An introduction to pathology | basis of pathology | cellular response to injury | Hypoxia | and...

 Introduction to Pathology

In the preface of the very first edition of Patho- logic Basis of Disease (1957), Stanley Robbins wrote: "The pathologist is interested not only in the recognition of structural alterations, but also in their significance, i.e., the effects of these changes on cellular and tissue function and ultimately the effect of these changes on the patient. It is not a discipline isolated from the living patient, but rather a basic approach to a better understanding of disease and there-fore a foundation of sound clinical medicine". 

The study of the origin & development of disease 

📙Pathologists investigate etiology & pathogenesis of disease by way of morphology (morphe form), using techniques of histology (histo tissue) as well as biochemistry and molecular biology with a goal of easing clinical signs and symptoms where the clinician begins.

📙Pathology means scientific study of sufferings or disease. (Pathos = suffering. Logos = study) 

📙The term pathology is used when one refers to the "scientific study of disease" or the alterations that occur when abnormal influences (bacteria, viruses, etc.) affect cells, tissues, or body systems. More specifically, pathology may be defined as the "scientific study of the molecular, cellular, tissue, or organ system response to injurious agents or adverse influences." Pathology is the study & diagnosis of disease through examination of organs, tissues, body fluids & whole bodies (autopsies).

📙Pathology has been one of the "keystones" of medicine & it serves as a "bridge" or "link" between the preclinical subjects (anatomy, physiology, etc.) & the courses in clinical medicine. Actually, pathology provides a logical means of relating the knowledge of normal structure & function (anatomy & physiology) to abnormal structure & function as encountered in a diseased person. 

It should be emphasized that pathology, as the scientific study of disease, follows the morbid process from its inception to its termination, & investigates the lesions produced. Therefore, a sound knowledge of pathology is the foundation of a solid understanding of disease as it occurs in the living patient. Pathology actually deals with etiology, pathogenesis, morphologic changes and clinical course of disease.

📙Pathology is devoted to the study of the structural, biochemical & functional changes in cells, tissues, and organs that underlie disease. By the use of molecular, microbiologic, immunologic and morphologic techniques, pathology attempts to explain the whys and wherefores of the signs and symptoms manifested by patients while providing a rational basis for clinical care and therapy. Traditionally the study of pathology is divided into general pathology and systemic pathology. The four aspects of a disease process that form the core of pathology are its cause (etiology), the biochemical and molecular mechanisms of its development (pathogenesis), the structural alterations induced in the cells and organs of the body (morphologic changes), & the functional consequences of these changes (clinical manifestations). 

📙General Pathology: General pathology is concerned with the common reactions of cells & tissues to injurious stimuli. Such reactions are often not tissue specific: thus acute inflammation in response to bacterial infections produces a very similar reaction in most tissues. General pathology is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as the body's means of responding to and repairing injury. Areas of study include cellular adaptation to injury, necrosis, inflammation, wound healing and neoplasia. It forms the foundation of pathology, the application of this knowledge to diagnose diseases in humans and animals.

📙Systemic Pathology: Refers to the study of the diseases of the organ systems of the body such as the respiratory system, digestive system and nervous system. Systemic pathology examines the alterations & underlying mechanisms in organ specific diseases such as ischemic heart disease.

📙Anatomic Pathology: Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, micro- scopic, chemical, immunologic and molecular examination of organs, tissues & whole bodies (autopsy). Anatomic pathology is itself divided in sub specialties, the main ones being surgical pathology, cytopathology & forensic pathology.

📙Clinical Pathology: Clinical pathology or Laboratory medicine, is a medical specialty that is concerned with the diagnosis of disease, based on the laboratory analysis of body fluids such as blood and urine, and tissues using the tools of chemistry, microbiology, hematology & molecular pathology. Clinical pathologists work in close collaboration with medical technologists, hospital administrations, & referring physicians to ensure the accuracy and optimal utilization of laboratory testing.

📙Forensic Pathology: Forensic pathology is a branch of pathology concerned with determining the cause of death by examination of a cadaver. The autopsy is performed by the pathologist at the request of a coroner usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Forensic pathologists are also frequently asked to confirm the identity of a cadaver. 

Pathology as a Medical Specialty

🖋 Pathologists are physicians who diagnose and characterize disease in living patients by exam- ining biopsies or body fluid. The vast majority of cancer diagnoses are made or confirmed by a pathologist. Pathologists may also conduct autopsies to investigate causes of death. Pathol- ogy is a core discipline of medical school and many pathologists are also teachers. As manag- ers of medical laboratories, pathologists play an important role in the development of laboratory information systems. 

🖋 Pathology is a unique medical specialty in that pathologists typically do not see patients directly, but rather serve as consultants to other physicians (often referred to as "clinicians" within the pathology community). 

🖋 In summary, pathology is one of several mechanisms employed to solve those problems encountered in clinical situations. Thus, the student is required to make practical use of information accumulated in the General and Special Pathology courses. The compartmental- ization & storage of knowledge for examination purposes is an exercise in futility. However, the utilization of accumulated knowledge in under- standing clinical problems is an educational reality. 

Basic Language of Pathology 

In order for a subject or course to be meaningful, one should become familiar with the basic terminology applicable to that subject. Listed below are a few basic terms used repeatedly in pathology and/or veterinary medicine. The student should become familiar with these terms and their definitions. 

Disease: A disease may be defined as a "state in which an individual exhibits an anatomical, physiological, or biochemical deviation from the normal." As generally used, the term "disease" is employed to describe a state in which there is sufficient departure from the normal for clinical signs or symptoms to be produced. 

Lesions: The term lesion is generally used to prefer to "structural or morphological altera- tions associated with a diseased state in an individual." It is the objective deviation from the normal. Lesions may be recognized with the naked-eye (gross lesions), with the aid of a light microscope (microscopic lesions), or with the aid of the electron microscope (ultrastructural lesions). Biochemical or functional lesions are recognized as changes which result from disturbed function. 

Etiology or Cause: The term "etiology" refers to a "study of the cause of a disease." An me etiologic agent is the factor (bacterium, virus, etc.) responsible for lesions or a disease state. 

Predisposing causes of disease: Refer to those factors which make an individual more suscep- tible to a disease (damp weather, poor ventila- tion, etc.) 

Exciting causes of disease: Refer to those factors which are directly responsible for a disease (bacteria, viruses, hypoxia, chemical agents, etc.). Etiologic factors can all be grouped into two classes: genetic (e.g., inherited muta- tions and disease associated gene variants, or polymorphisms) and acquired (e.g., infectious, nutritional, chemical, physical). 

Pathogenesis: Pathogenesis refers to the sequence of cellular, biochemical, and molecu- lar events that follow the exposure of cells or tissues to an injurious agent. The term "patho- genesis" refers to the "progressive development (sequence of events) of a disease from the time it is initiated to its final conclusion in recovery or death." 

Morphologic Changes: Morphologic changes refer to the structural alterations in cells or tissues that are either characteristic of a disease or diagnostic of an etiologic process. 

