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Textbook of Forensic Medicine and Toxicology PDF

612 Pages·2014·7.5 MB·English
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Textbook of Forensic Medicine and Toxicology Prelims.indd i Prelims.indd i 2/9/2011 6:36:39 PM 2/9/2011 6:36:39 PM “This page intentionally left blank" Textbook of Forensic Medicine Forensic Medicine and Toxicology and Toxicology Principles and Practice Fifth Edition Krishan Vij MD LLB Head Department of Forensic Medicine and Toxicology Adesh Institute of Medical Sciences & Research, Bathinda, Punjab Former Professor and Head Department of Forensic Medicine and Toxicology Government Medical College and Hospital, Chandigarh Counsellor Torture Medicine ELSEVIER A division of Reed Elsevier India Private Limited Prelims.indd iii Prelims.indd iii 2/9/2011 6:36:40 PM 2/9/2011 6:36:40 PM Textbook of Forensic Medicine and Toxicology, 5/e Krishan Vij ELSEVIER A division of Reed Elsevier India Private Limited Mosby, Saunders, Churchill Livingstone, Butterworth-Heinemann and Hanley & Belfus are the Health Science imprints of Elsevier. © 2011 Elsevier First Edition 2001 Second Edition 2002 Third Edition 2005 Fourth Edition 2008 Fifth Edition 2011 All rights are reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. ISBN: 978-81-312-2684-1 Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary. The authors, editors, contributors and the publisher have, as far as it is possible, taken care to ensure that the information given in this text is accurate and up-to-date. However, readers are strongly advised to confirm that the information, especially with regard to drug dose/usage, complies with current legislation and standards of practice. Published by Elsevier, a division of Reed Elsevier India Private Limited. Registered Office: 622, Indraprakash Building, 21 Barakhamba Road, New Delhi-110 001. Corporate Office: 14th Floor, Building No. 10B, DLF Cyber City, Phase-II, Gurgaon-122 002, Haryana, India. Managing Editor (Development): Shabina Nasim Development Editor: Shravan Kumar Manager – Publishing Operations: Sunil Kumar Manager – Production: NC Pant Typeset by Olympus Infotech Pvt. Ltd., Chennai, India. Printed and bound at xxx, India. Prelims.indd iv Prelims.indd iv 2/9/2011 6:36:40 PM 2/9/2011 6:36:40 PM To the memory of my daughter Divya Vij Prelims.indd v Prelims.indd v 2/9/2011 6:36:40 PM 2/9/2011 6:36:40 PM “This page intentionally left blank" Foreword In the present civilised society, every crime ought to be punished and a criminal must be taken to task. Investigators and those who are engaged in the dispensation of justice require aid of an expert, who, by experience and knowledge, has acquired scientific tem- perament and skill to unearth the crime. At the same time, with the aid of a forensic expert, an innocent can be saved from the gallows. Dr. Krishan Vij, in this edition, has put a great effort to notice transformation of medical jurisprudence to clinical foren- sic medicine. The present edition of Textbook of Forensic Medicine and Toxicology will be of great help not only to the under-graduate and postgraduate students but to all those who are engaged in investigation of the crime and administration of justice, be it lawyers or judges, and victims of violence and negligence. The 5th edition of Textbook of Forensic Medicine and Toxicology by Dr. Vij has summoned the resources of science from all quarters. Division of contents into segments, viz., (i) Of the Basics, (ii) Of the Dying and the Death, (iii) Of the Injured and the Injuries, (iv) Clinical Forensic Medicine, (v) Legal and Ethical Aspects of Medical Practice, (vi) Forensic Toxicology, and placement of illustrations, tables, flowcharts, etc. speak volumes of his experience and expertise spreading over about three decades. Chapters on brain-stem death vis-à-vis organ donation; sudden and unexpected deaths; custody related torture and/or death; deaths associ- ated with surgery, anaesthesia and blood transfusion; medicolegal examination of the living; complications of trauma (was wound- ing responsible for death?); medical negligence; informed consent and refusal; and medicolegal aspects of immuno-deficiency syndrome deserve extreme applause. Exceptional features