Medical Jurisprudence; Important Questions

 

  • Define Poison?  Classification of Poison. Classification on the basis of their mode of action. How is poisoning diagnosed? What are the symptoms of Opium poisoning and what is its cure? What are the duties of Medical officer in case of suspected poisoning?

    Poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism. Any substance dangerous to living organisms that if applied internally or externally, destroy the action of vital functions or prevent the continuance of life.
    Those substances which, when applied to the organs of the body, are capable of altering or destroying, in a majority of cases, some or all of the functions necessary to life, are called poisons.As per law, any substance, irrespective of its quality or quantity, when given with an intention to endanger, injure, or kill a person is called apoison.As per Section 284 of IPC – Negligent conduct with respect to poisonous substance
    whoever does, with any poisonous substance, any act in a manner so rash or negligent as to endanger human life, or to be likely to cause hurt or injury to any person, or knowingly or negligently omits to take such order with any poisonous substance in his possession as is sufficient to guard against any probable danger to human life from such poisonous substance, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine which may extend to one thousand rupees, or with both.Classification – on the basis or their mode of action –
  1. Corrosives
    1. Acids
      1. Inorganic: HCL, HNO3, H2SO4 (Oil of vitriol)
      2. Organic: Oxalic Acid, Phenol
    2. Alkalies– NaOH, Ca(OH)2, KOH
    3. Metallic Salts:Zinc Chloride, Ferrus Chloride, Chromates and Bichromates of alkalis
  2. Irritants
    1. Inorganic
      1. Non metallic – Phosphorus, chlorine, bromine, iodine
      2. Metallic – Arsenic, Lead, antimony, bismuth, zinc, silver, mercury, copper
    2. Organic
      1. Vegetable – Castor oil seed, croton oil, madar, and aloes,
      2. Animal – Cantherides, snakes, and insect bites
    3. Mechanical– Diamond dust, powdered glass, and hair
  3. Systemic
    1. Affecting the nervous system i.e. Neurotics
      1. Affecting the brain
        1. Somniferous: Reduce pain and induce sleep : Opium and its alkaloids barbiturate
        2. Inebriant: They intoxicate and induce symptoms of excitement as well as narcosis: Alchohol, ether, chloroform
        3. Deliriant: Cerebral poisons which cause delirium i.e. imaginary talks, images, feelings etc.: Dhatura, belladonna, hysosymous, cannabis indica
      2. Affecting the spinal cord: Nux vomica, gelsemium
      3. Affecting the perepheral nerves: Curare and conium
    2. Affecting the cardio vascular system – Aconite, digialis, oleander, tobacco, and hydrocyanic acid
    3. Affecting the respiratory system – aka Asphyxiants : cause respiratory failure: Poisonous irrespirable gases such as Carbon monoxide, phosphine

Diagnosis of poisoning – 

  1. In the living –
    1. If the onset of symptoms is sudden –  usually after a meal, drink, or a dose of medicine. The patient’s habits, working conditions, daily activities must be analysed.
    2. Sometimes symptoms are uniform in character and rapidly increase in severity followed by death or early recovery. Onepoison may be neutralized by other or increase the potency of other. For example, barbiturate with alcohol.
    3. Persons taking same food displaying same symptoms.
    4. Detection ofpoison in the food, medicine, vomit, urine, or stool.
  2. In the dead –
    1. Post mortem appearance
      1. External Examination – odour, stain, skin condition
      2. Internal Examination –  Hyperaemea (redness of mucus), softning, ulceration, perforation
    2. Chemical analysis – Urine, blood, stains, viscera
    3. Moral and circumstantial evidence

General Treatment of poisoning:

  1. Removal of unabsorbedpoison – cleaning, suction, stomach wash
  2. Antidote for neutralizing absorbedpoison – activated charcoal, chelates
  3. Removal of absorbedpoison and its intermediary substances – catharsis, enema
  4. Symptomatic relief

Symptoms of Opium Poisoning – 

The effect of opium upon the respiration is very important, and therein lies its danger as a lethal agent. In very small doses it is said to stimulate respiration, but large doses powerfully depress breathing, and in fatal opium poisoning death is usually due to asphyxia through centric respiratory paralysis. In a very short time, under a poisonous dose, drowsiness comes on, soon followed by profound stupor. The patient becomes apparently quite senseless, and lies without other observable motion than that of respiration, which is very slow, and not unfrequently stertorous. A dark suffusion of the countenance comes on, with an utter want of expression. When a toxic dose of morphine or opium has been taken there occur symptoms which may be grouped under three stages:

  1. The first, or stage of excitation, may be absent; or if present, be of very short duration.
  2. In the second stage, depression speedily comes on with a full and slow pulse, suspension of the cerebral functions, overpowering drowsiness followed by a deep sleep with slow and stertorous breathing, suffused, flushed or cyanotic countenance, strongly contracted pupils, warm dry skin, and muscular prostration. The patient may be aroused by shaking, flagellation, or loud shouting, but as soon as undisturbed sinks again into a deep slumber. If he is not kept awake and breathing stimulated, he passes almost imperceptibly into the final or lethal stage.
  3. In the third or lethal stage coma is absolutely complete. The face, at first turgid or livid, becomes pale and the lips livid, the extremities are cold, the pupils minutely contracted (pin-point myosis), the dry skin gives way to the sweat of death, the breathing becomes progressively slower and slower, shallow and labored, until it finally ends in a soft or almost imperceptible respiration. Death then takes place from respiratory paralysis or asphyxia, though the heart stops almost immediately after breathing ceases.

Opium diminishes all the secretions except that of the sweat. Normal diaphoresis remains unabated or is increased. Opium causes retention, rather than suppression, of the urine, though the secretion of the urine is thought to be somewhat inhibited by the drug. Opium very pronouncedly checks the secretions of the intestines and arrests peristalsis, chiefly by stimulation of the splanchnic inhibitory nervous apparatus. The result is constipation. On the other hand toxic doses may paralyze the inhibition and thus stimulate peristalsis.

Opium moderately elevates temperature unless the dose be toxic. In that event the body-heat is reduced. Opium limits tissue-waste by decreasing the output of urea and other nitrogenous detritus.

Treatment of Opium Poisoning

The treatment of acute opium poisoning must be prompt and unremitting.  There is no antidote to opium which can be relied on. Naloxone is a drug used to counter the effects of opioid overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory system. The important indications are to evacuate the stomach, and to support the system in the state of prostration which follows the direct influence of the poison.

  1. Owing to the fact that the vomiting centers and the peripheral nerves of the stomach are depressed by toxic doses of opium, emetics do not act well. They should be tried, however, as well as other means of inducing vomiting, as tickling the throat, etc., but should not be relied upon.
  2. Washing out the stomach by lavage is to be preferred, and should be repeated at short intervals because morphine is readily eliminated from the blood-current into the stomach, and continuation of the poisoning may be maintained through its reabsorption. In the meantime a solution of potassium permanganate (3 to 5 grains in a half pint of water) should be given to destroy the morphine.
  3. Strong black coffee administered freely by mouth and by rectum.
  4. The all-important necessity is to keep the patient breathing, as depression of respiration is the most dangerous feature of opium poisoning. For this purpose strychnine sulphate (1/30 to 1/10 grain) preferably, or atropine or cocaine is to be used. Ammonia or alcohol may be needed to support both the heart and respiration. While death probably does not take place because of the deep sleep or narcosis, it is absolutely necessary to keep the patient awake in order to have his co-operation and voluntary effort to keep up breathing, and thus fight the depression of the respiratory centers. The patient should be walked between two attendants constantly, and flagellated with hot and cold wet towels, or switches, artificial respiration performed or the faradic current applied to the skin.
  5. To prevent reabsorption of the drug from the urine, catherization should be resorted to several times.

Duties of Medical Officer in case of suspected posioning

(Duties can be classified into legal and medical)

  1. Medical practitioner must be very cautious in giving his opinion about poisoning.
  2. Never give verbal or written opinion on mere suspicion.
  3. Maintain proper record of his findings and the treatment administered.
  4. In case of acute poisoning, he must try to find out the nature of the suspectedpoison so that he can administer appropriate treatment.
  5. In case of slow poisoning, he should make notes of the symptoms exhibited.
  6. Collect the vomitted matter and 24 hrs urine and get them analysed forpoison.
  7. Call another collegue for consultation and the patient be removed to a hospital, where the doctor in charge should be informed about the suspicion.
  8. If the patient cannot be removed to the hospital, two trained nurses must be employed to take charge of the patient.
  9. Nust preserve all the evidence such as vomit, stomuch wash and samples of urine and faeces in clean glass jars, with appropriate labels, in strict lock and key.
  10. Must preserve any other evidence such as cup or spoon which has been used in taking thepoison. Failing to do this might render the MP liable under S. 201 of IPC for making the evidence disappear.
  11. If an MP in private practice is suspicious that the case is of homicidal poisoning, he is bound by 39 of CrPC to inform this to the police or a magistrate. Non compliance is punishable under S. 176 of IPC. This rule does not apply if the MP suspects the case to be of suicidal poisoning. However, he is bound to divulge all the information if summoned under S. 175 of CrPC. If he conceals any information or gives false information, he will be liable under S. 193 and 202 of IPC.To avoid these difficulties, it is suggested that all cases of poisoning be treated as homicidal poisoning and the question of suicide be decided by the police.
  12. A MO of a Govt. hospital is required to report to the police all cases of poisoning whether accidental, suicidal, or homicidal.
  13. If the poisoning proves fatal, the doctor must never grant a death certificate but must report the facts of death to the nearest police officer.