Pathognomonic Lesio: Refers to a change which is specifically characteristic of a disease. When one sees a pathognomonic lesion, he knows that a particular disease is present. 

Health: As generally used, the term "health" refers to the "state in which an individual is living in complete harmony with his environ- ment," it is a relative state. All body functions are performed normally even though lesions may be present in organs and/or tissues. It should be remembered that the transitional zone between health and disease is difficult to define. 

Clinical Signs : Refer to any "functional evidence of disease which can be determined objectively or by the observer" (lameness, salivation, increased respiratory efforts etc.). Remember, clinical signs are seen only in the living individual. The term clinical symptoms should be reserved for any "functional evidence of disease that can be determined subjectively or by the patient" (feeling of abdominal discomfort etc.). The end results of genetic, biochemical, and structural changes in cells and tissues are func- tional abnormalities, which lead to the clinical manifestations (symptoms & signs) of disease, as well as its progress (clinical course and outcome). Hence, clinicopathologic correlations are very important in the study of disease

The end results of genetic, biochemical, and structural changes in cells and tissues are func- tional abnormalities, which lead to the clinical manifestations (symptoms & signs) of disease, as well as its progress (clinical course and outcome). Hence, clinicopathologic correlations are very important in the study of disease

Diagnosis: The term "diagnosis" refers to the "determination of the nature of a disease expressed in a concise manner." 

A morphologic or anatomic diagnosis is based on the location and nature of the lesion (hemorrhagic enteritis, etc.). Etiologic diagnosis is made on the basis of the cause (dirofilariasis, etc.). Definitive diagnosis is made on the basis of the specific disease entity involved (canine distemper, animal disease etc.). A clinical diag- nosis is made on the basis of clinical signs observed in the living animal. 

Biopsy: Removal or collection of tissue or specimen obtained from the living body for examination is known as biopsy.

Necrosis: Refers to the morphological changes caused by the progressive degradative action of enzymes on the lethally injured cell within the living body. After a cell dies, lysosomes rupture and their hydrolytic enzymes are released. The release and activation of these lysosomal enzymes are responsible for cell necrosis. Remember, necrotic cells are dead cells, but dead cells are not necessarily necrotic. 

Postmortem change: Refer to cell death which accompanies or occurs after death of the entire body (somatic death), whereas antemortem changes refer to those alterations that occur in cells, tissues, organs, etc. prior to somatic death or in the living individual. It is important to differentiate postmortem changes from ante- mortem changes in order to interpret correctly those lesions encountered at necropsy. 

Gross Pathology (macroscopic pathology, patho- logical anatomy, morbid anatomy): Refers to the study of disease in which tissues and organs are examined with the unaided eye. 

Cellular Pathology (microscopic pathology, histopathology): Refers to the study of diseased tissues & organs with the aid of a micro-scope. 

Surgical Pathology: Refers to the study of tissues removed at the time of surgery

Clinical Pathology: Refers to the study of disease by examination of blood, urine, feces, skin scrapings, etc. 

Immunopathology: Refers to the study of diseases associated with abnormalities of the immune mechanisms of the body. 

Chemical Pathology: Refers to the study of chemical changes in the fluids and tissues of the body as the result of disease. This branch of pathology is merely a portion of clinical pathology. 

Morphologic Terminologies

• Follicular pattern: Forming follicle-like structure. 
• Diffuse pattern: Distributed diffusely.
• Glandular pattern: Arranged in a gland like structure.
• Acinar pattern: Cells arranged in gland having lumen.
• Tubular pattern: Arranged in tubule like structure.
• Villous pattern: Forming villi-like structure
• Papillary pattern: Arranged in finger like structure.
• Stag-horn or antler-horn pattern: Arranged in tight clusters or monolayered sheets of cells taking the pattern of antler horn
• Cyst: - Abnormal closed sac like structure containing liquid or semi solid substances. lined by epithelium.
• Pseudocyst: Abnormal closed sac containing fluid covered by fibrocollagenous tissue
• Adenoma: Benign epithelial neoplasms forming glands or formed from the glands (but not necessarily exhibiting gland pattern).
• Papilloma: Benign epithelial neoplasm growing on any surface that produce micro- scopic or macroscopic finger-like projections. 
• Polyp: A mass that projects above a muco- sal surface to form a macroscopically visible structure. 
• Abscess: Collection of pus lined by pyogenic membrane.
• Ulcer: Ulcer is a local defect or excavation of the surface of an organ or tissue that is produced by the sloughing (shedding) of inflamed necrotic tissue (breech in the tissue continuum) e.g. Peptic ulcer, Typhoid ulcer. 

Cellular response to stress

Cells are the basic unit of tissues, which form organs and systems in human body.Normal cell is in a steady state "Homeostasis". Change in Homeostasis due to stimuli "Injury". When a cell is exposed to an injurious agent, it achieves a new steady state to survive is called cellular adaptation. If the adaptive capability is exceeded or if the external stress is inherently harmful or excessive, adaptation fails and thus cell injury develops. 

When stimuli or stress is mild to moderate the injured cell may recover or revert to normal (reversible cell injury). When stimuli or stress is persistent or severe the injured cell cannot recover or revert to normal (irreversible cell injury or cell death). The effects of reversible cell injury may persist in the cell as evidence of cell injury at subcellular level (subcellular alteration). Various metabolites may accumulate within the cells (intracellular accumulation). 

The effects of injury depend on : 

a. Type, duration and severity of injury.

b. Type of injured tissue, its adaptability and genetic makeup. 

■Brain tissue is very sensitive to hypoxia (3-4 min). 

■ Myocardial tissue is also sensitive to hypoxia (20-30 min).

■ Skeletal muscles can adapt hypoxia for 2-6 hours. 

■Reversibility depends on the type, severity and duration of injury. 

■Cell death is the result of irreversible injury. 

Injurious Stimulus / Stress factors (Causes of cell injury) 

The causes of cell injury range from gross physical trauma (such as after a motor vehicle accident) to a single gene defect (results in a nonfunctional enzyme in metabolic disease). 

Most injurious stimuli can be grouped into the following categories: 

1. Oxygen Deprivation: 

• Hypoxia (deficiency of oxygen in tissue level). 
• Hypoxemia (deficiency of oxygen in arterial blood). 
• Ischemia (loss of blood supply).
• Anoxia (complete lack of oxygen).

2. Physical agents: 

•  Mechanical trauma.
• Extremes of temperature (burn or deep cold). 
• Sudden change in atmospheric pressure.
• Radiation.
• Electric shock. 

3. Chemical agents & drugs: 

• Glucose or salt in high concentration. 
• High concentration of oxygen.
• Trace amounts of poisons (e.g. Arsenic, cyanide, mercuric salt).
• Environmental and air pollution.
• Insecticides and herbicides.
• Industrial & occupational hazards (e.g. asbestos).
• Alcohol. 

4. Infectious/microbiological agent: 

• Virus.
• Bacteria.
• Fungi.
• Protozoa. 
• Parasites. 

