The Essentials Of Forensic Medicine And Toxicology

717 Pages·2015·45.48 MB·English

by  K. S. Narayan Reddy, O. P. Murty

THE ESSENTIALS OF
FORENSIC MEDICINE
AND TOXICOLOGY
By
Dr. K.S. NARAYAN REDDY
M.D., D.C.P., Ph.D., F.A.M.S.,
F.I.M.S.A., F.A.F.Sc., F.I.A.M.S., F.A.F.M.
Honorary Professor of Forensic Medicine,
S.V.S. Medical College, Mahabubnagar [AP]
(Retired Principal, Osmania Medical College, Hyderabad)
and
Dr. O.P. MURTY
M.D.
Additional Professor of Forensic Medicine,
All India Institute of Medical Sciences,
New Delhi
Thirtythird Edition
2014
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The Essentials of Forensic Medicine and Toxicology
First Edition: 1973
Thirtythird Edition: 2014
ISBN 978-93-5152-557-8
Printed at Rajkamal Electric Press, Plot No. 2, Phase-IV, Kundli, Haryana.
PREFACE
"To study disease without books is to sail an uncharted sea, while to
study books alone is not to go to sea at all."-William Osler.
"Some books are to be tested, others to be swallowed and some few
to be chewed and digested."-Bacon.
This treatise is designed to provide a brief and essentially practical guide to current teaching in Forensic
Medicine with pmticular reference to India. The subject matter has been dealt with concisely, which is easy
to grasp and simplified in presentation, and wherever necessary illustrations, tables and points have been
inserted to help the students. The airn is to provide reasonable coverage of the subject as a whole. An attempt
has been made to maintain the practical character of the book. I hope the reader will find it of immense help
while dealing with any medicolegal case. Over and above, the book has been entirely revised and special
additions and alterations have also been made and the overall text brought up-to-date.
It is intended ptimarily to meet the needs of the undergraduate medical students, to have clear grasp of
this subject. Certain topics, such as forensic ballistics, regional injuries, anesthetic and operative deaths, DNA
fingerprinting and blood stains have been dealt with in detail to meet the requirements of medical officers.
Even where less attention is given to some topics, sufficient has been included to meet the requirements of
medicolegal experts. Every endeavour has been made to preclude the identification of the deceased from the
photographs. A few new topics, such as procedure to be followed in dealing with medicolegal cases, virtual
autopsy have been incorporated. The undergraduate medical students may omit the text printed in
smaller type, except tables, which is meant only for medical officers. It is also useful to medical officers
in Government service who have to undertake medicolegal work, medical practitioners, members of the legal
profession and other law enforcement officers. I have consulted various textbooks and periodicals in the
preparation of this book, to the authors of which, I am grateful. The opinions expressed in the text are entirely
mine. I am also grateful to many friends and professional colleagues for their help and advice and to all those
whose comments and criticisms have helped to keep revisions of this book accurate and up-to-date, which
is hereby acknowledged wholeheartedly. It is requested that the discrepancies, if any noticed may please be
intimated to me, so that it may be taken care of in the next edition. Suggestions for improvement are welcome.
The physical pathology of trauma alters little over the years, but academic and practical approaches to
the subject do evolve. Accordingly, I have attempted to introduce new ideas. It is said that the proof of the
pudding lies in the eating. The popularity of the previous editions of this title prompted the publication of this
edition. It is hoped that this edition will be warmly welcomed just like the previous editions of this treatise.
K.S.N. REDDY
Hyderabad, A.P.
SOME OPINIONS
(1) Journal of Forensic Medicine and Toxicology
Vol. 15, No. I, Jan-June, 1998
The author, a well-known and reputed medical teacher with long experience, has been very successful in
giving a comprehensive account of all aspects of Forensic Medicine and Toxicology in this book, which in the
opinion of this reviewer is one among the best textbooks that has so far been published by Indian authors. It
provides up-to-date and reasonable material on the subject, and is well suited to undergraduates, postgraduate
students, medical teachers and officers, and lawyers.
O.P.MURTY
(2) Journa,l of Indian Medical Association
Vol. 70. No. 12, 16th June, 1981
The book is a short and concise treatise on Forensic Medicine but providing reasonable coverage of the
subject as a whole. This will be found well-suited and very helpful not only for the undergraduates for whom this
is primarily meant, but also for the postgraduate students and medical officers undertaking medicolegal works.
The author, a reputed professor with long experience, has been very successful in giving a comprehensive
account of all aspects of legal medicine in this book, which in the opinion of the reviewer, is the best that has
so far been published by Indian authors.
D. BANERJEE
(3) Journal of Indian Academy of Forensic Sciences
Vol. 19, No.2, 1980
The book is well written in a clear concise style. It is designed to provide to the point practical guidance to
teaching of forensic medicine in India. Apart from medical officers, lawyers and members of law enforcement
agencies would find this book useful; the undergraduate medical students, if study texts like this, could learn
a great deal of the pros and cons of the subject. But for the minor fail of perfection, Dr. Reddy has succeeded
in his aim of covering a vast subject in a compendium. On the whole, this is a commendable work, especially
for students and specialists in this field.
