||
| Fatal Dose | 464 | ||
| Fatal Period | 464 | ||
| Management | 464 | ||
| Postmortem Appearances | 464 | ||
| Externally | 464 | ||
| Internally | 464 | ||
| Chronic Poisoning | 464 | ||
| Treatment | 464 | ||
| Medicolegal Aspects | 464 | ||
| Metallic Irritants | 465 | ||
| Arsenic | 465 | ||
| Metabolism | 465 | ||
| Mechanism of Action | 465 | ||
| Acute Poisoning | 465 | ||
| Fatal Dose | 466 | ||
| Fatal Period | 466 | ||
| Subacute Form of Poisoning | 466 | ||
| Chronic Poisoning | 466 | ||
| Diagnosis | 466 | ||
| Management | 466 | ||
| Postmortem Appearances | 467 | ||
| Medicolegal Aspects | 467 | ||
| Lead (Shisha) | 468 | ||
| Metabolism | 468 | ||
| Mechanism of Action | 469 | ||
| Acute Poisoning | 469 | ||
| Fatal Dose | 469 | ||
| Fatal Period | 469 | ||
| Management | 469 | ||
| Chronic Poisoning (Plumbism, Saturnism or Saturnine Poisoning) | 469 | ||
| Clinical Features | 469 | ||
| Facial Pallor | 469 | ||
| Anaemia with Punctate Basophilia | 470 | ||
| Colic and Constipation | 470 | ||
| Lead Encephalopathy | 470 | ||
| Effects on Reproductive System | 470 | ||
| Effects on Circulatory System | 470 | ||
| Diagnosis | 470 | ||
| Management | 470 | ||
| Medicolegal Aspects | 471 | ||
| Mercury (Para, Quicksilver) | 471 | ||
| Poisonous Compounds of Mercury and their Sources | 471 | ||
| Absorption, Fate and Excretion | 471 | ||
| Fatal Dose | 472 | ||
| Fatal Period | 472 | ||
| Acute Poisoning | 472 | ||
| Diagnosis | 472 | ||
| Management | 472 | ||
| Postmortem Appearances | 472 | ||
| Chronic Poisoning (Hydrargyrism) | 473 | ||
| Clinical Features | 473 | ||
| Medicolegal Aspects | 473 | ||
| Thallium | 473 | ||
| Mechanism of Action | 473 | ||
| Acute Poisoning | 474 | ||
| Fatal Dose | 474 | ||
| Fatal Period | 474 | ||
| Chronic Poisoning | 474 | ||
| Management | 474 | ||
| Medicolegal Aspects | 474 | ||
| Chapter 35 - Irritants of Plant Origin | 476 | ||
| Ricinus communis (Castor Oil Plant, Arandi) | 476 | ||
| Symptoms and signs | 476 | ||
| Fatal dose and fatal period | 476 | ||
| Medicolegal aspects | 476 | ||
| Croton tiglium (Jamal Gota or Nepala) | 477 | ||
| Chapter 36 - Irritants of Animal Origin | 481 | ||
| Snakes (Ophida) | 481 | ||
| Epidemiology | 481 | ||
| Anatomy/identification (fig. 36.1) | 481 | ||
| Venom composition, pharmacology and Pathophysiology | 482 | ||
| Clinical features of snake-bite poisoning | 483 | ||
| Degree of Toxicity Resulting From Snake Bite | 483 | ||
| Inability for Envenomation | 483 | ||
| Bites by Colubridae (Back-fanged Snakes) | 483 | ||
| Bites by Atractaspididae (Burrowing Asps or Stiletto Snakes) | 483 | ||
| Bites of Elapidae (Cobras, Kraits, Mambas, Coral Snakes, etc.) | 483 | ||
| Bites by Hydrophidae (Sea Snakes and Sea Kraits) | 483 | ||
| Bites by Viperidae (Vipers, Adders, Rattle Snakes and Pit Vipers, etc.) | 484 | ||
| Management of Snake Bite | 484 | ||
| First Aid Measures | 484 | ||
| Hospital Treatment | 484 | ||
| Antivenom Therapy | 484 | ||
| Other Measures | 485 | ||
| Postmortem appearances | 485 | ||
| Medicolegal aspects | 485 | ||
| Arthropods | 485 | ||
| Class insecta | 485 | ||
| Bees | 485 | ||
| Wasps | 486 | ||
| Venom Composition | 486 | ||
| Symptoms and Signs | 486 | ||
| Diagnosis of Venom Hypersensitivity | 486 | ||
| Chapter 37 - Somniferous Group | 489 | ||