of this ensuing edition have been the presentation of cases clinching to the text and updation of information in every segment. I am sure that the edition would serve as a guiding light for all concerned. I wish Dr. Vij all success in his endeavour. Kanwaljit Singh Ahluwalia Judge Punjab & Haryana High Court Prelims.indd vii Prelims.indd vii 2/9/2011 6:36:40 PM 2/9/2011 6:36:40 PM “This page intentionally left blank" Preface to the 5th Edition The rapid exhaustion of the last four editions reflects volumes of wide acceptance and popularity of the book, encouraging me to bring about the 5th edition. The current edition reflects the meticulous work that has been done to revamp its predecessor. Based on the feedback received from students, teachers, advocates and the judiciary, both Sections of the book (Forensic Medicine and Forensic Toxicology) have been extensively revised with consequent deletion of outdated information and incorporation of the new. Extensive placement of photographs, illustrations, tables and flowcharts has made this edition extremely catchy and easy to grasp. Appearance of enormous references in the flow of the text is the result of extensive study and the period of toil and turbulence through which I had to creep in. The integral thread of evidence-based description is seen running through the entire content. Placement of precise information about the relevant legal provisions and forensic aspects of anatomical structures/findings at appropriate places promote interdisciplinary understanding of issues. Cases of extreme medicolegal significance, commensurating with the flow of the text, have been introduced to illustrate medi- colegal principles and explore solutions to tackle problems usually encountered in day-to-day medicolegal work. And therefore, the ensuing edition will be of immense help not only to undergraduates and postgraduates (the 'would be' medical practitioners/ experts), but also to wide segments of other professionals engaged in the administration of justice; be it prosecutors, defense counsels, and of course, the judiciary. User friendliness of the book is depicted in its lucid style, rational use of various levels of headings, subheadings and boldface words. Presentation of ‘cases’ is an exceptionally interesting feature of the book helping the user to have an in-depth approach to the intricacies of medicolegal issues. Author’s view has always been that the modern time student should not be deprived of the fruits of recent information; therefore, topics like Sudden and Unexpected Deaths; Deaths due to Asphyxia; 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?; Medical Education via-à-vis Medical Practice; Medical Negligence; Consent to and Refusal of Treatment, etc., have been thoroughly up-dated with placement of ‘cases’ clinching to the text. In their effort to add to the learning experience, the publisher, Elsevier, has made use of this book’s companion website http://www.manthan.info/Vij/web-home.aspx easy for all students. Now any student can use features like Interactive Assessment, Downloadable Images and Updates by simply logging in into the Website and creating an ID for self. In essence, the 5th edition has been nurtured with most recent information, which will serve as an excellent resource for the undergraduates as well as postgraduate students. Teachers will find it as a guiding light. A wide segment of other professionals like practitioners (medical as well as legal), investigative agencies, and above all, the judicial officers will also be benefited with far-reaching content of this edition. Krishan Vij Prelims.indd ix Prelims.indd ix 3/1/2011 1:58:28 PM 3/1/2011 1:58:28 PM Acknowledgements Revision of any book is a gigantic task. The revision of the fourth edition would have not been possible without uninterrupted encouragement from well-wishers in general and my colleagues in particular. The acutely updated and illustrated fifth edition has been made possible through rigorous and continued efforts. I am grateful to my friends and colleagues who obliged me through healthy discussions. While it is not possible to list them all, I record my indebtedness to: Dr. BBL Aggarwal, Ex-Principal, University College of Medical Sciences and Head of the