  • What are the objectives of Autopsy? Explain the rules that govern a medico legal post mortem examination. What facts should be incorporated in Post Mortem Report. How does post mortem help in crime detection? What is Post Mortem staining in detail. How does it help in crime detection?

What is Viscera?

Autopsy
The word autopsy is from Ancient Greek with αυτος (autos) meaning to do something to oneself and όψις (opsis) meaning eye hence autopsy means ‘to see for oneself’. It is used specifically for the post-mortem examination of a human corpse. It is also known as a post-mortem examination, necropsy (particularly as to animals), autopsia cadaverum, or obduction and is a medical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist.

Kinds of Autopsy
Autopsies are either performed for legal or medical purposes. For example a forensic autopsy is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and internal examination is conducted. Once an internal autopsy is complete the body is reconstituted by sewing it back together. Consent of relative is required in case of academic autopsy but is not required in legal autopsy, which is ordered by the magistrate or other appropriate legal authority. In case of legal autopsy, all three – cranial, thoratic, and abdominal cavities are opened, while in case of academic one, it may be limited to an area of interest.

Techniques of Autopsy

  1. Virchow – organs are removed one by one.
  2. Tokitanski – a combination of in situ dissection with en bloc removal
  3. Ghon – Thoratic and cervical organs , abdominal organs, and urogenital organs are removed separately as organ blocks.
  4. Letulle – All organs are removed en masse and subsequently disected into organ blocks.

Objective of an autopsy is to determine the following information –

  1. Establish the identity of the body if unknown.
  2. Ascertain the time of death.
  3. Ascertain the cause of death.
  4. Whether the death was natural or unnatural.
  5. If death was unnatural, whether it was homicidal, suicidal, or accidental.
  6. In case of new born infants, determine whether it was a live birth and its viability.
  7. The manner of death such as kind injury, wound, or impact.
  8. Whether there was any psychological disturbance or derangement resulting in cause of death such as asphyxia, coma, or syncope.

Rules governing medico-legal Autopsy

  1. Must never be undertaken unless there is a written order from a police officer or the district magistrate. A letter from the IO asking the medical officer to carry out the ML autopsy and authorizing him to collect any material from the body for furtherinvestigations, if necessary,  is required
  2. Before commencing, the MO should carefully read the police report on the appearance and situation of the body when it was first found and the cause of death as ascertained. A copy of the “Panchanama” carried out by the IO
    at the site of death. This document pictures the scene of death for the prosector.
  3. Dead Body Challan:Is a set of questions to be answered by the investigating officer pertaining to the death under investigation. This document provides background information to the prosector A police constable accompanies the dead body along
    with these documents.
  4. It should be as complete and through as is possible. Incomplete or partial post mortem is not acceptable. All three cavities must be analysed.
  5. In exceptional situations the MO may be taken to visit the scene of death where the dead body may be lying. In this case, he should note the place and nature of the soil where the body is placed, its position, and state of its clothes. The ground where the body is lying should be carefully searched for any footprints or other evidence such as fibre or dust.
  6. Protect different parts of the body in plastic bags or pads to prevent loss of contact tracer.
  7. The MO must establish the identity and record the means of identification.
  8. All details of post mortem observed by the MO should be entered by him on the spot in the post mortem report, which can be used in a legal inquiry. Nothing should be erased and all alterations must be initialized.

Facts to be incorporated in Autopsy report
All the facts must be entered in appropriate format prescribed by law for the purpose.

On the body of:                                                                Place:            Date:            Time:
Body identified by police constable:                            Probable time since death:
Probable age:         Height

External Examination

  1. Condition of the body – muscularity, rigor mortis, livor mortis, emaciation, and putrefaction.
  2. Marks of identification
  3. Eyes
  4. State of natural orifices
  5. External injury marks
  6. State of limbs – contents of hand if clenched.
  7. Genitalia, breasts
  8. Additional remarks

Internal Examination

  1. Head and Neck
    1. Scalp, skull
    2. Vertbrae
    3. Membranes
    4. Brain, base of skull
    5. Spinal cord
    6. neck structures
    7. Additional Remarks
  2. Thorax
    1. Walls, ribs, cartilages
    2. Pericardium
    3. Pleurae, diaphragm
    4. Heart with weights, cavities and valves coronary
    5. Larynx, trachea and bronchi
    6. Lungs with weights
    7. Addititional Remarks
  3. Abdomen
    1. Walls
    2. Liver and gall bladder
    3. Peritoneum
    4. Pancreas
    5. Spleen
    6. Kidneys and Bladdar
    7. Esophagus
    8. Stomach and its contents
    9. Small and large intestine and their contents
    10. Additional Remarks

Viscera and other samples/materials collected from the body.