| Opium (Afim) | 489 | ||
| Mechanism of action and metabolism | 490 | ||
| Acute poisoning | 490 | ||
| Stage of Excitement | 490 | ||
| Stage of Stupor | 490 | ||
| Stage of Narcosis | 490 | ||
| Fatal Dose and Fatal Period | 490 | ||
| Treatment | 490 | ||
| Postmortem Appearances | 491 | ||
| Medicolegal Aspects | 491 | ||
| Chronic poisoning (morphino-mania/ morphinism) | 492 | ||
| Symptoms Of Withdrawal | 492 | ||
| Heroin | 492 | ||
| Postmortem findings | 492 | ||
| Cause of death | 493 | ||
| Some additional points of medicolegal interest | 493 | ||
| Pethidine (MeperidineŠUsa) | 493 | ||
| Methadone | 493 | ||
| Chapter 38 - Alcohol and Alcoholism | 495 | ||
| Alcohol | 495 | ||
| Alcohol concentrations (units and various drinks) | 495 | ||
| Consumption, absorption and elimination with their medicolegal implications | 496 | ||
| Stages of alcohol intoxication | 497 | ||
| Stage of Excitement (Blood Alcohol Concentration 50-150mg%) | 497 | ||
| Stage of Incoordination (Blood Alcohol Concentration 150-300mg%) | 497 | ||
| Stage of Narcosis (Blood Alcohol Concentration > 300mg%) | 498 | ||
| Fatal dose and fatal period | 498 | ||
| Diagnosis | 498 | ||
| Treatment | 498 | ||
| Alcohol Withdrawal Syndrome | 498 | ||
| Treatment | 499 | ||
| Aversion Therapy | 499 | ||
| Supportive Psychotherapy | 499 | ||
| Drunkenness | 499 | ||
| Ethanol and vehicular accidents | 499 | ||
| Breathalyser (alcometer/intoximeter/ drunkometer) | 500 | ||
| Ethanol and crime | 500 | ||
| Death In Acute Alcoholic Poisoning | 500 | ||
| Collection and Preservation of Blood and Urine Samples | 501 | ||
| Collection | 501 | ||
| Preservation | 501 | ||
| Post-sampling formation/elimination of alcohols | 502 | ||
| Alcoholism and Drug Dependency | 502 | ||
| Methanol (Methyl Alcohol/Wood Spirit/ Wood Naphtha/Colonial Spirit) | 503 | ||
| Mode of action | 503 | ||
| Clinical features | 503 | ||
| Management | 503 | ||
| Fatal dose and fatal period | 503 | ||
| Postmortem appearances | 503 | ||
| Medicolegal aspects | 504 | ||
| Medicolegal Examination in Case of Alcohol Intoxication | 504 | ||
| Examination proper | 504 | ||
| Eyes and Visual Acuity | 504 | ||
| Vital Parameters | 504 | ||
| Reflexes | 504 | ||
| Muscular Coordination Tests | 504 | ||
| Mental Examination | 504 | ||
| Systemic Examination | 505 | ||
| Examination of Injuries | 505 | ||
| Collection of Samples | 505 | ||
| Opinion | 505 | ||
| Chapter 39 - Non-narcotic Drug Abuse | 506 | ||
| Non-narcotic Drugs | 506 | ||
| Methods of abuse | 506 | ||
| Hazards of drug abuse | 506 | ||
| Accidental Overdosage | 506 | ||
| Delayed Presentation | 506 | ||
| Contaminants | 507 | ||
| Non-drug Hazards | 507 | ||
| Body Packing and Stuffing (Table 39.1) | 507 | ||
| Body PackingŠAn Unusual Case | 507 | ||
| Barbiturates | 507 | ||
| Absorption, distribution and elimination | 508 | ||
| Fatal dose | 508 | ||
| Symptoms and signs | 508 | ||
| Treatment | 508 | ||
| Postmortem appearances | 508 | ||
| Chapter 40 - Deliriant Poisons | 518 | ||
| Dhatura | 518 | ||
| Mechanism of action | 518 | ||
| Symptoms and signs | 518 | ||
| Fatal dose and fatal period | 519 | ||
| Treatment | 519 | ||
| Postmortem appearances | 519 | ||
| Medicolegal aspects | 519 | ||
| Chapter 41 - Spinal Poisons | 521 | ||
| Strychnine (Kuchila) | 521 | ||
| Mechanism of action | 521 | ||