5. Immunologic reactions (several autoimmune diseases discuss in lesson 20). 

6. Genetic defects (discuss in lesson 19) 

7. Nutritional imbalance (discuss in lesson 22A). 

8. Free radical damage (discuss in lesson 2C). 

9. Reperfusion injury. 

Hypoxia

Definition: 

Hypoxia is a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level. 

There are Four Types of Hypoxia : 

1. Hypoxic hypoxia: Due to low oxygen in arterial blood. 
2. Anemic hypoxia: Due to low level of hemo-globin in blood. 
3. Stagnant hypoxia: Due to inadequate blood supply.
4. Histotoxic hypoxia: Low oxygen uptake due to cellular toxicity. 

Clinical Manifestations: 

1. Cyanosis (bluish discoloration of skin and mucous membrane) 
2. Confusion / disorientation / hallucinations / behavioral change, 
3. Dyspnea (Breathlessness) 
4. Lethargy. 

Hypoxemia

Definition: 

Hypoxemia is defined as reduced partial pressure of oxygen (mmHg) in arterial blood. Hypoxemia can cause hypoxia (hypoxemic hypoxia), but hypoxia can also occur via other mechanisms, such as anemia. 

■It can be estimated by measuring the oxygen saturation of blood using a pulse oximeter, a small device that clips to a finger. 

■Normal pulse oximeter readings usually range from 95 to 100 percent. 

■Values under 90 percent are considered low. Normal arterial oxygen is approximately 75 to 100 millimeters of mercury (mm Hg). 

■Values under 60 mm Hg usually indicate the need for supplemental oxygen.

Causes: 

1. Decrease concentration of oxygen in air. 
2. Respiratory acidosis. 
3. Ventilation defect 
4. Perfusion defect 
5. Hemoglobin related abnormalities e.g. anemia. 

Ischemia 

Definition: 

Ischemia is a decrease in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism. 

Causes : Coronary artery atherosclerosis, decreased cardiac output, Thrombosis. 

Consequences: 

1. Atrophy 
2. Infarction of tissue 
3. Organ dysfunction 

Clinical manifestations are acute limb ischemia include pain, pallor, pulseless, paresthesia, paralysis. 

Major structural targets for cell damage: 

• Cell membranes : 

• Plasma membrane 
• Organelle membranes 

• DNA. 

•Structural protein 

• Enzymes 

• Mitochondria: 

• Oxidative phosphorylation 

Cellular responses to Injury 

1. Cellular adaptation: 

• Atrophy. 
• Hypertrophy. 
• Hyperplasia. 
• Metaplasia. 

2. Cell injury: 

• Reversible (Cellular swelling, Fatty change). 
• Irreversible (Necrosis, Apoptosis). 

3. Subcellular alterations- in sublethal & chronic injury. 

4. Intracellular accumulations. 

5. Pathologic calcification. 

6. Cell aging. 

Cellular response to injurious stimuli

Reference: -

🖎Text book of pathology by Harsh Mohan

🖎 Pathology tutorial by Mohammad Zillur Rahman

Legal procedure| Inquest & chalan| Inquest report| Witness| Evidence| Dying declaration & dying deposition| Oath| Viva| MCQ| Forensic medicine|

 Legal Procedure

It is the responsibility of the police to preserve & protect the scene of crime. The doctor should carry with him a hand lens, measuring tape & ruler, gloves, slides, swabs, chemical thermometer, & envelopes if possible. Complete & accurate recording of the scene as it was found is very important. This can be done by accurate diagrams, notes & photography. The scene may show evidence of struggle & on the body, vital trace evidence may be present. The examination at the scene should be limited to a search for such evidence which might be dislodged or possibly lost during the transfer of the body to the mortuary. If a doctor sees the dead body for the first time in the autopsy room, they may form incorrect opinions about the origin of various injuries. Seeing the body at the scene of the crime with the various surrounding objects helps to avoid such mistakes. The visit to the scene of death is more valuable if the body shows a patterned injury, the origin of which is in doubt. Even a retrospective visit to the scene enables the doctor to have a true appreciation of the nature of the surroundings, which are usually found to differ from the impression formed from the description of other persons & will be of help in interpretation the of the findings in the victim. The scene of a violent death usually shows significant findings for understanding, reconstructing & solving problems. The finding of a dead body together with evidence of burglary indicates murder. Disturbance of furniture may be seen sometimes if a person dying suddenly & naturally falls down & injures himself. The sequence of events preceding death must be reconstructed logically to support or contradict inferences from other areas of investigation. The fatal injuries should be evaluated to find out how much purposeful action & walking, the victim could have carried out before he became disabled & died. In every case, priority must be given to the injured, & to any action designed to prevent further casualties. Evidence to connect the victim, suspect & location of the murder may be found at the scene of the incident, on the clothing or bodies of the victim & suspect, or in some other place to which the body was transported.

Inquest & chalan

👉What is Inquest: -

It is a legal investigation or inquiry on the circumstances & causes of death, where the death has occurred sudden, suspicious, or unnatural.

Or.

An inquest is a primary inquiry or investigation into the cause of an unnatural, sudden, or 

suspicious death. 

Types of inquest: -

1. Police inquest (In Bangladesh) 
2. Magistrate inquest (In Bangladesh) 
3. Coroner's inquest (In Mumbai, Japan, USA) 
4. Medical examiner's system (In USA, Japan, Canada) 

1. Police inquest: -The officer-in-charge (Usually sub-inspector but not below the rank of head constable: Reddy 35th-5/ not below the rank of S.I.: Lecture note) of a police station makes an investigation report under circumstances of death or cause of death. 

2) Magistrate inquest: -A magistrate will hold the inquest on some special circumstances when 

police officer of any rank has no provision. 

3) Coroner's inquest: - A person who is empowered to make investigation of unnatural & suspicious 

death. This type of inquest is done in U.K., some states in U.S.A. 

4) Medical examiner's system: A medical expert is engaged to investigate over the death of a 

person. 

👉What are the indications of inquest?

Indications of an inquest/an inquest is done in: -

1. Sudden death. 
2. Suicide, homicide, and infanticide.
3. Death from accident, poisoning, drug mishap or machinery.
4. Unexplained death or death from burns or fall from height. 
5. Death under anesthesia or on operation table or from postoperative shock.
6. Death due to medical negligence or within 24 h of admission in a hospital. 
7. Death of a convict in jail, police custody, mental hospital, or correctional school. 
8. Dowry deaths.
9. Death due to any industrial disease. 

👉Types of death where inquest report is necessary: - 

1. Sucide
2. Murder
3. Killing by an animal or machinery
4. Accidents
5. Torture or ill-treatment
6. Occupational disease
7. Suspected medical negligence
8. Suspicious (Unnatural) death
9. Anesthesia or operation
10. In case of unidentified or skeletonized bodies
11. Unexplained sudden death

Magistrate inquest: -

An inquiry or investigation conducted by the District Magistrate, Sub-divisional Magistrate, or any other executive Magistrate, especially empowered by the state Government, into the cause of death, where the death has occurred in a suspicious circumstance is called Magistrate inquest. 

