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Date posted: October 24, 2011

Dr  Sanil Kumar BHMS MD(Hom)
Department of Forensic Medicine & Toxicology
Govt Homeopathic Medical College. Calicut
Email : drsakumkumar@yahoo.co.in

SEXUAL OFFENCES
Abnormal Sexual Perversions
1. Necrophagia—Necros = corpse; phagia = to eat.
2. Masochism—Opposite to sadism. Derived from the name of Leopold von Sacher-masoch, an Austrian novelist. Being whipped by his wife used to be a stimulant for his literary work.
3. Necrophilia—Sexual intercourse with dead body.
4. Fetichism—Sexual satisfaction by contact with articles of opposite sex.
5. Voyeurism (Scoptophilia)—Peeping Tom. It is sexual enjoy¬ment from watching.
6. Frotteurism—Contact with other persons to obtain sexual gratification.
7. Undinism—Sexual pleasure by witnessing the act of Urination.
8. Transvestism—Trans = opposite, Vesta = clothing or Eonism. The term is derived from the name of Chevelier d’ Eon Beamont, a Frenchman. It is usually found in the males who derive sexual pleasure by wearing female dress.
9. Satyriasis—Incessant sexual desire.
10. Priapism—Painful penile erection in absence of sexual desire.
11. The combining of Sadism and Masochism is called bondage.
12. Pyromania — Sexual stimulation while seeing flames or, destruction of buildings.

Classification of Sexual Offences
 
I. Natural offences (1) Rape (2) Incest
II. Unnatural offences (1) Sodomy (2) Tribadism (3) Bestiality (4) Buccal coitus.
III. Sexual perversions: (1) Sadism (2) Masochism (3) Necrophilia (4) Fetichism (5) Transvestism (6) Exhibitionism (7) Masturbation (8) Voyeurism (9) Frotteurism (10) Undinism, etc.

Rape (S. 375, IPC)
A man is said to commit rape, if he has sexual intercourse with a woman:

  1. against her will,
  2. without her consent,
  3. with her consent, when her consent has been obtained by putting her or any person whorn she is interested in fear of death, or of hurt,
  4. with her consent, when the man knows that he is not her husband and that she has given consent because she believes that he is another man to whom she is lawfully married.
  5. with her consent, when at the time of giving such consent, by reason of unsoundness of mind or intoxication or the administration of any stupefying substance, she is unable to understand the nature and consequences of that to which she gives consent,
  6. with or without her consent when she is under 16 years of age;

Exception:— sexual intercourse by a man with his own wife is not rape, if she is above 15 years of age (Sec 375 IPC).

Rape offence is punishable under Sec- 376 IPC.
(1) Whoever commits rape shall be punished with imprisonment for a term of not less than 7 years, but which may be for life or ten years and also fine. If the woman raped is his own wife and is not under 12 years, the imprisonment may extend to 2 years or fine or with both.
(2) Whoever, (a) being a police officer commits rape, within the limits of his jurisdiction, in the premises of any station house, or on a woman in his custody, (b) being a public servant takes advantage of his official position and commits rape on a woman in his custody, (c) being on the management or the staff of a jail, remand home, etc., commits rape on any inmate, (d) being on the management of a staff of a hospital commits rape on a woman of that hospital, (e) commits rape on a woman knowing her to be pregnant, (f) commits rape on a woman below 12 years, or (g) commits gang rape, shall be punished with rigorous imprisonment of not less than 10 years or life imprisonment and also fine.

A woman of 16 years and above can give valid consent for sexual intercourse. The slightest penetration of the penis within the vulva, with or, without emission of semen or rupture of hymen constitutes rape. Rape can be committed even when there is inability to produce erection of penis. Under the law, rape can only be committed by a man and a woman cannot rape a man, although she may be guilty of an indecent assault upon him. In India, there is no age limit under which a boy is considered physically incapable of committing rape. Medical proof of intercourse is not legal proof of rape. Rape is a cognizable offence.
False rape is called simulated rape.

Incest: Incest is a sexual intercourse by a man with a woman, who is closely related to him by blood e.g. a daughter, grand daughter, sister, stepsister, aunt and mother. In India, incest as such is not an offence.

Paraphilias: Abnormal and unorthodox sex play by using unusual objects or parts of the body are known as paraphilia.

Unnatural Offences
Voluntary sexual intercourse against the order of nature with any man or woman or animal is an unnatural sex offence (S. 377, IPC). These offences are punishable with imprisonment for life or up to 10 years and also with fine.