| Symptoms and signs (Table 41.1) | 521 | ||
| Fatal dose and fatal period | 522 | ||
| Treatment | 522 | ||
| Postmortem appearances | 522 | ||
| Medicolegal aspects | 522 | ||
| Peripheral Nerve Poisons | 523 | ||
| Curare | 523 | ||
| Chapter 42 - Cardiac Poisons | 525 | ||
| Nicotine | 525 | ||
| Action And Metabolism | 525 | ||
| Clinical features | 526 | ||
| Fatal dose | 526 | ||
| Nicotine withdrawal | 526 | ||
| Treatment | 526 | ||
| Nicotine Replacement Therapies | 526 | ||
| Medicolegal aspects | 527 | ||
| Non-Nicotine pharmacological treatment | 527 | ||
| Aconite | 527 | ||
| Active principles and action | 528 | ||
| Symptoms and signs | 528 | ||
| Fatal dose and fatal period | 528 | ||
| Treatment | 528 | ||
| Postmortem appearances | 528 | ||
| Medicolegal aspects | 528 | ||
| Oleander (Kaner) | 529 | ||
| Nerium odorum (white oleander/kaner) | 529 | ||
| Chapter 43 - Agro-chemical Poisoning | 531 | ||
| Pesticides | 531 | ||
| Herbicides | 532 | ||
| Fungicides | 532 | ||
| Rodenticides | 532 | ||
| Acaricides | 532 | ||
| Nematicides | 532 | ||
| Molluscicides | 532 | ||
| Miscellaneous pesticides | 532 | ||
| Organophosphates | 532 | ||
| Mode of usage | 532 | ||
| Classification | 532 | ||
| Absorption, fate and excretion | 533 | ||
| Mechanism of action | 533 | ||
| Clinical features | 533 | ||
| Intermediate syndrome | 533 | ||
| Delayed Neuropathy | 533 | ||
| Fatal period | 533 | ||
| Diagnosis | 533 | ||
| Normal Cholinesterase Values | 533 | ||
| Treatment | 534 | ||
| Antidotes | 534 | ||
| Postmortem appearances | 534 | ||
| Toxicological analysis | 534 | ||
| Medicolegal Importance | 534 | ||
| Carbamates | 535 | ||
| Chapter 44 - Fumigants | 541 | ||
| Aluminium Phosphide | 541 | ||
| PhosphineŠPhysical Properties And Absorption | 541 | ||
| Mechanism Of Toxicity | 542 | ||
| Toxic Dose | 542 | ||
| Clinical Features | 542 | ||
| Poisoning Due To Inhalation Of Ph3 | 542 | ||
| Poisoning Due To Ingestion Of Alp | 542 | ||
| Mild Ingestional Intoxication | 542 | ||
| Moderate and Severe Poisoning | 542 | ||
| Shock | 542 | ||
| Diagnosis | 543 | ||
| Management | 543 | ||
| Reduction of Absorption of PH3 | 543 | ||
| Reduction of Absorbed PH3 | 543 | ||
| Enhancement of Excretion of PH3 | 543 | ||
| Treatment of Shock | 543 | ||
| Treatment of Arrhythmias | 543 | ||
| Treatment of Metabolic Acidosis | 543 | ||
| Postmortem Appearance | 543 | ||
| Medicolegal Aspects | 544 | ||
| Case: Determination To Commit SuicideŠHow Far Stretchable | 544 | ||
| Chapter 45 - Asphyxiants | 546 | ||
| Hydrocyanic Acid and Its Salts | 546 | ||
| Mechanism of action | 547 | ||
| Absorption, fate and excretion | 547 | ||
| Fatal dose | 547 | ||
| Fatal period | 547 | ||
| Signs and symptoms | 547 | ||
| Gastrointestinal Tract | 548 | ||
| Central Nervous System | 548 | ||
| Respiratory System | 548 | ||
| Cardiovascular System | 548 | ||
| Lactic Acidosis | 548 | ||
| Diagnosis | 548 | ||
| Treatment | 548 | ||
| Stabilisation | 548 | ||
| Decontamination | 548 | ||
| Antidotal Therapy | 548 | ||
| Postmortem appearances | 548 | ||
| Internally | 549 | ||
| Toxicological analysis | 549 | ||
| Medicolegal aspects | 549 | ||
| Smoke | 550 | ||
| Clinical features | 550 | ||
| Diagnosis | 550 | ||
| Treatment | 550 | ||
| Medicolegal considerations | 550 | ||