💥Purpose: - The main intention behind the magistrate inquest is to ensure that: 

• No person is unjustly deprived of his liberty & his rights as citizen. 
• No person, who is deprived of his liberty, can die as a result of neglect or brutality of the people who are in-charge of him. 
• In case of a buried body, there is no doubt with regards to identity, cause of death or manner of death. 
• The death is not a 'dowry death'.

💥Conditions when Magistrate inquest is required/Where police officer is not allowed to make inquest report: 

1. Death in police custody, & while under police interrogation.
2. Death due to police firing or by any uniformed person, e.g., B.D.R.
3. Death in prison, reformatories, Borstal school.
4. Death in a psychiatric hospital (Insane death). 
5. Dowry death (Unnatural death of a woman within 7 yrs of marriage by husband or his relatives) 
6. Exhumation (Digging out of already buried body from the grave). 
7. Any person dies or disappears, or rape is alleged to have been committed on any woman, while such person or woman is in the custody of the police, or any other custody authorized by the court. 
8. When an aggrieved person loses his faith over the police. 

💥Police officer is not allowed to make inquest report in above mentioned cases: 

1. It is probably based on the assumption that it is not always safe or advisable to depend entirely upon the option of police, particularly when it relates to the death of a person in police custody. There should be a further check & independent inquiry by a magistrate. 
2. A magistrate inquiry is likely to inspire greater public confidence & it may help to pacify ruffled or injured feelings of that have been created in the minds of the people by reason of violent or sudden death of human being specially in police custody or of a bride under suspicious circumstances. 
3. The proceedings of the magistrate are intended to discover the cause of death, that is, whether in a given case, the death was accidental, suicidal or homicidal. 

💥Procedure of police inquest: 

1. This is conducted by a police officer (Known as investigating officer), not below the rank of sub-inspector (S.I.). 
2. When the police officer receives any information of unnatural or suspicious death- 
3. At first, he informs about it to nearest executive magistrate of same area
4.  Then proceed to scene of crime. 
5. There in presence of two or three respected persons (Panchas) makes an investigation.
6. He prepares a report about the cause of death as judged by him & panchas from the appearance & surroundings of the body including nature of injuries thereon. This report (Inquest report) is then signed by him & witness. 
7. He also collects any object or material from the scene of death, which may subsequently be used as evidence. 
8. The report is then sent to district or sub-divisional magistrate. 
9. If no foul play is suspected, dead body is released for disposal.
10. In case of suspected foul play or doubt, dead body is sent for autopsy to nearest authorized center with a request form & a copy of inquest report. 

Inquest report

Inquest report/ Surat-hal report: -

It is the preliminary investigation report made by an investigation officer into the cause of sudden & suspicious death. 

1. Particulars of the victim: Name- 
   Parentage- 
   Residence-
2. Place where the body was found: 
3. Description of the corps & position in which found. 
4. Apparent injuries or marks on the body. 
5. Manner in which & weapons (If any) by which injuries appeared to have been inflicted.
6. Circumstances if any, which give rise to suspicion of foul play. 
7. Accurate list & description of clothes, ornaments, weapons, & other articles found on or near the dead body. 
8. Opinion of the witness as to the cause of death:
9. Opinion of the I.O. as to the cause of death: \

💥Define chalan: -

Chalan: -

It is the written requisition in a tabulated form written by the investigating officer submitted to the authorized Govt. doctor while handling over the dead body for performing the post-mortem 

examination. 

Contents of a chalan: 

1. Chalan number. 
2. Religion & caste of deceased. 
3. Sex & age. 
4. Residence. 
5. Where body was found. 
6. Date & hour of dispatch & distance from place of post-mortem. 
7. Means of dispatch.
8. Name of identifying police officer. 
9. Marks on the body. 
10. Cause of death as far known.
11. Remarks notice what clothes & articles were certified with the body.

💥Sample of a chalan: -

Sample of a chalan 

Witness

A witness is a person who gives evidence regarding facts in the Court of law. 

Or.

A witness is a person who gives evidence in the Court of law regarding the case in question what he/she had seen, heard or knowledge about the case. 

Types: 

1) Common witness 

2) Expert witness 

3) Hostile witness

According to some teachers, 4th type of witness is "professional witness".

Professional witness: -

Here a doctor gives some purely factual evidence on something he did or saw during his medical work, e.g. He may have sutured a scalp injury caused by a fight. 

 Hostile witness /Adverse witness: -

A hostile witness is supposed to have some interest or motive for concealing truth or part of the truth or for giving false evidence in the Court of law. 

Examples: 

A common or expert witness may become hostile. 

1. The Court will declare a witness hostile on the suggestion of the lawyer of the party who has summoned the witness or prosecution lawyer. 
2. On declaration of a witness as hostile, he can be cross-examined by the same lawyer. 

Medico-legal importance: 

Hostile witness may be punished with 

1. Imprisonment extending up to 7 years (under oath inside the court)
2. Imprisonment up to 3 years. (other than under oath, inside the court) 

Criteria of an ideal witness/Conduct of a doctor in witness box: 

1. Must attend in time & when summon is served to him. 
2. Should collect all reports or necessary notes. 
3. Refresh memory by referring medico-legal note & academic books. 
4. Be well dressed & modest. 
5. Don't discuss the case with anyone except the calling lawyer. 
6. Give proper salute/salaam to the Judge when entering into witness box. 
7. Address the judge properly as "Sir" or "Your honor". 
8. Stand up straight. Be calm & quiet. Not to be frightened or nervous. 
9. Speak slowly, distinctly & audibly. So that the Judge & the lawyer hears clearly.
10. Use plane & simple language.
11. Be precise & avoid superlative or exaggerated words, e.g., savage blow.
12. Be concise in answer. In many medical matters the answer requires explanation & the doctor should reply to the answer to with a "Yes" or "No".
13. State facts only. 
14. Express an opinion from knowledge & experience "In my opinion", not to say or think or imagine, etc. 
15. Don't avoid question, better say don't know.
16. Don't lose temper for initiating a disgraceful question.
17. If a question is read from book & asked the doctor whether he is agreed or not. In that the doctor should always see the book before replying. 

Evidence

All legal means which help to prove or disprove any fact in legal question including all 

statements & documents in called evidence. 

Or. 

Evidence means & includes: 

1. All statements which the Court permits or requires to be made before it by witnesses, in relation to matters of fact under inquiry. 
2. All documents produced for inspection of the Court. 

Types: 

 

1. Oral evidence: - (i) Direct or eyewitness (ii) Indirect or circumstantial (iii) Hearsay
2. Documentary evidence: -

 It includes all papers written or printed, which may be produced for the inspection of the Court during the course of trial. 

Types: 

A) Medical certificates: e.g., 

1. Birth certificate. 
2. Death certificate. 
3. Ill-health certificate. 
4. Insanity certificate. 

B) Medico-legal reports: e.g., 

1. Post-mortem report. 
2. Injury report. 
3. Repot on sexual offence, e.g., rape, sodomy, etc. 
4. Age estimation report. 
5. Report of pregnancy, delivery & abortion. 
6. Chemical examination report. 