Opinion as to the cause and manner of death.

Place :
Date:                        Medical Officer:

The National Human Rights Commission has recommended video recording of the autopsy in case of custodial death. Circular directing the police to do this recording have been issued by many states such as Gujarat and TN.

In case of Dayaram vs State 1986, it was observed that a post mortem report is undoubtedly a very important document, which not only aids the medical officer in determining the nature of the injuries during their evidence at the trial but also heps the court in appreciating the evidence in the case.

In Gofur Sheikh vs State 1984, it was held that where the MO who conducted the autopsy is not examined in court nor the PM report has been tendered in evidence, the same cannot be used as substantive evidence.

In Sharad vs State of Mah 1984, serious interpolations were found in the PM report. The entries in the PM report filed in court and in the copy of PM report sent to the chemical examiner were different. The SC invalidated the PM report and also debarred the medical officer from performing the PM in future.

Post Mortem Staining (aka Livor Mortis) –
Livor mortis or postmortem lividity or hypostasis (Latin: livor—bluish color, mortis—of death), one of the signs of death, is a settling of the blood in the lower (dependent) portion of the body, causing a purplish red discoloration of the skin: when the heart is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity. This discoloration does not occur in the areas of the body that are in contact with the ground or another object, as the capillaries are compressed.

Coroners can use the presence or absence of livor mortis as a means of determining an approximate time of death.  It can also be used by forensic investigators to determine whether or not a body has been moved (for instance, if the body is found lying face down but the pooling is present on the deceased’s back, investigators can determine that the body was originally positioned face up).

Livor mortis starts 20 minutes to 3 hours after death and is congealed in the capillaries in 4 to 5 hours. Maximum lividity occurs within 6-12 hours. The blood pools into the interstitial tissues of the body.

How does autopsy help in crime detection

Fatta

Viscera

Viscera are the internal organs of the body, specifically those within the chest (as the heart or lungs) or abdomen (as the liver, pancreas or intestines).  The singular of “viscera” is “viscus” meaning in Latin “an organ of the body.”

The following procesure is usually adopted to collect viscera for medicolegal purposes:

  1. The viscera are preserved in wide mouthed glass bottles of 1 to 1.5 ltr capacity having a screw cap lid. Containers made up of synthetic material like polyurethane,plastic etc are not to be used as the material is likely to react with the viscera preserved and alter their chemical composition. Saturated salt solution is the common preservative used to prevent putrefaction except in cases of corrosive mineral acid (H2SO4, HCl,HNO3) poisonings. Rectified spirit (not denatured spirit) is ideal preservative which can be used in all cases, except ethyl/methyl alcohol poisoning. Sodium fluoride is used as preservative for blood along with potassium oxalate as anticoagulant. 30 mg of potassium oxalate and 10 mg of sodium fluoride are required for 10 ml blood.
  2. For viscera the preservative solution is added in equal volume. As a rule 1/3 volume of the container is to be occupied by viscera, 1/3 by the preservative and 1/3 to be empty as room for any gases evolving. This also prevents spillage of the contents during transportation and thus avoids spoiling of the label on the bottle. The viscera should be fully immersed in the preservative. Large pieces should be partly sliced to ensure entry of the preservative to the inner portions.
  3. Usually, whole of stomach, after having opened (along the greater curvature) and examined, and its contents; 6”- 8” (one loop) of small intestine tied at both ends with contents inside, are put into one bottle. This represents the unabsorbed, still in the gut, portion of the poison.
  4. 500 gm of liver along with intact gall bladder, one half of each kidney, de-capsulated, and half of spleen are put into the second bottle. This represents the absorbed portion of poison. 50 ml of blood is preserved in a third small mouthed screw capped bottle. A small penicillin vial containing control sample of preservative used is also to be sent along with.
  5. These bottles, sealed with a legible specific seal of the prosector and labeled legibly, are handed over to the authorised police constable, packed in the wooden viscera box. The receipt obtained from the constable to that effect is to be preserved as proof of chain of custody of evidence.

  • Explain and classify Insanity. Describe the medico legal aspects of Insanity. What are the main causes of Insanity. Differentiate between true and feigned insanity?