| Chapter 46 - poisoning in conflict: chemical and biological warfare agents | 552 | ||
| Chemical Warfare Agents | 552 | ||
| Vesicants or blistering gases | 552 | ||
| Diagnosis | 553 | ||
| Treatment | 553 | ||
| Pulmonary oedema inducing compounds/lung irritants | 553 | ||
| Symptoms and Signs | 554 | ||
| Treatment | 554 | ||
| Nerve agents | 554 | ||
| Hydrogen Cyanide | 554 | ||
| Lesser Used Chemical Warfare Agents | 554 | ||
| Early irritant compounds (lacrimators/ tear gases) | 554 | ||
| Sternutators or nasal irritants | 555 | ||
| Chapter 47 - HydrocarbonsŠPetroleum Distillates | 558 | ||
| Hydrocarbons | 558 | ||
| Determinants of toxicity | 558 | ||
| Common usage | 558 | ||
| Fatal dose and fatal period | 558 | ||
| Clinical features | 559 | ||
| Specific features of kerosene intoxication | 559 | ||
| Treatment | 559 | ||
| Postmortem appearances | 559 | ||
| Medicolegal aspects | 560 | ||
| Volatile Substance Abuse | 560 | ||
| Clinical features | 560 | ||
| Diagnosis and management | 560 | ||
| Medicolegal considerations | 560 | ||
| Autopsy | 561 | ||
| Chapter 48 - Food Poisoning and Essential Metals Toxicity | 562 | ||
| Food Poisoning | 562 | ||
| Bacterial Food Poisoning | 562 | ||
| Staphylococcus aureus | 562 | ||
| Bacillus cereus | 563 | ||
| Clostridium perfringens | 563 | ||
| Clostridium botulinum | 563 | ||
| Shigella | 563 | ||
| Salmonella | 563 | ||
| Vibrio parahaemolyticus | 563 | ||
| Vibrio cholerae | 563 | ||
| Campylobacter jejuni | 563 | ||
| Escherichia coli | 563 | ||
| Travellers Diarrhoea | 564 | ||
| Postmortem Appearances | 564 | ||
| Medicolegal Aspects | 564 | ||
| Ptomaine Poisoning | 564 | ||
| Poisonous Foods | 564 | ||
| Lathyrus sativus (Kesari Dal) | 564 | ||
| Mushrooms | 564 | ||
| Symptoms | 565 | ||
| Diagnosis | 565 | ||
| Treatment | 565 | ||
| Rye, Wheat, Oats, Barley and Bajra | 565 | ||
| Argemone mexicana | 565 | ||
| Active Principles | 565 | ||
| Medicolegal Aspects | 565 | ||
| Lolium temulentum (Darnel) | 565 | ||
| Paspalam scrobiculatum (Kodra) | 565 | ||
| Stigmata maides (Maize) | 565 | ||
| Groundnuts | 565 | ||
| Potato | 565 | ||
| Fish and Marine Animals | 566 | ||
| Metallic Contamination of Food | 566 | ||
| Migrants from Packaging Materials | 566 | ||
| Food Allergy | 566 | ||
| Essential MetalsŠPotential for Toxicity Thereof | 566 | ||
| Zinc (Zn) | 566 | ||
| Essentiality | 566 | ||
| Deficiency | 567 | ||
| Toxicity | 567 | ||
| Acute Poisoning | 567 | ||
| Fatal Dose and Fatal Period | 567 | ||
| Treatment | 567 | ||
| Postmortem Appearance | 567 | ||
| Selenium (Se) | 567 | ||
| Essentiality | 567 | ||
| Annexure 1: Scientific Aids to Investigative\rTechniques | 571 | ||
| Annexure 2: Proforma for Age Certification | 573 | ||
| Annexure 3: Proforma for Medicolegal Examinationof Injuries | 575 | ||
| Annexure 4: Proforma for Examination of a Victimof Sexual Assault | 577 | ||
| Annexure 5: Proforma for Examination of an Accusedof Sexual Offence | 579 | ||
| Annexure 6: Issuing/Supplying Copies of Injuryand/or Postmortem Reports(MLR and/or PMR) | 581 | ||
| Annexure 7(a): Penal Provisions Applicable toMedical Persons | 582 | ||
| Annexure 7(b): Penal Provisions Affording Protection toMedical Persons | 583 | ||
| Annexure 8: Standard Weights/Measures/Dimensionsof Organs/Tissues | 584 | ||
| Index | 585 |