FORENSIC MEDICINE & TOXICOLOGY

The broad goal of the teaching of undergraduate students in Forensic Medicine is to produce a physician who is well informed about medicolegal responsibilities in practice of medicine. He/She will also be capable of making observations and inferring conclusions by logical deductions to set enquiries on the right track in criminal matters and connected medicolegal problems. He/She acquires knowledge of law in relation to medical practice, medical negligence and respect for codes of medical ethics.

COURSE CONTENT

A – FORENSIC MEDICINE

1. FORENSIC PATHOLOGY

Definition of Forensic Medicine, State Medicine, Legal Medicine and Medical Jurisprudence.

History of Forensic Medicine.

1. Criminal procedure code, Criminal cases, Civil cases, Definition of Inquest , Different types of inquest procedures police inquest, magistrate’s inquest. Cognizable and non-cognizable offences, Different types of courts in India and their powers – Supreme court, High Court, Session Court, Magistrate’s court. Court procedures: Summons,oath, affirmation, conduct money, types of witnesses, types of examination in court. Examination in chief, Cross-examination, Re- examination, court questions, Evidence – Oral, Documentary, Medical evidence, Medical Certificate, Dying declaration, Dying deposition, Conduct of a doctor in witness box and Examination of dead body at the scene of crime.

2.  Definition of death, Types of death-Somatic/Clinical/Cellular, Molecular and Brain death including cortical death and Brainstem death, Natural and Unnatural death, Suspended animation Moment of death, Modes of death – Coma, Syncope and Asphyxia, Presumption of death and Survivorship and Sudden death.

3.  Description of signs of death. Post-mortem changes after death –cooling of dead body, postmortem lividity, rigor mortis, cadaveric spasm, heat and cold stiffening, putrefaction, mummification, adipocere formation maceration and preservation of dead bodies.

4.  Estimation of time since death on postmortem examination.

5.  Examination of mutilated bodies or fragments, bundle of bones and exhumation.

6.  Definition of postmortem examination, Different types of autopsies, aims and objectives of postmortem examination, Legal requirements to conduct postmortem examination, Procedure to conduct medicolegal postmortem examination, obscure autopsy, examination of clothing, preservation of viscera on postmortem examination for chemical analysis and other medicolegal purposes, postmortem artefacts.

7.  Definition and classification of asphyxia, medico-legal interpretation of postmortem findings in asphyxial deaths.

8.  Definition and types of hanging and strangulation. Description of clinical findings, causes of death,postmortem findings and medico-legal aspects of death due to hanging and strangulation. Examination and despatch of ligature material.

9.  Definition, pathophysiology, clinical features, postmortem findings and medicolegal aspects of traumatic asphyxia, obstruction of nose & mouth, suffocation, sexual asphyxia.

10.  Definition, types, pathophysiology, clinical features, postmortem findings and medicolegal aspects of drowning, diatom test, Gettler test.

11.  Clinical features, postmortem finding and medico-legal aspects of injuries due to physical agentsheat (heat-hyper-pyrexia, heatstroke, sunstroke, Heat exhaustion (Prostration), heat cramps (miner‘s cramp)), cold (hypothermia, Frostbite, trench foot, Immersion foot), lightening, electrocution and radiations.

12.  Clinical features, postmortem findings and medicolegal aspects of death due to starvation and neglect.

Types of injuries, clinical features, pathophysiology, postmortem findings and medicolegal aspects in cases of burns and scalds.

13.  Definition of infanticide, foeticide and stillbirth. Signs of intrauterine death, Signs of live birth, viability of foetus, age determination of foetus, demonstration of ossification centres, precipitate labour, Haase’s rule, Hydrostatic test, maceration, Sudden infants death syndrome, Munchausen’s syndrome by proxy.