B. BATTACHARYA
(4) Criminal Law Journal, August, 1989
This is a very useful and exhaustive work on the subject. It is designed for the use of students, teachers
of Forensic Medicine and Toxicology. It will serve as a useful practical guide to those who are dealing with
medicolegal cases at the investigation stages or in the Court rooms while arguing for the criminal prosecution
or for providing successful defense to an accused. The medical practitioners would find a fund of information
in the book during their work in medicolegal involvement. The book provides sufficient coverage on the
subject. It is very well illustrated, contains useful charts and tables on various aspects of the subject matter
for making the points discussed easily understandable.
L.K.K.
(5) Medical Books news-A Guide to new Books
This is one of the most comprehensive volumes on the subject written by an Indian author and in fact
contains more details than required by an undergraduate. It would, therefore, be helpful when a reference on
any topic becomes necessary.
THE ESSENTIALS OF
FORENSIC MEDICINE
AND TOXICOLOGY
OTHER BOOKS BY THE SAME AUTHOR
(1) THE SYNOPSIS OF FORENSIC MEDICINE AND TOXICOLOGY
Twentyeighth Edition, 2014, 24 em x 18 em, pp 8 + 392, Price Rs. 360/-
(2) THE HANDBOOK OF FORENSIC MEDICINE AND TOXICOLOGY
(3) MEDICOLEGAL MANUAL
Third Edition, 2015, 24 em x 18 em, pp 4 + 300, Price Rs. 250/-
(4) M.C.Q's IN FORENSIC MEDICINE
Sixth Edition, 2011, 24 em x 18 em, pp VIII + 236, Price Rs. 270/-
(5) MEDICOLEGAL MANUAL FOR POLICE OFFICERS
Second Edition, 2015
(6) MEDICAL JURISPRUDENCE AND TOXICOLOGY
Third Edition, 2010, 24 em x 18 em, LXXX + 1344, Price Rs. 1350/-
(7) LEGAL MEDICINE FOR LAWYERS AND DOCTORS
(Out of print)
(8) CONCISE FORENSIC MEDICINE AND TOXICOLOGY
Fourth Edition, 2015, 17 em x 11 em, pp. IV + 238
(9) SELF-STUDY GUIDE IN FORENSIC MEDICINE AND TOXICOLOGY
(Out of print)
(10)~ ~&ifw
Second Edition, 2013, 24 em x 118 em, pp. 200, Price Rs. 200/-
CJft Wn"
(11) '""llr~r61~-~ ~Fcl>ct1r ~ ~ Rlt4RlS"~r'1
First Edition, 2007, 24 em x 18 em, pp. 230, Price Rs. 200/-
CONTENTS
SECTION 1: FORENSIC MEDICINE
1. Introduction 1
2. Legal Procedure 6
3. Medical Law and Ethics 24
4. Identification 57
5. Medicolegal Autopsy 102
6. Death and its Cause 134
7. Postmortem Changes 152
8. Mechanical Injuries 179
9. Regional Injuries 242
10. Medicolegal Aspects of Wounds 290
11 . Thermal Deaths 317
12. Starvation 335
13. Mechanical Asphyxia 338
14. Anaesthetic and Operative Deaths 377
15. Impotence and Sterility 382
16. Virginity, Pregnancy and Delivery 389
17. Abortion 400
18. Sexual Offences 411
19. Infant Deaths 437
20. Blood Stains 448
21. Artefacts 468
22. Forensic Science Laboratory 474
23. Forensic Psychiatry 480
SECTION II: TOXICOLOGY
24. General Considerations 498
25. Agricultural Poisons 520
26. Corrosive Poisons 530
27. Metallic Poisons 538
28. Inorganic Irritant Poisons 550
29. Organic Irritant Poisons 554
30. CNS Depressants 568
31. Psychotropic Drugs 593
32. Deliriant Poisons 598
33. Drug Dependence and Abuse 604
34. Spinal Poisons 612
35. Cardiac Poisons 615
36. Asphyxiants 620
37. Miscellaneous Poisons 630
38. Food Poisoning 535
Appendices 642
Index 680
INTRODUCTION
There are two distinct aspects of law-medicine Medical etiquette deals with the conventional
relationship: ( 1) Forensic medicine, and (2) Medical laws of courtesy observed between members of
jurisprudence. They are essentially different subjects, the medical profession. A doctor should behave with
but are closely related. his colleagues as he would have them behave with
Forensic or legal medicine (forensic= forums of himself.
or used in Courts of law) deals with the application Ethical behaviour is a self-imposed duty upon each
of medical and paramedical knowledge to aid in doctor. A doctor should not criticise or denigrate the
the administration of justice. It is used by the legal professional ability of another doctor, while dealing
authorities for the solution of legal problems. Some with a patient.