Department of Forensic Medicine, New Delhi; for whom my vocabulary fails to locate adequate words of appreciation. An excellent teacher, guide and philosopher, he has been a source of inspiration and encouragement to me in all walks of my life. Dr. Gurpreet Inder Singh, Director Principal, AIMS&R, Bathinda (Punjab) and Dean Colleges, Baba Farid University of Health Sciences, who commands exceptional mention for his constructive and leadership qualities. Hailing from the Army Background, he has effectively been able to transmit a message of True Army Spirit at the institute as he performs and expects everything in a scheduled and meticulous manner. Dr. TD Dogra and Dr. GK Sharma, Head of the Department of Forensic Medicine, All India Institute of Medical Sciences, and Director Principal, Lady Hardinge Medical College, New Delhi, respectively, distinct and magnanimous personalities in the field of Forensic Medicine, deserve exclusive appreciation. Earnest feeling of gratitude are expressed to the authors/writers of various books/journals/articles whose references have been cited in the text. Dr. JS Dalal, Dr. J Gargi, Dr. RK Gorea, Dr. Dalbir Singh, Dr. AS Thind and Dr. Jagjiv Sharma deserve thanks for their constructive inputs. Dr. KK Aggarwal, Dr. SS Oberoi, and Dr. DS Bhuller invite appreciation for their interaction. Dr. Vijay Vij, my brother-in-law, who was instrumental in making me visit various libraries and book centres during my visit to the United States of America, deserves special appreciation. I was truly amazed by his profound interest in gaining more and more knowledge and, in fact, I happened to collect rich material from his personal library. Dr. Parmod Goyal and Dr. Vishal Garg, my colleagues at the Institute, deserve extreme applause for their inputs and cooperation. I must confess that I have been highly demanding on quality and accuracy from all staff members of Elsevier, a division of Reed Elsevier India Pvt. Ltd, sometimes rather impatiently, but all of them have been quite accommodating. In particular, I would like to pen down my appreciation for Mr. Shravan Kumar, Development Editor, for his pleasant-pitched interaction with an eye on the market placement. The users of previous editions are gratefully acknowledged for having brought the textbook at this pedestal. In the past, I have been benefited from suggestions by colleagues, students, advocates and the judiciary, and I urge them to continue to give their valuable suggestions. Before I conclude, I must acknowledge with profound gratitude, the encouragement and inspiration extended to me by wife, Anu, and my daughter, Divya (during the Herculean exercise of the maiden edition). My wife has been socially bearing the pangs of loneliness owing to my remaining obsessively occupied. Her contribution, albeit silent, is far-reaching. Krishan Vij Prelims.indd x Prelims.indd x 2/9/2011 6:36:41 PM 2/9/2011 6:36:41 PM Contents Section 1 Forensic Medicine PART I Of the Basics Chapter 1 Introduction to Forensic Medicine and Indian Legal System 3 Ancient traditional writings describing considerations for regulating human behaviour and providing punishments, medical ethics, and medical practice for purposes of law | Explanation for the terms forensic, medicine, medical jurisprudence, legal medicine, forensic pathology, etc. | Police inquest | Magistrate’s inquest | Various Courts in India | Documentary and oral evidence | Exceptions to oral evidence | Procedure of recording evidence | Dying declaration and its importance | Kinds of witnesses | Doctor in the witness box Chapter 2 Medicolegal Autopsy, Exhumation, Obscure Autopsy, Anaphylactic Deaths and Artefacts 17 Clinical and medicolegal autopsy | Precautions for medicolegal autopsy | Objectives of medicolegal autopsy | Importance of examining clothing | Incisions for the autopsy | Procedure for external and internal exami nation | Selection, preservation and dispatch of viscera/specimens | Exhumation | Obscure autopsy | Anaphylactic deaths | Artefacts Chapter 3 Identification 35 Complete and incomplete identity | Corpus delicti | Identification in the living | Identification in the dead | Primary and secondary characteristics | Comparative techniques | Importance of dentition in the medicolegal