2. CLINICAL FORENSIC MEDICINE

14.  Establishment of identity of living persons – Definition of Corpus Delicti, Race, sex, religion, complexion, stature, age determination using morphology, teeth-eruption, decay, bite marks, bone ossification centres, medicolegal aspects of age. Foetal age determination, Identification of criminals, unknown persons, dead bodies from the remains-hairs, fibers, teeth, anthropometry, dactylography, footprints, scars, tattoos, poroscopy and Superimposition.

15.  Definition and classification of injuries, Various types of injuries. Abrasion, bruise, laceration, stab wound, incised wound, chop wound, defence wound, self inflicted/fabricated wounds and their medicolegal aspects.

16.  Description of regional injuries to head (Scalp wounds, fracture skull, Intracranial hemorrhages,Coup and contrecoup injuries), Neck, Chest, Abdomen, Limbs, Genital organs, Spinal cord and skeleton, Vehicular injuries – Primary and Secondary impact, Secondary injuries, crush syndrome, railway spine, reconstruction of scene of crime.

17.  Definition of Injuries, Assult and Hurt. IPC pertaining to injuries. Accidental,Suicidal and Homicidal Injuries. Types of Injuries – Simple ,Grievous and Dangerous. Different types of weapons, Dangerous weapons and their examination. Antemortem and Potmortem Inuries, Medico-legal aspects of injuries.

Factors influencing, Infliction of Injuries and Healing, Different legal questions, examination and certification of wounds, Wound as a cause of death: Primary and Secondary. Dowry death. Workman’s Compensation Act.

18.  Firearm injuries. Classification of fire-arms. Structure and components of various firearms,description of ammunition propellant charge and mechanism of fire-arms, Various terminology in relation of firearm – calibre, range,choking. Description of different types of cartridges and bullets.

19.  Description of wound ballistic, blast injuries and their interpretation. Preservation and despath of trace evidences in cases of firearm and blast injuries. Various test related to confirmation of use of firearms.

20.  Definition and types of sexual offences, Definition of rape. Section 376 IPC, Examination of the victim of an alleged case of rape, Examination of the accused of an alleged case of rape, preparation of report and framing the opinion in rape cases, preservation and despatch of trace evidences in cases of rape. Adultery, Unnatural Sexual offences Sodomy, Examination of accused and victim, preparation of report and framing of opinion, preservation and despath of trace evidences in cases of sodomy, incest, lesbianism, buccal coitus, bestiality, indecent assault. Sexual perversions. Fetichism, transvestism, voyeurism, sadism necrophagia, masochism, exhibitionism, frotteurism, necrophillia.

21.  Definitions of Impotence, Sterility, Frigidity, Sexual Dysfunction, Premature Ejaculation, Causes of Impotence and sterility in male and female, Sterilization, Artificial Insemination, Surrogate mother, Delhi Artificial Insemination act 1995.

22.  Definition of Virginity and defloration, anatomy of male and female genitalia, Hymen and its types, Medicolegal importance of hymen, Medicolegal importance of pregnancy, diagnosis of pregnancy, Superfoetation, superfecundation, Definition of Legitimacy and its medicolegal importance, Diputed paternity and maternity, Medicolegal aspects of delievery, Signs of delievery, Signs of recent and remote delievery in living and dead.

23.  Definition, Classification and complication of abortion, MTP act 1971, Methods of procuring criminal
abortion, Evidences of abortion-Living and Dead,Duties of doctor in cases of abortion.
24. Battered baby syndrome.

3. MEDICAL JURISPRUDENCE

25.  Medical council of India, state medical councils- Their functions and disciplinary control. Laws in relation to medical practice, duties of medical practitioner towards the patients and society. Indian Medical Register, rights priviliges of medical practitioner, penal erasure, infamous conduct, disciplinary committee, warning notice & euthanasia.

26.  Code of medical ethics, unethical practices, dichotomy, consumer protection act , Prenatal diagnostic techniques act, Human organ transplantation act, ESI act, medicolegal issues in relation to family violence, Violation of human rights, NHRC and doctors, Doctors and media, ethics related to HIV patients.