    In English, the word “sane” derives from the Latin adjective sanus meaning healthy. Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity. In modern usage insanity is most commonly encountered as an informal unscientific term denoting mental instability, or in the narrow legal context of the insanity defense. In the medical profession the term is now avoided in favor of diagnoses of specific mental illness such as schizophrenia and other psychotic disorders.When discussing mental illness in general terms, “psychopathology” is considered a preferred descriptor.Indian Lunacy Act 1912 defined lunatic as an idiot or a person of unsound mind.Mental Patients are governed by Mental Health Act, 1987.Classification
  1. Medical– Medical jurists such as Esquirol have classified insanity under four distinct forms:
    1. Mania– This is general derangement of the mental faculties, accompanied by greater or less excitement, sometimes amounting to violent fury. The individual is subject to hallucinations and illusions.
    2. Monomania– Here, the mental alienation is partial. The delusion is said to be confined either to one subject or to one class of subjects. It  monomania varies much in degree. Many persons affected with it are able to direct their minds with reason and propriety to the performance of their social duties, so long as these do not involve any of the subjects of their delusions.
    3. Dementia– In this state there is a total absence of all reasoning power. The mental faculties are not perverted, but destroyed. There is a lack of memory as well as of consciousness, on the part of the individual, of what he does or says. It is a frequent consequence of mania or monomania. It has been known to occur suddenly in individuals, as an effect of a strong moral shock.
    4. Idiocy(Amentia) – In this state, the lack of mental power is due to a congenital defect i.e. birth defect. Legally, mania, monomania, and dementia, are classified as “dementia accidentalis” and idiocy is classified as  “dementia naturalis”. This intellectual deficiency is marked by a peculiar physiognomy, an absence of all expression, and a vague and unmeaning look, whereby an idiot may in general be clearly identified. In many cases of congenital deficiency, the mind is capable of receiving a few ideas, and of profiting to a certain extent by instruction.WHO has recommended in the “International Classification of Diseases”, the following classification of psychiatric disorders –
    5. Organic mental disorders – dementia, Alzheimer’s disease, amnesic syndrome, behavioral disorders due to brain disease, damage, or dysfunction/
    6. Mental and behavioral disorders due to psychotropic substance use
    7. Schizophrenia
    8. Mood Disorders – depressive disorders
    9. Neurotic Stress related and somatoform disorders
    10. Behavioral syndromes associated with physiological disturbances and physical factors – eating disorders, non-organic sleep disorders, sexual dysfunction
    11. Personality disorders – specific personality disorders, gender identity disorder
    12. Mental Retardation
  2. Legal – Generally, two states of mental disorder or alienation are recognized legally –  1.Dementia naluralis, which corresponds to idiocy and 2. Dementia accidentalis, which means  general insanity in people who have once had reasoning power but are insane now due to some accidental cause.

    A third term lunacy is also used by lawyers generally for to all the disordered states of mind which have specific medical terms such as maniamonomania and dementia; and which may even be accompanied by lucid intervals.

    The main character of insanity, in a legal view, is said to be the existence of delusion; i. e., that a person should believe something to exist which does not exist, and that he should act upon this belief. Many persons may labor under harmless delusions, and still be fitted for their social duties; but should these delusions be such as to lead them to injure themselves or others in person or property, then the case is considered to require legal interference.Unsoundness of mind – Besides the terms Idiocy and Lunacy, another term is frequently employed in legal proceedings, namely, ” unsound mind”  i.e. non compos mentis, for which there is no consistent legal definition. The test for unsoundness of mind in law does not just depend on the existence of delusion, but on proof of incapacity in the person, from some morbid condition of intellect, to manage his own affairs. Thus, there are two necessary conditions – morbid condition of intellect and incapacity to manage his own affairs. Neither condition will suffice to establish unsoundness without the other for the intellect may be in a morbid state, and yet there may be no legal incompetency, or the incompetency alone may exist because of bodily infirmity or want of education, which is obviously not insanity. It can be said that an insane person is lacks the controlling power of the will.

Causes of Mental Ill health

  1. Heredity
  2. Environmental Factors – parental attitudes
  3. Psychogenic causes – problems occurring due to reconciliation of natural desires with societal norms. When such reconciliation between conflicting desires becomes painful, patient may resort to various mental mechanisms to build defenses around it, which may then produce various types of mental symptoms
  4. Precipitating causes –  emotional or physical trauma
  5. Organic causes – diseases