field | Age from ‘ossification activity’ of bones | Symphyseal surface in estimating age | Skull sutures in estimating age | Medicolegal importance of age | Morphological and skeletal changes in determining sex | Intersex states | Stature from the bones | Medicolegal information from hair, scar, tattoo mark(s), etc. | Skeletal indices for determining sex and race | Dactylography | Medicolegal information from blood/blood stain | Medicolegal application of blood groups | Mass disaster | Collection, preservation and dispatch of samples for DNA testing | OJ Simpson case PART II Of the Dying and the Death Chapter 4 Death and Its Medicolegal Aspects (Forensic Thanatology) 74 Death | Presumption of death and survivorship | Somatic and molecular death | Brain death with its medicolegal aspects, especially in relation to organ transplantation | Suspended animation | Mode, manner, mechanism and cause of death | Estimation of ‘time since death’ from the immediate, early and late changes after death, and factors influencing such changes | Medicolegal aspects of immediate, early and late changes after death | Differentiation between postmortem staining and bruising, hypostasis and congestion, rigor mortis and cadaveric spasm, rigor mortis and conditions simulating rigor mortis, etc. | Postmortem damage by predators | Entomology of the cadaver and postmortem interval Chapter 5 Sudden and Unexpected Death 100 Concept of ‘sudden’ and ‘unexpected’ death | Morbid anatomy of heart and its blood supply | Types of occlusion | Sequelae of coronary occlusion | Approaching the cause of death | Postmortem demonstration of myocardial infarction | Hypertensive heart disease and sudden death | Epilepsy as a cause of unexpected death | Pulmonary embolism | Vagal inhibition and sudden death | Sudden death in infancy Prelims.indd xi Prelims.indd xi 2/9/2011 6:36:41 PM 2/9/2011 6:36:41 PM Contents xii Chapter 6 Asphyxial Deaths 110 Asphyxia and its types | Asphyxial stigmata | Suffocation and its types | Medicolegal aspects of carbon monoxide and carbon dioxide | Medicolegal aspects of smothering, gagging, choking, traumatic asphyxia, burking, etc. | Mechanism of death by compression of the neck | Types, cause of death, autopsy findings and the circumstances of hanging | Types, cause of death, autopsy findings and circumstances of strangulation | Mugging, garroting, bansdola, palmar strangulation, etc. | Types, mechanism of death, cause of death, pathophysiology, and diagnosis of death in drowning | Floatation of body in water | Circumstances of drowning Chapter 7 Infanticide and Foeticide 146 Infanticide and the related law | Primary and secondary issues to be resolved in relation to infanticide | Age of viability and its medicolegal significance | Concept of live birth and separate existence | Proof of live birth | Hydrostatic test and its importance | Other tests for separate existence | Probable duration of life of the child | Autopsy | Cause of death, i.e. acts of commission and acts of omission | Foeticide | Abandoning of children and concealment of birth | Development of foetus Chapter 8 Thermal Deaths 159 Heat regulation, systemic hyperthermia (heat cramps, heat exhaustion and heat stroke) | Character of burns produced by various agents | Different classification of burns | Rule of nine | Causes of death in burn | Nature of burn injury in the absence of death | Age of burn injury | Autopsy findings | Medicolegal aspects of death due to burns | Antemortem and postmortem differentiation of burns | Some legal provisions in relation to dowry death | Scalds and their medicolegal aspects | Differentiation of injuries due to dry heat, moist heat and chemicals | Pathophysiology of hypothermia | Circumstances of injury due to cold | Autopsy findings in death due to cold Chapter 9 Starvation and Neglect 173 Starvation and its types | Autopsy findings | Circumstances of death | Malnutrition Chapter 10 Death by Electrocution 175 Types of fatal electrocution | Factors influencing effects of electricity | Mechanism of death | Autopsy findings in ‘medium-tension’ and ‘high-tension’ currents | Joule burn (endogenous burn) | Circumstances of electrocution | Iatrogenic electrocution | Judicial electrocution | Lightning and mechanism of