27.  Malpractice- Civil, Criminal and ethical

28.  Consent, kinds of consent, informed consent, negligence, vicarious liability, the doctrine of res Ipsa Loquitor, Contributory Negligence, Therapeutic Privilige, Rules of Consent, Malingering, Therapeutic Misadventure, corporate negligence, Professional negligence, Professional Secrecy, Human Experimentation, IPC related to medical Practice, Products liability, Medical Indemnity Insurance, Medical records.

4. FORENSIC PSYCHIATRY

29.  Definition, Various types of mental disorder, Lucid interval, Classification of mental disorder, mental subnormality, Diagnosis of Insanity and Feigned insanity, Restraint, admission and discharge of Insane in accordance to Mental Health act 1994, Mental disorder and responsibility-Civil and Criminal responsibility, Testamentary Capacity, Mc Naughten‘s rule.

5.  FORENSIC SCIENCES

1. Definition of DNA fingerprinting, Techniques of DNA Fingerprinting, Application of DNA profiling in forensic Medicine, HLA typing.

2. Locard’s exchange principle, Examination, preservation, despatch and identification of blood, Seminal stains (Physical,microscopic, chemical and serological test, blood grouping) and its medicolegal aspects, Saliva, vaginal fluid, faecal and urinary stain, examination of skin, nail tooth pulp and other body fluids group specific substances, hazards of blood transfusion.

B. TOXICOLOGY

1. GENERAL TOXICOLOGY

History of Toxicology, Definition of Toxicology, Forensic Toxicology, Clinical toxicology and Poison, Laws in relation to poisons, Medicolegal aspects of poisons, Classification of poisons, Toxicokinetics and Toxicodynamics, diagnosis of poisoning in living and dead, General principles of management of poisoning, Antidotes and its types, Medicolegal autopsy in cases of poisoning, preservation and despatch of viscera for chemical analysis.

2. CLINICAL TOXICOLOGY

Types of poison, Clinical signs and Symptoms, diagnosis, management and medicolegal aspects of :

1.  Corrosive poisons – sulphuric acid, phenol ,oxalic acid, nitric acid, hydrochloric acid, organic acids and alkalies.

2.  Irritant non metallic poisons- Phosphorus, Halogens, Organophosphorus, chlorinated hydrocarbons, miscellaneous preparation & mechanical irritatants.

3.  Agricultural poisons- Organophosphorous, Organochlorine. Classification and description of common insecticides and pesticides used in India

4.  Metallic poison – arsenic, lead, iron, copper, zinc, thallium.

5.  Animal poisons – snake bite, scorpion bite , wasp, bee, cantherides & toxic fishes.

6.  Somniferous poisons – opium & its derivatives, synthetic preparations, pethidine & codeine.

7.  Deliriant poisons – Dhatura , hemlock, cannabis, LSD, muscaline & cocaine .

8.  Spinal & peripheral nerve poisons – strychnine, curare & domestic poisons – kerosene, cleansing agents, disinfectants, household medicines.

9.  Barbiturate poisoning, drug abuse & common drug overdoses.

10.  Vegetable poisons – abrus, ricinus, croton, ergot, capsicum, camphor, argemone, lathyrus & calotropis.

11.  Describe and examine Alcohol poisoning (ethyl & methyl alcohol) and drunkenness, its medicolegal aspects & benzodiazepine poisoning.

12.  Cardiac poisons – HCN, aconite, tobacco, quinine, digitalis and oleander.

13.  Asphyxiant poisons – carbon monoxide, , carbon dioxide, hydrogen sulphide, phosgene and phosphine.

14.  Definition of food adulteration. Names of common adulterants and general methods of detection for food adulterants, Common food poisonings- Botulism, Chemical Poisoning, Poisonous Mushrooms and epidemic dropsy.

3. ENVIRONMENTAL TOXICOLOGY

15.  Description of toxic pollution of environment, its medico-legal aspects & toxic hazards of occupation and industry.

16.  Description and medico-legal aspects of poisoning in Workman’s Compensation Act.

4. ANALYTICAL TOXICOLOGY

17.  General principles of analytical toxicology and its application in management , prevention and control of poisoning.