Consequences of Insanity –

  1. Civil Responsibility
    1. Property– Chapter VI of Mental Health Act 1987 provides for the legal proceedings to be followed in cases concerning the protection and property of a mentally ill person. In general, a court may appoint a manager to manage the person’s property.
    2. Contract–  Under S 11 of Indian Contract Act 1872, only persons of sound mind are eligible to enter into agreements or contract. As per S 12, a contract is invalid if one of the parties at the time of making the contract was by reason of insanity incapable of understanding it and forming a rations judgment as to its effect upon his interests.
      Court may order dissolution of the partnership of a firm if one of the partners is found to be mentally ill person.
      CPC Order 32 enacts special provisions regarding suits by and against a person of unsound mind. Ram Chandra vs Ram Singh AIR 1968 – SC held that a decree passed against a minor or a lunatic without appointment of a guardian is a nullity and is void and not merely voidable.
    3. Marriage– The HMA 1955 if a party is incapable of giving a valid consent to a marriage in consequence of unsoundness of mind, or if capable of consent but has been suffering from mental disorder of such a kind as to be unfit for marriage and procreation, or has been subject to recurrent attacks of insanity, then the marriage is voidable.
    4. Testamentary Capacity– Making a Will requires an understanding of the nature of the Will, a knowledge of the property to be disposed off, and an ability to recognize those who may have moral claims of the testator’s bounty. A court may invalidate a Will if it is proved that the testator, at the time of making the Will, was of unsound mind.
  2. Criminal Liability– Law presumes every individual of the age of discretion to be sane.
    McNaughten Rules – In this case, Danial M’Naghten was tried for the murder of a private secretary of the then prime minister of England. He was acquitted on the ground of insanity. This caused a lot of uproar and the case was sent to bench of fifteen judges who were called upon to lay down the law regarding criminal responsibility in case of lunacy. Some questions were posed to the judges which they had to answer. These questions and answers are knows as M’Naghten’s Rules which form the basis of the modern law on insanity. The following principals were evolved in this case –

    1. Regardless of the fact that the accused was under insane delusion, he is punishable according to the nature of the crime if, at the time of the act, he knew that he was acting contrary to law.
    2. Every man must be presumed to be sane until contrary is proven. That is, to establish defence on the ground of insanity, it must be clearly proven that the person suffered from a condition due to which he was not able to understand the nature of the act or did not know what he was doing was wrong.
    3. If the accused was conscious that the act was one that he ought not to do and if that act was contrary to law, he was punishable.
    4. If the accused suffers with partial delusion, he must be considered in the same situation as to the responsibility, as if the facts with respect to which the delusion exists were real. For example, if the accused, under delusion that a person is about to kill him and attacks and kills the person in self defence, he will be exempted from punishment. But if the accused, under delusion that a person has attacked his reputation, and kills the person due to revenge, he will be punishable.
    5. A medical witness who has not seen the accused previous to the trial should not be asked his opinion whether on evidence he thinks that the accused was insane.

The Indian Law recognizes the first two principals and incorporates them in section 84 of IPC, which says that nothing is an offence which is done by a person who, at the time of doing it is by reason of unsoundness of mind, incapable of the nature of the act or that he is doing what is either wrong or contrary to law.

In criminal cases, the MO must consider

  1. personal history of the the defendant
  2. the absence of motive
  3. the absence of secracy
  4. Multiple murders
  5. Want of preparedness or pre arrangement
  6. Absense of accomplices
  1. Tortious Liability –Even in England, there is little authority to show whether a person of unsound mind is liable for tort committed by him. The question here is whether the defendant knows the nature and quality of his act. If he is capable of knowing that his act was wrong, then he is liable in tort.
    The opinion of Salmon is as follows –
    Lunacy is not in itself any ground for exemption, but that, like infancy, it operates (if at all) only an evidence that the mental state requisite to create liability is no present. In applying this rule, the following species of wrong must be distinguished –

    1. In wrongs based of malice or on some specific intent like malicious prosecution, malicious libel, or a privileged occasion, or deceit, lunacy may be a good defense because there is no ill intention.
    2. In wrongs of voluntary interference with the person, property, reputation or other rights of other persons, such as trespass, assault, conversion, or defamation, it is no defense that the defendant was under an insane delusion as to the existence of sufficient legal justification. For in such cases, mistake, however inevitable, is no defense and it can make no difference that mistake is due to unsoundness of mind.
    3. In wrongs of absolute liability, there is no reason why lunacy should be any defense at all.
    4. In wrongs dependent on negligence, the conduct of the defendant must be judged by reference to his knowledge or means of knowledge. Lunacy, therefore, may be relevant as evidence that the necessary knowledge or means of knowledge did not exist.InWilliams vs Hays, the defendant, a co-owner of a ship was held liable to his co-owners for negligent wrecking of the ship owing to his insanity. It was held that an insane person is just as responsible in tort as a sane person except where malice and hence intention, actual or implied, is necessary.In the words of Justice Esher MR, “a lunatic is liable unless the disease of his mind is so great that he cannot understand the nature and the consequences of his act.” But the onus lies on the defendant to prove that his disease is so great.Drunkenness is no defense in tort or in crime because it is presumed that a man knows that if he gets drunk he is likely to commit acts likely to result in injuries to others.

Feigned Insanity
Feigned insanity is the simulation of mental illness in order to avoid or lessen the consequences of a confrontation or conviction for an alleged crime. Malingering is the  medical term for feigned insanity that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of “secondary gain” motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy.