injury by it | Circumstances of lightning Chapter 11 Deaths Associated with Surgery, Anaesthesia and Blood Transfusion 183 Surgical intervention | Respiratory embarrassment | Cardiac embarrassment | Regional and spinal anaesthesia | Instruments and instrumentation | Unforeseeable problems | Precautions for autopsy | The autopsy | Medicolegal considerations | Blood transfusion—hazards and risks | Periprocedural complications, etc. Chapter 12 Custody Related Torture and/or Death 191 Meaning of custody and torture | Methods of torture | Circumstances of death | Related cases | Role of autopsy surgeon | Incisions at autopsy PART III Of the Injured and the Injuries Chapter 13 Injuries: Medicolegal Considerations and Types 197 Wound, trauma, injury, etc. | Mechanism of production of mechanical injuries | Differentiation between antemortem and postmortem wounds | Wound healing | Important Sections of IPC relating to offences against the human body | Simple, grievous and dangerous injuries | Classification of injuries Prelims.indd xii Prelims.indd xii 2/9/2011 6:36:41 PM 2/9/2011 6:36:41 PM xiii Contents Chapter 14 Injuries by Blunt Force 213 Forensic aspects of the anatomy of skin | Abrasion and its types | Patterned abrasions | Fate of an abrasion | Differentiation between antemortem and postmortem abrasions | Medicolegal aspects of abrasions | Bruise (contusion) and factors influencing its production | Migratory/ectopic bruising | Fate of a bruise | Patterned bruising | Differentiation between antemortem and postmortem bruising | Medicolegal aspects of bruising | Lacerations and its types | Incise-looking wounds | Features of lacerations | Differentiation between antemortem and postmortem lacerations | Medicolegal aspects of laceration Chapter 15 Injuries by Sharp Force 225 Incision/cut/slash, etc. | Features of incised wounds | Bevelled cuts | Hesitation cuts | Chopping wounds | Types and features of stab wounds | Factors influencing size, shape and configuration of stab wounds | Injuries by blunt penetrating/dull instruments | Wounds by glass | Pointers towards suicide/accident/homicide Chapter 16 Injuries by Firearms 234 Types of firearms | Types of ammunition | Parts of cartridge and their functions | Mechanism of bullet wound production | Characters of wounds produced by rifled and smoothbore firearms | Exit wounds by rifled and smoothbore weapons | Direction of fire | Unusual circumstances in firearm injuries | Various tests for firearm residues | Autopsy in firearm fatalities | Suicide, accident or homicide Chapter 17 Injuries by Explosives 266 Mechanism of production of injuries by bomb blast | Autopsy in explosion fatalities | Medicolegal considerations in explosion injuries Chapter 18 Regional Injuries 270 Injuries of the scalp including forensic aspects of anatomy of the scalp | Fractures of the skull including forensic aspects of anatomy of the skull | Mechanism of production of skull fractures | Meningeal haemorrhages with their medicolegal aspects | Mechanism of production of cerebral injuries | Medicolegal aspects of coup and contrecoup injuries | Concussion | Head injuries in boxers | Spinal injuries with their medicolegal aspects | Facial, cervical, thoracic and abdominal trauma Chapter 19 Transportation Injuries 296 Mechanism of vehicular injury | Pattern of injuries to the driver, front-seat occupants and rear-seat occupants of a motor car | Pattern of injuries to the pedestrians, motor cyclists and pedal cyclists, etc. | Aircraft accidents, railway accidents and vehicular conflagration | Medicolegal aspects of transportation injuries PART IV Clinical Forensic Medicine Chapter 20 Medicolegal Examination of the Living 304 Clinical forensic medicine | Medicolegal examination of the victim of assault and extending opinion | Classification of sexual offences | Meaning and scope of the offence of ‘rape’ with particular emphasis on implications of consent/ nonconsent | Medicolegal examination of the victim and of the alleged accused of rape and extending opinion in either case | Medicolegal examination in ‘unnatural sexual offences’ and extending opinion | Medicolegal aspects of ‘semen’ | Acid phosphatase test and its medicolegal importance | Medicolegal importance of pregnancy | Presumptive, probable and positive signs of pregnancy | Differential diagnosis of pregnancy | Surrogate motherhood | Child abuse Chapter 21 Complications of Trauma: Was Wounding Responsible for Death? 