C) Dying declaration: It is a written or oral statement of a person, who is dying as a result of some unlawful acts, relating to the material facts of cause of his death or bearing on the circumstances. 

D) Dying deposition: It is a statement made by a person on oath, who is dying as a result of unlawful act, recorded by the Magistrate in the presence of the accused or his lawyer, who is 

allowed to cross-examine the witness

💥Oral evidence: -

Oral evidence: It includes all statements which the Court permits, or which are required to be made before it by the witness, in relation to matters of fact under enquiry. 

Direct evidence: An evidence is a direct evidence, when a person who himself has seen, heard or perceived something gives the statement. 

Example: 'A' has seen 'B' & 'C', fighting with sticks on a certain road on particular day & time. Now 'C's evidence in the Court will be direct evidence. 

Indirect or circumstantial evidence: Evidence of a fact which is not actually in issue, but which is derived from circumstances is called indirect evidence. 

Or, 

It is not the direct testimony of an eyewitness but has a bearing upon the fact of the other & subsidiary facts which are relied upon as consistent. 

Example: In case of alleged murder of 'A' by 'B' at certain place on a particular day & time, the circumstantial evidence would be that 'C' saw 'B' with a knife on that day at that place, a few minutes before the murder. 

. 

Procedure of giving evidence in the court of law: 

1. Receiving a summon on warrant. 
2. Attendance in the Court.
3. Oath taking.
4. Deposition. 

1) Receiving summon on warrant: At first the doctor receives summon from the court to give evidence. 

2) Attendance in the court: A doctor who has received the summons should attend the Court on the specific date at the specified time. In the Court, the doctor should report his attendance to the prosecution lawyer, when he is a prosecution witness or to the defense lawyer, when he is a witness for the defense. 

3) Oath taking: When the doctor is called to give evidence, he will step up in witness box & take an oath. The oath is- "I do swear in the name of God, that what I shall state shall be the truth, the whole truth, & nothing but the truth". If the doctor is an atheist, he has to "solemnly affirm” instead of "swearing in the name of God". 

4) Deposition: 

a) Examination-in-chief (Direct examination): Conducted by the lawyer of the party who has summoned him. The object is to place before the court all the facts that bear on the case. At this stage no leading questions are allowed. 

b) Cross-examination: Conducted by the lawyer for the accused. The opposing lawyer would try discredit or weakens the evidence of the medical man by all possible means. 

c) Re-examination (Re-direct examination): Conducted by the lawyer for the side who has called the witness. The object is to correct any mistake or to clarify or add details to the statements the witness has made in cross-examination. 

d) Question by the Judge: The Judge may ask any question during any stage of deposition, 

which he feels necessary. 

After completing the deposition, the witness will put his signature on the written record of his deposition, receive the conduct money, take Court attendance certificate & then with the permission 

of the Court he can leave the Court. 

Dying declaration & dying deposition

Dying declaration: It is a written or oral statement of a person, in a sound state of mind who is dying as a result of some unlawful act, relating to the material facts or cause of death, or bearing of the circumstances. responsible for his death. 

Or, 

 

It is a statement made by a person, who is about to die, related to the cause or circumstance bearing with the cause of his impending death. 

Procedure of recording dying declaration: 

1. If there is time, a Magistrate should be called to record the declaration. 
2. If the condition of the victim is serious, & there is no time to call a Magistrate, the doctor should take the declaration in presence of two witnesses.
3. Before recording the statement, the doctor should certify that the person is conscious & his mental faculties are normal (Compos mentis).
4. Oath is not necessary, because of the belief that the dying person tells the truth.
5. The statement should be recorded in the man's own words, without any alteration of terms or phrases.
6. Leading questions should not be put. 
7. The declarant should be permitted to give his statement without any undue influence, outside promoting or assistance. 
8. If a point is not clear, question may be asked to make it clear, but the actual question & the answer received should be recorded. 
9. If the dying person is unable to speak, but he is able to make signs in answer to questions put to him, this can be recorded & it is recorded as a "verbal statement". 
10. After writing the declaration, it should be read over to the declarant. 
11. Then the signature or thumb impression of the declarant is taken.
12. The doctor & the witness should also sign the declaration.
13. Then the declaration is sent to the Magistrate in a sealed cover. 

Dying deposition: -

It is a statement made by a dying person on oath, in a sound state of mind who is dying as a result of unlawful act, recorded by the Magistrate in the the accused or his lawyer, who is allowed to cross examine the witness. 

Or.

Procedure of dying deposition: 

1. It must be conducted by a Magistrate, never by a doctor or a police officer. 
2. Accused or his lawyer is present here.
3. Before recording, the doctor should certify the mental soundness of the person. 
4. Then the victim is to take oath.
5. The statement should be recorded in the man's own words. 
6. There should not be any undue influence, outside promoting or assistance.
7. The accused or his lawyer has the opportunity to cross-examine the victim.
8. After writing the statement, it should be read over to the victim. 
9. The signature of the victim is taken.
10. Then the signature of Magistrate, accused or his lawyer is also taken. 

Medico legal examination: -

Medico-legal examinations done in our country: 

Medico-legal examinations in living: 

1. Identification of person. 
2. Physical examination for injury report.
3. Examination of a rape victim.
4. Examination for medico-legal certificates.
5. DNA profiling. 

Medico-legal examinations in dead: 

1. P.M. examination. 
2. DNA profiling for identification of the deceased. 

Court   

Court means the hall of justice, where law is practised. 

Or, 

Court of justice denotes a judge who is empowered by law to act judicially alone or a body of judges, empowered by law to act judicially as a body, when such judge or body of judges is acting judicially. 

 Or, 

Court can be defined as legal institution where complaints against offences are prosecuted & 

verdict is declared. 

Crime 

Crime: Crime means a social harm, which has been defined & made punishable by law. 

Criminology: It is the branch of forensic medicine, which deals with crimes & criminals. 

💥Classification of criminals: 

1. Developmental
2. Repetitive 
3. Occasional (i) Situational (ii) Physical

1) Developmental: 

A young man- 

• Steals a car. 
• Then commits a burglary. 
• Then a robbery. 
• Settles down at about the age of 30 years. 

2) Repetitive criminal: 

• Repetitive burglar. 
• Pick pocketer. 
• Sexual violence. 
• Activities often continue well middle age. 

3) Occasional criminal: 

a) Situational: 

• Economic problem.
• Infidelity of marital partner. 
• Frustration in love. 
• Severe sickness in family. 

b) Physical: 

• Alcoholic bout.
• Mental illness. 

Offence

Offence means ‘any unlawful act or omission' made punishable by law. (Ref. Lecture note) 

Types: 

1. Cognisable offence: It is an offence in which a police officer can arrest a person without warrant from the Magistrate. Examples: Rape, murder, dowry death, ragging, kidnapping, death due o rash or negligent act, etc. In such offences, the individual is sent by the police to the doctor for medical examination. 
2. Non-cognisable offence: It is an offence in which a warrant must be issued by an authorized person (e.g., Magistrate) for arresting a person. 