Feigned Insanity True Insanity
Comes on suddenly Rarely develops all of a sudden
Usually has a motive Usually has no specific motive
Individual tries to pass of as mentally ill by putting forward incoherent maniacal symptoms, especially when he knows he is under observation. There is total remission of all symptoms when he thinks he is not being observed.  
Symptoms are not uniform. Patient usually mixes up symptoms of two distinct types of mental illness.  
Violent exertions occasioned by imitating maniacal frenzy will bring on exhaustion, perspiration, and sleep. Truelly ill person can exhibit all these symptoms for days without any exhaustion.
Usually not dirty or filthy in his habits.  
Usually resents being examined repeatedly.  
It is almost impossible to feign sleeplessness for long.  

  • Explain different types of Abortion. When is abortion permissible and when is it not? Discuss criminal liability of persons involved in illegal abortion – doctor, woman undergoing abortion, persons encouraging illegal abortion.

    Abortion
    An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus/embryo, resulting in or caused by its death. An abortion can occur spontaneously due to complications during pregnancy or can be induced, in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the gravida (pregnant female) is termed a therapeutic abortion, while an abortion induced for any other reason is termed an elective abortion. The term abortion most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.Kinds of Abortion
    Abortion can be classified in several ways.
  1. Legal and Illegal
  2. Spontaneous and Induced
  3. Surgical and Non Surgical
  4. Therapeutic and Elective
  5. Voluntary and Involuntary

When is abortion permissible

Detailed provisions of legal abortion are given in Medical Termination of Pregnancy Act, 1971. Section 3 to 5 of this act specify the situation when abortion is permissible.

Section 3 – When pregnancies may be terminated by registered medical practitioners –

(1) Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act.

(2) Subject to the provisions of sub-section (4), a pregnancy may be terminated by a registered medical practitioner –
(a) Where the length of the pregnancy does not exceed twelve weeks if such medical practitioner is, or
(b) Where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioner are, of opinion, formed in good faith, that –
(i) the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or
(ii) there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities to be seriously handicapped.

Explanation 1 – Where any pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.

Explanation 2 – Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be resumed to constitute a grave injury to the mental health of the pregnant woman.

(3) In determining whether the continuance of a pregnancy would involve such risk of injury to the health as is mentioned in sub-section (2), account may be taken of the pregnant women’s actual or reasonable foreseeable environment.

(4)   (a) No pregnancy of a woman, who has not attained the age of eighteen years, or, who, having attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in writing of her guardian.
(b) Save as otherwise provided in clause (a), no pregnancy shall be terminated except with the consent of the pregnant woman.

Section 4 – Place where pregnancy may be terminated – No termination of pregnancy shall be made in accordance with this Act at any place other than,-
(a) a hospital established or maintained by Government, or
(b) a place for the time being approved for the purpose of this Act by Government.

Section 5 – Sections 3 and 4 when not to apply –

(1) The provisions of section 4, and so much of the provisions of sub-section (2) of section 3 as relate to the length of the pregnancy and the opinion of not less than two registered medical practitioners, shall not apply to the termination of a pregnancy by a registered medical practitioner in a case where he is of opinion, formed in good faith, that he termination of such pregnancy is immediately necessary to save the life of the pregnant woman.
(2) Notwithstanding anything contained in the Indian Penal Code, the termination of pregnancy by a person who is not a registered medical practitioner shall be an offence punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years under that Code, and that Code shall, to this extent, stand modified.
(3) Whoever terminates any pregnancy in a place other than that mentioned in section 4, shall be punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years.
(4) Any person being owner of a place which is not approved under clause (b) of section 4 shall be punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years.
Explanation 1. –
For the purposes of this section, the expression “owner” in relation to a place means any person who is the administrative head or otherwise responsible for the working or maintenance of a hospital or place, by whatever name called, where the pregnancy may be terminated under this Act.

Criminal Liability of persons involved in illegal abortion

Causing the death of an unborn child is a serious offence and the general rules regarding this are given in Section 312 to 315 of IPC. Section 312 to 315 of IPC are applicable to whoever takes part in an illegal abortion.

Section 312 – Causing miscarriage – Whoever voluntarily causes a woman with child to miscarry, shall if such miscarriage be not caused in good faith for the purpose of saving the life of the woman, be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both; and, if the woman be quick with child, shall be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine.

Explanation – A woman who causes herself to miscarry, is within the meaning of this section.

Section 313 – Causing miscarriage without woman’s consent – Whoever commits the offence defined in the last preceding section without the consent of the woman, whether the woman is quick with child or not, shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine.

Section 314 – Death caused by act done with intent to cause miscarriage – Whoever, with intent to cause the miscarriage of a woman with child, does any act which causes the death of such woman, shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine; and if the act is done without the consent of the woman, shall be punished either with imprisonment for life, or with the punishment above mentioned.

Explanation – It is not essential to this offence that the offender should know that the act is likely to cause death.