335 Immediate causes of death—primary or neurogenic shock; injury to vital organ(s); haemorrhage; air embolism | Delayed causes of death—secondary shock; wound infection; pulmonary thromboembolism; fat and bone marrow Prelims.indd xiii Prelims.indd xiii 2/9/2011 6:36:41 PM 2/9/2011 6:36:41 PM Contents xiv embolism; crush syndrome; exacerbation of pre-existing disease | Trauma and operation/anaesthesia | Weapon and its implications PART V Legal and Ethical Aspects of Medical Practice Chapter 22 Medical Education vis-à-vis Medical Practice 346 Ethics and moral in relation to medical practice | Various ‘codes’ of medical ethics | Constitution and powers of the Indian Medical Council | Constitution and powers of the State Medical Council | Code of ethics by Medical Council of India | Duties of doctors towards patients and towards each other | Duties of doctors towards the state | Professional secrecy and privileged communication | Professional misconduct/infamous conduct/malpractice | Difference between unethical conduct and misconduct | Red Cross emblem policy Chapter 23 Medical Negligence 361 Negligence and its various components | Medical negligence—differentiation from negligence in other fields | Mistaken diagnosis/errors of clinical judgement whether amount to negligence | Defensive medicine | Proof of negligence with particular emphasis on the doctrine of ‘res ipsa loquitur’ | Contributory negligence | Vicarious liability | Medical product liability | Criminalisation of negligence | Failure to take X-ray—whether amounts to negligence | Consumer Protection Act and medical negligence Chapter 24 Consent to and Refusal of Treatment 370 Types of consent | Scope of consent | Doctrine of informed consent and its components | Hospital’s role | Ability to consent | Exceptions to material disclosure | Evidentiary proof of adequate disclosure | Decision-making for the patient without capacity | Sections 53, 53A and 164A CrPC in relation to consent | Doctor-assisted suicide and euthanasia Chapter 25 Acquired Immunodeficiency Syndrome: Medical, Social, Ethical and Legal Implications 376 Healthcare worker(s) with HIV infection | Criminalisation of HIV transmission | AIDS and autopsies | Universal blood and body fluid precautions Chapter 26 Abortion and Delivery 380 Abortion and its classification | Grounds for justifiable abortion | Rules of the MTP Act | Methods of inducing abortion under the MTP Act | Methods used in criminal abortion | Unskilled, semi-skilled and skilled interference for inducing abortion | Abortion stick and its hazards | Enema syringe and its hazards | Complications of criminal abortion | Examination of a woman who has allegedly aborted | Differentiation between nulliparous and parous uterus | Penal provisions relating to criminal abortion Chapter 27 Impotence, Sterility, Sterilisation and Artificial Insemination 393 Impotence and sterility | Examination of a case of impotency and sterility and expressing opinion | Causes of impotence and sterility in the male and female | Medicolegal aspects of sterilisation | Types, procedures, guiding principles and legal status of artificial insemination | Test tube baby | Concept of ‘wrongful pregnancy’, ‘wrongful birth’ and ‘wrongful life’ cases Chapter 28 Nullity of Marriage, Divorce and Legitimacy 400 Circumstances for void and voidable marriage | Legitimacy of children of void and voidable marriages | Grounds for divorce | Alternate relief in divorce proceedings | Medicolegal issues relating to legitimacy | Some important considerations Chapter 29 Forensic Psychiatry 405 Forensic psychiatry | Various ‘terms’ in the Mental Health Act | Signs/symptoms of mental disturbance with their medicolegal importance | Mental retardation | Psychosis and neurosis | Association of cerebral tumours, pregnancy and epilepsy with psychosis | Personality disorders | Diagnosis of mental illness | True and feigned Prelims.indd xiv Prelims.indd xiv 2/9/2011 6:36:42 PM 2/9/2011 6:36:42 PM

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Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.