Example: Assault. In such cases, the injured person may go direct to the doctor, or he may file an affidavit in the Court of a Magistrate who will send him to the doctor for examination & report.

Oath:

Oath: The oath is a declaration required by the law, which is compulsory & holds the witness responsible for consequences of his evidence. 

Or, 

The oath is a solemn affirmation by a witness to speak truth. 

💦Viva Question: -

𝑸Mention the fundamentals of leagal procedure?

𝑸Who does prepare the inquest report? Who are the inquiring &  investing officers? 

𝑸Who can take dying declaration? 

𝑸Mention the roll of doctor in taking the dying declaration.

𝑸Define criminal law & civil law. 

𝑸What do you mean by verbal statement? 

𝑸What do you mean by approval witness?

💦Multiple choice Question: -

𝑸Medical documentary evidence are: -

a. Medical certificates (T) 

b. Medico-legal reports (T)

c. Dying declaration (T)

d. Dying deposition (T) 

e. Hearsay evidence (F) 

𝑸Inquest report done in case of- 

a. Natural death (F) 

b. Unnatural death (T) 

c. Suspicious death (T) 

d. Sudden death (T) 

e. Death due to poisoning (T) 

𝑸Magistrate inquest is done in case of- 

a. Death due to fall from height (F) 

b. Death in police custody (T) 

c. Exhumation (T) 

d. Death due to burn (F) 

e. Death in prison (T) 

𝑸A session judge- 

a. Can try any case (T) 

b. Can fine any amount (T) 

c. Can give life imprisonment (T) 

d. Cannot pass death sentence (F) 

e. can pardon a condemned man (F) 

𝑸Police inquest is done in following cases- 

a. Death in prison (F) 

b. Death due to negligence of a physician (T) 

c. Death due to criminal abortion (T)

d. Death in hospital under police custody (F) 

e. Infant death (T) 

𝑸Parts of deposition are- 

a. Cross examination (T) 

b. Leading question (T) 

C. Summon (T) 

d. Examination in chief (T) 

e. Perjury (F) 

 

𝑸 Followings are cognisable offences- 

a. Adultery (F) 

b. Rape (T) 

C. Murder (T) 

d. Dowry death (T) 

e. Physical assault (T) 

𝑸Followings are the criminal Court- 

a. Assistant judge court (F) 

b. Magistrate court (T) 

c. Session judge court (T) 

d. High court (T) 

e. Supreme court (T) 

𝑸Sentences authorized by law are- 

a. Rigorous imprisonment (T)

b. Grievous hurt (F) 

c. Solitary confinement (T) 

d. Death sentences (T) 

e. Disfiguring the face (F) 

𝑸Parts of deposition in the courts of law are- 

a. Arrival in the court (F) 

b. Examination in chief (T) 

C. Cross examination (T) 

d. Re-examination (T) 

e. Question by the judge (T) 

𝑸Sentences authorized by the law are- 

a. Death sentence (T) 

b. Life imprisonment (T) 

C. Erasure of name from registration (F) 

d. Forfeiture of property (F) 

e. 

Fine (T) 

Q) Death sentence is given by- 

a. Supreme court (T) 

b. High court (T) 

C. 

Session judge court (T) 

d. Additional session judge court (F) 

e. CMM court (F) 

𝑸Inquest report consists of- 

a. Signature of the witness is not necessary (F) 

b. Particulars of the deceased (T) 

c. Signature of the investigating officer on right hand side of bottom (T) 

d. Signature of the bearing constable (F) e. Brief history & circumstances under which the body was found (T) 

𝑸Chalan consists of- 

a. Signature of the IO(T) 

b. Signature of at least 02 witness (F) 

c. Name & number of bearing constable (T) 

d. Brief history of the case (F) 

e. Details of the circumstances under which the body was found (F) 

𝑸Expert witnesses are- 

a. Doctor (T) 

b. Chcinical examiner (T) 

c. Sub-inspector (F) 

d. Magistrate (F) 

e. Firearm expert (T) 

𝑸Objectives of cross examination- 

a. To find out favourable facts (T) 

b. To modify what has been said (T) 

C. To discredit the witness (T) 

d. To test the accuracy of the statement (T) 

e. To prove the case favourable for prosecution (F) 

𝑸Leading questions are permitted only in- 

a. Examination in chief (F) 

b. Cross examination (T) 

c. Re-examination (F) 

d. Dying declaration (F) 

e. Dying deposition (F) 

𝑸Subpoena is kind of- 

a. Court (F) 

b. Conduct money (F) 

c. Tribunal (F) 

d. Document (T) 

e. Saponification (F) 

 

𝑸Following cognizable offence: 

a. Adultery (F) 

b. Rape (T) 

c. Physical assault (F) 

d. Murder (T) 

e. Dowry death (T) 

𝑸Death sentence is given by: 

a. Supreme court (F) 

b. District and session judge court (F) 

C. Additional District and session judge court (F) 

d. Judicial magistrate court (F) 

e. High court (T) 

𝑸Expert witness are:

a. Doctor (T) 

b. Sub inspector (F) 

c. Magistrate (F) 

d. Chemical examiner (T) 

e. Firearm expert (T) 

𝑸Parts of deposition in courts: [DU-19M] 

a. Question by judge (T) 

b. Receiving a summon (F) 

c. Re-examination (T) 

d. Oath taking (F) 

e. Cross examination (T) 

𝑸Conduct money is paid by in civil case: 

a. Court (F) 

b. Opposite party (T) 

c. Lawyer (F) 

d. Judge (F) 

e. Public prosecutor 

𝑸Followings are criminal courts: 

a. Asstt. Judge court. (F) 

b. Magistrate court. (T) 

c. Session judge court. (T) 

d. High court. (T) 

e. All of the above courts. (T) 

𝑸Inquest report done in case of:

a. Natural death. (F) 

b. Unnatural death. (T) 

c. Suspicious death. (T) 

d. Sudden death. (T) 

e. Death due to poisoning. (T) 

𝑸Expert witness are:

a. Doctor. (T) 

b. Pedestrian. (F) 

C. Firearm expert. (T) 

d. Fingerprint expert. (T) 

e. Police constable. (F) 

𝑸Death sentence awarded by: 

a. Chief Judicial Magistrate (F) 

b. Session Judge (T) 

c. High court (F) 

d. Coroner's court (F) 

e. Executive Magistrate (F) 

𝑸A session Judge: 

a. Can try any case. (T) 

b. Can fine any amount. (T) 

C. Can give life imprisonment. (T) 

d. Cannot pass death sentence (F) 

e. Can pardon a condemned man. (F) 

𝑸Death sentence given by: 

a. Supreme court (T) 

b. High court (T) 

C. Session judge court (T) 

d. Chief judicial magistrate (F) 

e. Chief metropolitan magistrate (F) 

𝑸Medical documentary evidences are:

a. Medical certificate (T) 

b. Medicolegal reports (T) 

c. Dying declaration (T) 

d. Dyeing deposition (T)

e. Hearsay (F) 

𝑸Power of district session judge:

a. Up to 10 yrs imprisonment (F) 

b. Death sentence (T) 

c. Life imprisonment (T) 

d. Writ petition (F) 

e. Forfeiture of property (T) 

𝑸Inquest report contains:

a. Particulars of deceased (T) 

b. Name of exhibits 

c. Actual cause of death 

d. Signature of two witness (T) 

e. Signature of magistrate in some cases. (T) 

𝑸Medical documentary evidences are:

a. Post-mortem reports (T) 

b. Dying deposition (T) 

c. Subpoena (F) 

d. Age certification (T) 

e. Dying declaration taken by doctor (T) 

𝑸Subpoena is a kind of:

a. Designation (F) 

b. Document (T) 

c. Decomposed body (F) 

d. Tribunal (F) 

e. Court (T) 

Ref........