Section 315 – Act done with intent to prevent child being born alive or to cause it to die after birth – Whoever before the birth of any child does any act with the intention of thereby preventing that child from being born alive or causing it to die after its birth, and does by such act prevent that child from being born alive, or causes it to die after its birth, shall, if such act be not caused in good faith for the purpose of saving the life of the mother, be punished with imprisonment of either description for a term which may extend to ten years, or with fine, or with both.

Section 5 of MPT Act further makes termination of pregnancy by an unregistered medical practitioner an offence punishable by 2 to 7 yrs of rigorous imprisonment.


  • Define Injury and Wound. Discuss medico legal classifications of Injury and Wound. State the differences between Simple, grievous, and dangerous injury. How is the nature of Injury determined? What are the characteristics of Accidental, Homicidal, and Suicidal Wounds? How can they be differentiated? What do you understand by accident? What are the characteristics of Accidental Wound. Explain its medico legal aspects briefly. Which kind of injuries happen in Vehicular accidents? Differentiate between in incisive and lacerated wounds.

Injury and Wound A wound is the term given to tissue damage caused by mechanical force. It is the forcible solution of continuity by mechanical force or any of the tissues of the body including the skin, mucous membrane, or cornea. This includes wounds caused by stabbing, blunt trauma (punching, kicking, beating etc), strangling, biting, shooting, falling from a height, being hit by a vehicle, and blast trauma from explosives.  In legal medicine, the word Wound means all lesions of the body and also includes bruises, contusions, fractures, dislocations, and the like. In general, to make a wound, in criminal cases, there must be an injury to the person by which any kind of tissue is broken.

Injury is as a result of an accident, fighting or when one is hurt while doing something. For example injury while playing or injuries in a bomb blast. Wound is when one is hurt with a weapon, especially a knife or a gun shot.

The word “injury” also has specific legal connotations as given in Section 44 of IPC, which says: The word “injury” denotes any harm whatever illegally caused to any person, in body, mind, reputation or property.  Thus, all wounds are injuries but all injuries may not be wounds.

Descriptions of wounds must include:

  1. the nature of the wound, ie whether it is a bruise, abrasion or laceration etc
  2. the wound dimensions, eg length, width, depth etc. It is helpful to take a photograph of the wound with an indication of dimension (eg a tape measure placed next to the wound), and for measurements to be taken of the wound as it appears first, and then with wound edges drawn together (if it is a laceration etc).
  3. the position of the wound in relation to fixed anatomical landmarks, eg distance from the midline, below the clavicle etc
  4. the height of the wound from the heel (ie ground level) – this is particularly important in cases where pedestrians have been struck by motor vehicles

Medical Classification of Wounds

  1. abrasions – loss of the superficial epithilial layer of the skin and do not leave a scar after healing.
  2. bruises/ contusions / haematomas – blow from a blunt weapon such as lathi. caused due to rupture of small subcutaneous blood vessels, called ecchymosis. e.g. black eye
  3. lacerations – tears or splits produced by blows from blunt objects e.g fall on hard surface, machinery, railway accidents, claws or teeth of animal, edges are irregular with surrounding abrasion, deeper tissues are torn
  4. incised/slash wounds – orderly solution of skin and tissue by sharp cutting instruments such as knife, razor, scissors.
  5. perforating
  6. punches
  7. kicks
  8. bite marks
  9. defense injuries

Legal Classification of Wounds

  1. Simple – one which is neither extensive or serious and which heals rapidly without leaving any permanent disfigurement or deformity.
  2. Grievous – one which are covered under S. 320 of IPC – emasculation, permanent privation of the sight or either eye, ear,  privation of any joint, permanent impairing of the powers of any member or joint, permanent disfigurement of head or face, fracture or dislocation of a bone or tooth, any hurt which endangers life or which causes the sufferer during the space of 20 days in sever bodily pain or unable to follow his ordinary pursuits.
  3. Fatal – extensive and implicate important structures or organs so that they prove fatal.
  Accidental Wounds Homicidal Wounds Suicidal Wounds
  May or may not be self inflicted    
Situation and Character   clothes are damaged, room is disturbed Usually incised, punctured, or gunshot,
clothes are not damaged, in closed
room
Number,   may be multiple in any direction Usually single shot or multiple linear
and parallal
Direction and extent   deep at beginning and superficial at end Slightly angled upwards, superficial at
beginning and deep at end
Location   anywhere usually on front, especially on chest,
throat, wrist or temple
Weapon Location   usually absent clenched in hands
Residue      
History      
Surrounding evidence   Struggle suicide note
Defensive cuts   present  
Hesitant or Tentative cuts     present

Wounds in Vehicular Accidents

Site of impact  
direction of impact  
force of impact  
design of vehicle  
behavior of vehicle  
ejection of victim  
supervening factor such as fire  
Pedestrain Injuries  
Occupants Injuries  
Primary Impact  
Secondary Impact  

 

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