18.  Basic principles of functioning of Gas Liquid Chromatography, Thin Layer Chromatography, Atomic Absorption Spectrophotometer, Spectrophotometer, Neutron Activation Analysis, Mass spectrometry, alcometer.

PRACTICALS IN FORENSIC MEDICINE & TOXICOLOGY

1.  Preparation of a Medico-legal report of an injured person due to mechanical violence.

2.  Preservation and despatch of the exhibits in a suspected case of poisoning.

3.  Estimation age of a person for medico-legal and other purposes.

4.  Conduct & prepare postmortem examination report in a case of suspected poisoning and to preserve & dispatch viscera for chemical analysis.

5.  Conduct & prepare postmortem report in a case of death due to violence of any nature – road accident, fall from height, assault, factory accident, electrocution, burns & accident due to any other cause, firearm injury, asphyxia, natural death & medical negligence. At least 10 postmortem reports should have been written by the student.

6.  Demonstration, interpretation and medico-legal aspects from examination of hair (human &animal)fibre, semen & other biological fluids.

7.  Demonstration & identification of a particular stain is a blood and identification of its species origin.

8.  Identification ABO & RH blood groups of a person.

9.  Examination & drawing opinion from examination of skeletal remains.

10.  Identification & drawing medico-legal inference from various specimen of injuries e.g. contusion,abrasion, laceration, firearm wounds, burns, head injury and fracture of a bone .

11.  Identification & description of weapons of of medicolegal importance commonly used e.g. lathi, knife, kripan, axe, gandasa, gupti, farsha, dagger, bhalla, razor & stick

12.  Description of the contents and structure of bullet & cartridges used & medico-legal interpretation drawn.

13.  Estimation of age of foetus by postmortem examination.

14.  Examination & preparation of report of an alleged accused in a rape/unnatural sexual offence.

15.  Examination & preparation medico-legal report of a victim of sexual offence/unnatural sexual offence.

1. Examination and preparation of medico-legal report of a drunk person.

17.  Demonstration of the common instrument used in analysis of poision & DNA profile – TLC,GLC,AAS.

18.  Identification & drawing of medico-legal inference from common poisons e.g. Dhatura, castor, cannabis, opium, aconite copper sulphate, pesticides compounds, marking nut, oleander, Nux vomica, abrus seeds, snakes, capsium, calotropis, lead compounds & tobacco.

19.  Examination & preparation of a medico-legal report of a person brought for medical examination in cases pertaining to police, judicial custody or referred by court of law and violation of human rights as requirement of NHRC.

20.  Identification & drawing of medico-legal inference from histopthological slides of Myocardial infarction pneumonitis, tuberculosis, brain infarct, liver cirrhosis, brain hemorrhage, bone fracture, pulmonary odema, brain odema, soot particles, diatoms & wound healing.

METHODOLOGY OF TEACHING

1.  Lectures/Demonstration
2.  Tutorials/Seminars

SUGGESTED TEXTBOOKS

1.  Dr.K.S.N.Reddy- The essential of Forensic Medicine & Toxicology 21st Edition 2002. Published by K.Saguna Devi, H,No. 16-11-15/2/2, Saleem nagar Colony, No.1, malapet, Hyderabad-500036.

2.  Modi‘s Textbook of Medical Jurisprudence and toxicology- Edited by BV Subramanyam, Butterworths India, New Delhi.22nd edition, 2001.

3.  Dr. C.K.Parikh- A text book of Medical Jurisprundence, Forensic Medicine & Toxicology, CBS Publishers, Delhi, Sixth Edition 1999.

4.  Dr. Apurba Nandy- Principles of Forensic Medicine, 3rd Edition 2000, New Central Book Agency (P) ltd. Calcutta.

5.  Dr. Krishan Vij- Text book of Forensic Medicine & Toxicology- Principles and Practice, BI Churchill Livingston, New Delhi, 2nd edition, 2002.