examples are: applying the medical knowledge in Forensic medicine deals almost entirely with
deciding cases of injuries, murder, suicide, accidents, crimes against human beings in which medical
sexual offences, poisoning, etc. In short, it deals with examination and evidence are required. Forensic
medical aspects of law. medicine is mostly an exercise of commonsense,
Medical jurisprudence (juris= law; prudentia = combined with the application of knowledge and
knowledge) deals with legal responsibilities of the experience, already acquired in the study of other
physician with particular reference to those arising branches of medicine, surgery, obstetrics, etc. Its aim
from physician-patient relationship, such as medical is to find out the truth. Its particular field of activity
negligence cases, consent, rights and duties of doctors, is judicial investigation, both civil and criminal. All
serious professional misconduct, medical ethics, etc. medical work is of a responsible character, especially
In short, it deals with legal aspects of practice of the medicolegal work, such as issuing certificates of
medicine. lunacy, ill-health, etc. In all cases of crime involving
Forensic pathology deals with the study and the person, e.g. homicide, suicide, assault, sexual
application of the effects of violence or unnatural offences, traffic accidents, poisoning, etc., the help
disease in its various forms in or on the human body, of the medical practitioner is sought by the police. In
in determining the cause and manner of death in case all such cases, the doctor will be required to appear
of violence, suspicious, unexplained, unexpected, as an expert witness in a Court of law. In some cases.
sudden and medically unattended deaths. the doctor is the chief source of evidence upon which
Medical ethics deals with the moral principles legal decisions are made. In cases of sudden death.
which should guide members of the medical the authorities will depend mostly or completely on
profession in their dealings with each other, their medical evidence in establishing the cause of death.
patients and the State. and in case of accident to determine blame.
2 Essentials of Forensic Medicine
A doctor may be called to testify (1) as an ordinary evidence in the case. He should not be influenced
witness who saw an incident, (2) as the medical in any way by emotional consideration, such as
practitioner who treated the patient, (3) as an expert sympathy or antipathy. The doctor must be honest,
to give his opinion on matter of science. In the first for confidence is inspired by honesty and success
two conditions, it is his duty and obligation to testify. depends upon confidence.
In the last condition he may refuse the request:, ( 1) The medicolegal aspects of any case must
if he feels reluctant to undergo what he fears will always be secondary to life saving treatment of
be a painful experience, (2) if he feels that he is not the patient. It is advisable that the doctor should
sufficiently qualified to testify with any conviction in learn to look from the medicolegal standpoint upon
that particular case, and (3) if he feels that he cannot such of his cases as are likely to become the subject
spare the time to prepare properly or to make long matter of judicial investigation. He should acquire
appearances in Court. A properly prepared physician the habit of making a careful note of all the facts
often finds his Court room experience educative and observed by him. Alan Moritz stated "If evidence has
not as traumatic as he would have anticipated. His been properly gathered and preserved, a mistake
introduction to the legal process may be unpleasant, if in interpretation may always be corrected. If the
he is irritated by an aggressive prosecuting or defence facts required for a correct interpretation are not
lawyer. The reluctance of medical practitioners to preserved, the mistake is iiTeversible". Vagueness and
become witnesses is mainly due to the pressures of theory have no place in forensic medicine. He should
their private practice. Other factors include a fear of examine the facts which come to his knowledge in
merciless cross-examination. harassment, and even his special capacity, draw his conclusions logically
the recall. and correctly after a detailed consideration of the
All forensic science expert witnesses must strive pros and cons of the case, and indicate to the Court
to achieve respect, understanding and credibility that interpretation, along with the grounds on which
in Court. They must give the appearance, the aura it is based. Presumption is not proof, and conjecture
of being independent, non-partisan witnesses. is not evidence. The Court has no special medical
The appearance and projected image of neutrality, knowledge. It relies on his witness for an opinion and
impartiality and objectivity are as important as expects him to assist it with his special knowledge
the authentic characteristics. A doctor should not and experience. The burden of presenting medical
become partisan. Once a theory is embraced, it is facts and medical opinions in the best possible way
only human nature to eagerly search for facts which rests on the doctor. Forensic pathologist testifies on
support that theory, and reject those which indicate so-called "fact issues", such as cause and manner
some other theory. Brouardel, the French medico of death, rather than "ultimate issue" of guilt or
legal authority wrote, "if the law has made you innocence, so that opinion based upon reasonable
(the physician) witness, remain a man of science; medical certainty is adequate to support the testimony
you have no victim to avenge, no guilty person to of the forensic pathologist. Medical evidence is not a
convict, and no innocent person to save. You must substantive evidence. but is a conoborative evidence.
bear testimony within the limits of science". The The medical evidence does not itself prove the case
attitude of a scientific witness should be the same of prosecution. Other things being equal, the better
whether he is called by the prosecution or by the the presentation of medical evidence, the better is
defence. The doctor really testifies neither for nor the administration of justice. A good command of
against the prosecution or the defence. The doctor's language. clear presentation, and ability in expressing
expertise is in the application of science to a legal a relatively firm opinion are necessary for the success
controversy and the proper interpretation of scientific of the medical witness. The presentation of findings
findings. His sole obligation is to present the truth as involves both writing skills and an ability to express
he sees it, adding nothing, withholding nothing and in the courtroom while being examined by trained
distorting nothing. He should not concern himself with lawyers. Demeanour, appearance, professional
the previous character of the accused or with other manner and general behaviour of the expert witness