• Nandy3rd- 14
• Reddy 32th-20

 An in

Introduction of Forensic medicine | Branches |Aim | Medical jurisprudence | Bioinformatics| Short notes| Viva | MCQ | PDF|

FORENSIC MEDICINE

 INTRODUCTION: -

Medicine & law have been related from the earliest times & the bonds which united them were religion, superstition & magic. Law medicine problems were found in the written records in Egypt, Sumer, Babylon, India & China dating back 4000 to 3000 B.C. A Chinese Materia medica of about 3000 B.C. gives information on poisons. Imhotep (27th century B.C.), Grand Vizir, Chief Justice & chief physician of King Zoser of Egypt, enacted rules for medical practice, which was brought under law. The code of Hammurabi, King of Babylon (about 2200 B.C.), is the oldest known medico-legal code. In fourth century, B.C., Manu (King & lawgiver) in his treatise, Manusmriti, laid down various laws including punishment for various sexual offences, & recognized mental incapacity due to intoxication, illness & age. Hippocrates (460 to 377 B.C.), the "Father of Western Medicine" was born & practiced in the island of Kos in Greece, discussed the lethality of wounds. His contribution to medical ethics is by far greatest in our field. Later, Greek & Roman jurists & medical men collaborated in the development of the principles of forensic medicine. In the sixth century A.D. the Justinian Code (Roman emperor) & Institutes regulated the practice of medicine & surgery & established the function of the medical expert for legal procedure. The first medico-legal autopsy was done in Bologna (Italy) in 1302, by Barolomeo De Varignana. In the thirteenth century, a manual was prepared to aid in the investigation of death in China. The 'Constitutio Criminalis Carolina', published in Germany in 1532, recognized that there were several types of homicide which were not punishable under certain conditions, one of which was an offender who was 'deprived of his understanding.' The first book on Forensic Medicine was published in 1602 by an Italian physician, Fortunato Fedele. The greatest of all works was the "Questions Medico-legalis", written by Paulus Zacchias, who was principal physician to Pope Innocent X, & Alexander VII, & an expert before the Rota Romana, the Court of Appeal. This was published in seven volumes from 1621 to 1635 & two additional volumes in 1666, at Amsterdam. Paulus Zacchias is considered the Father of Legal Medicine as well as Father of Forensic Psychiatry. Around the end of the sixteenth century, autopsies in medico-legal cases began to be generally practiced. In the eighteenth century, professorships in legal medicine were founded by the State in Germany. Orfila (1787 to 1853), professor of chemistry & legal medicine at Paris introduced precise chemical methods into toxicology. He is considered the founder of modern toxicology. 

👉What is Forensic Medicine And its branches

Forensic"- Forums of or used in Courts of law 

Forensic medicine may be defined as the branch of science, which embraces all those aspects of medical science including its fundamental, e.g. physical, chemical or biological principles as well as its specialties such as forensic toxicology, or forensic pathology and participate in partnership with the process of law both civil & criminal. 

Or, 

Forensic medicine or legal medicine is the branch of science which deals with the application of medical & paramedical knowledge to aid in the administration of justice. It is used by the legal authorities for the solution of legal problems. In short, it deals with medical aspects of law. 

Or, 

Forensic medicine relates to application of medical knowledge for dispensation of justice in a court of law.

👉Branches of Forensic medicine: - 

1. Forensic pathology: Deals with the study & application of pathological principles in determining the cause & manner of death
2. Forensic toxicology: Deals with the comprehensive study of poisons.
3. Forensic odontology: Deals with the medico-legal aspects of study of teeth.
4. Forensic gynecology & obstetrics: Deals with the gynecological & obstetrical principles in relation to the law of forensic medicine.
5. Forensic psychiatry: It deals with the psychiatric aspects of law in relation to the law of forensic medicine.
6. Forensic chemistry: Deals with the application of chemistry in forensic science.
7. Forensic haematology: Deals with the study of blood & blood products in relation to law.
8. Forensic serology: Deals with the various activity & antigen-antibody reaction in relation to the forensic science.
9. Forensic anthropology: Deals with the origin & development of human being.
10. Forensic anthropometry: Deals with the measurement of different parts of the body in relation to the forensic science.
11. Forensic radiology and Imaging: Deals with the determination of age & foreign particle in relation to the crime & criminal.
12. Medical ethics: Deals with the character, behavior & activities of persons related with medical profession or death.
13. Forensic dactylography: Deals with the fingerprint system for identification of the individual.
14. Forensic thanatology: Deals with the medical & legal aspects of death.
15. Forensic cytogenetics: Deals with the study of genetics of cells in relation to law.
16. Forensic ballistics: Deals with the investigation of firearms, ammunition & the problems arising from their use.
17. Forensic osteology: Deals with the study of bones.
18. Clinical forensic medicine
19. Forensic cyber technology.
20. Forensic osteology.

👉Aim & Objective of Forensic medicine: -

• Application of medical & paramedical knowledge to aid in the administration of justice.
• Solution of legal problems by legal authorities. Some examples are: Applying the medical knowledge in deciding cases of injuries, murder, suicide, accidents, sexual offences, poisoning, etc. 
• Ethical aspect of medical science 
• Legal aspect of medical science

👉 Doctors of all categories should have a fair knowledge about forensic medicine for the following reasons: 

• For professional safeguard: Fair knowledge of forensic medicine helps a doctor to safeguard himself from some legal problems arising during the treatment of victims of criminal act, like a patient of stab injury, during performing criminal abortion, during treating a poisonous case.
• For giving opinions in court of law: A doctor may be asked by the court for his opinion on matter of science as an expert. Forensic medicine helps them in such cases.
• To know about the code of conduct: By knowing forensic medicine a medical man comes to know his own code of conduct that is what to do & what not to do. 

👉Scopes/Uses of forensic medicine: 

1. Application of medical & paramedical knowledge in legal matters, both in civil & criminal cases.
2. Helps in investigation of sudden, unexpected, suspicious or frankly criminal deaths. 
3. Examination of various trauma, injury, dead body, etc. & giving medico-legal opinion regarding the cause & nature of injuries & death.
4. Identification of person by different examinations using medical knowledge & thus helps in crime investigations. 

👉Requirements of medico-legal practice: 

Medico-legal practice requires knowledge, skills & attitude. The skills needed are: 

1. Clinical: The ability to elicit a history, to examine for injuries & to perform the appropriate investigations.
2. Precision in recording the findings. 
3. The ability to present the findings in a clear, concise, correct & meaningful manner.
4. Attitude: (a)Proper respect to the patient.

                  (b)Maintain objectivity in recording the findings.

  MEDICAL JURISPRUDENCE

  "Juris "- Law & "Prudentia"-Knowledge. 

Medical jurisprudence may be defined as the science, concerned with the legal responsibilities of the physician with particular reference to those arising from physician-patient relationship, such as medical negligence cases, consent, rights & duties of doctors, serious professional misconduct, medical ethics, etc. In short, it deals with legal aspects of practice of medicine.

Or. 

Medical jurisprudence may be defined as the science, concerned with the application of rules & regulations for the guidance of medical profession. It deals with those relationships which are generally recognized as having legal consequences, e.g.,

1. Doctor-patient relationship. 
2. Doctor-doctor relationship.
3. Doctor-state relationship.

👉Role of medical jurisprudence during practice of medicine: 

Medical jurisprudence deals with the legal responsibilities of the physician with particular reference to those arising from the doctor-patient relationship, doctor-doctor relationship & door-state relationship, such as- 

• Medical negligence cases. 
• Consent, rights & duties of doctor 
• Serious professional misconduct, medical ethics volante
• It is the subject conducted with knowledge & law of the practice of medicine.

👉Role of anatomy over forensic medicine: 

1. Autopsy: Anatomical knowledge is must to perform the medico-legal autopsy.
2. Toxicology: Preservation of different viscera is essential & helpful to identify the poisonous agent.
3. Identification: Knowledge of anatomy is essential to identify the persons of different races.

👉Different between Forensic medicine & Medical jurisprudence: -

Different between forensic medicine & medical jurisprudence

Short notes

💥Forensic Radiology: -

Forensic radiology may be defined as the branch of forensic medicine which deals with the X- ray examinations, USG, CT, MRI etc for various legal purposes. 

Uses/Role: It is used in- 

• Determining the age, sex, race & stature of a person.
• Diagnosis of pregnancy (Detection of fetus in the uterus).
• Detection of foreign body (bullet) in the body. 
• Diagnosis of live birth. 
• Examination of bone fracture, e.g., In head injury, dislocation of joints.
• It is done in some autopsies (Virtual autopsies). 
• Homicidal cases. 

💥Forensic Pathology: -

Forensic pathology is the branch of forensic medicine which deals with the study & application of the effects of violence or unnatural diseases in its various forms in or on the human body, in determining the cause & manner of death in case of violence, suspicious, unexplained, unexpected, sudden & medically unattended deaths.

Or.

Forensic medicine is the branch of forensic medicine which deals with the study & application of pathological principles in determining the cause and manner of death for medico-legal purposes.

 

Uses: It deals with- 

1. Interpretation of autopsy findings in a medico-legal investigation of deaths! 1910.
2. Study & application of the effects of violence & unnatural diseases on human body.
3. Determination of cause of death & manner of death in unnatural, suspicious, unexplained, unexpected, sudden & medically unattended death. 

💥Clinical forensic medicine (CFM): 

CFM is is the branch of forensic medicine which deals with those who are still alive and on whom a medico-legal opinion is required. It is the interaction of clinical medicine and the law. 

Or.

Clinical Forensic Medicine (CFM) is a medical specialty which deals with the interaction of clinical medicine and the law. 

Or.

It deals with those who are still livened on whom a medico-legal opinions required. This includes those who have been traumatized physically and/or sexually, but who have not succumbed to their injuries, those who are under the influence of alcohol and/or drugs in relation to such matters as driving, human rights abuse etc.

Or. 

Clinical Forensic Medicine is that area of medical practice whereby medicine and law overlaps.

Scopes of CFM: -

• It deals physical trauma, sexual assault, pregnancy, abortion, delivery, age dispute. 
• It deals traffic medicine 

(i) Influence of Alcohol and/or drugs in relation to such matters as driving, human right abuse. (ii) fitness to drive 

(iii) Medical aspects of crash analysis 

• It deals Custodial medicine, i.e. 

(i) examine the treatment of police detainees. 

(ii) fitness for interview assessments of police detainers. 

💥Forensic Thanatology: -

"Thanatos" (Greek word) -Death

"Logia" (Greek word) -Speaking

Forensic thanatology is the branch of forensic medicine which deals with the scientific study of death, types of death, the various events or changes that occur in the cadaver & their medico-legal significance. 

Or.

Forensic thanatology is the branch of forensic medicine which deals with all legal & medical aspects of death.

💥Medical etiquette: -

Medical etiquette means the sense of courtesy & respect which should govern the conduct & relationship between the members of medical profession.

Or.

Medical etiquette deals with the conventional laws of courtesy observed between members of the medical profession. Ethical behavior is a self-imposed duty upon each doctor.

Example: -  

1. A doctor should behave with his colleagues as he would have them behave wih himself.
2. A doctors should not criticize or denigrate the professional ability of another doctor, while dealing with a patient. 

💥Bioinformatics: -

Bioinformatics is a field of study that uses computation to extract knowledge from biological data. It includes the collection, storage, retrieval, manipulation and modeling of data for analysis, visualization or prediction through the development of algorithm and software. 

Function: -

1. DNA sequencing 
2. Genome annotation 
3. Genetics of disease
4. Analysis of gene expression 

Viva Question 

1. What do you mean by forensic medicine?
2. What do you mean by forensic dactylography?
3. What do you mean by forensic anthropometry?
4. What is the role of medical jurisprudence during practice of medicine? 
5. What is bioinformatics?

Multiple choice Question (MCQ)

𝙌Branches of forensic medicine- 

a. Forensic odontology (T)

b. Forensic hematology (F)

c. Forensic serography (F)

d. Forensic chromatography (F)

e. Forensic obstetrics (T)

𝙌 Forensic medicine deals with- a. Legal aspects of practice of medicine (T) b. medical aspects of law (F) c. Investigation of law (F)

d. Post-mortem examination (T) e. Solution of legal problems (T)

𝙌First ML autopsy performed in:

a. Italy (T)

b. France (F) c. Denmark (F)

d. Japan (F

e. Sweden (F)

𝙌Clinical forensic medicine deals To detect foreign body (T) a. Post-mortem examination (F)

b. Rape case examination (T) c. Injury patient examination (T) d. Chemical analysis (F) e. Age determination (F)

𝙌Forensic medicine deals with: -

a. Legal aspect of medical practice. (T)

b. medical aspect of law. (F)

c. Investigations of law (F)

d. PM examination. (T)

e. Used for solution of legal problem. (T)

💥Reference: -

⟥Reddy 35th 1, Nandy 3rd- 1

Q F