Homosexuality means persistent emotional and physical attraction to members of same sex.

Sodomy is anal intercourse between two males or, between a male and female. It is also called buggery. It is called gerontophilia when the active agent is an adult and paederasty, when the passive agent is a young boy, who is known as catamite.

A paedophile is an adult who repeatedly engages in sexual activities with children below the age of puberty. The consent of sodomy is of no value, as both partners are punishable.

Buccal coitus (coitus per os or sin of Gommorrah): The male organ is introduced into mouth, usually of a young child.
1. Male prostitutes are called—Eunuchs.
2. Castrated Eunuchs—Hijrahs.
3. Eunuchs with intact genitalia—Zenana.

 Tribadism:
Female homosexuality is known tribadism or lesbianism. Sexual gratification of a woman is obtained by another woman by simple lip kissing, generalised body contact, deep kissing, manual manipulation of breast and genitalia, genital apposition, friction of external genital organs etc. In some cases, enlarged clitoris is used as an organ of passion or some artificial penis or phallus may be used. Many lesbians are masculine in type, possibly because of endocrine disturbances. The practice is usually indulged in by women who are mental degenerates or who suffer from nymphomania (excessive sexual desire). Lesbians who are jealous of one another, when rejected may commit homicide, suicide or both.

Bestiality: Bestiality is sexual intercourse by a human being with a lower animal. Dogs and cats are common animals for female. Usually the animal manipulates the genitalia with its mouth and the actual coitus is very rare.

Sexual Perversions: Sexual perversions are persistently indulged sexual acts in which complete satisfaction is sought and obtained without sexual intercourse.
1. Uranism—Perversion of sexual instinct.
2. Sadism—In sadism, sexual gratification is obtained or increased from acts of physical cruelty or causing of pain upon one’s partner. The term is derived from the name of a French nobleman, the Marquis de Sade, infamous for his crimes and writings. Many of his stories were about sexuality, cruelty, and torture.
3. Lust murder—In extreme cases of sadism, murder serves as a stimulus for sexual act and becomes equal to coitus.
4. Sexual oralism—It is the obtaining of sexual pleasure from the application of the mouth to the sexual organs.
—Sin of Gommorrah —>Buccal coitus, coitus per os.
—Felatio —> is the oral stimulation or manipulation of the penis either by the female or male.
— Cunnilingus is the oral stimulation of the female genitalia.

5. Masturbation (Onanism, ipsation)—Masturbation is the deliberate self stimulation, which effects sexual arousal. In females, a finger is gently and rhythmically moved over clitoris or labia minora or steady pressure is applied over these parts with several fingers or whole hand. Masturbation is an offence when practiced openly e.g. in telephone booth, lavatories etc.

6. Exhibitionism: It is a willful and intentional exposure of the genitalia in a public place while in the presence of others, to obtain sexual pleasure. This is punishable under Sec 294 IPC with imprison¬ment up to 3 months or fine.

7. Indecent Assault: Indecent assault is an offence committed on a female, with the intention or knowledge to outrage her modesty.
— This includes: Kissing of any part of female body, Pressing the breasts or private parts, Touching private parts or- thereabout including thighs, Exposing her genital parts or breasts,
 
 A medical practitioner can be accused of indecent assault if he examines a female patient by stripping her clothes without her consent and even with her consent in the absence of a female attendant (viz. nurse).
Such assaults are punishable under Sec 354 IPC up to 2 years imprisonment and/or fine.

SEMINAL FLUID

Seminal stains have to be detected in cases of rape or attempted rape, sexual murder of the female, sodomy and bestiality. Fertility of fluid has to be proved in disputed paternity. Chemical Examination:
(a) Florence test: It is the best test for seminal stains. The stain is extracted by 1% hydrochloric acid and a drop is placed on a glass slide. A drop of florence solution (potassium iodide, iodine and water) is allowed to run under the cover slip. If semen is present, dark-brown crystals of choline iodide appears immediately. They are rhombic crystals resembling haemin. The test is not proof of seminal fluid, but only of presence of some vegetable or animal substance.
(b) Barberio’s test: A saturated aqueous or alcoholic solution of picric acid when added to spermatic fluids produces yellow needle-shaped rhombic crystals of spermine picrate. In Barberio’s test, presence of spermine in semen is detected.
(c) The Acid phosphatase test: The prostatic secretion element of seminal fluid contains very much higher percentage of acid phosphatase. This test is conclusive in the absence of demonstrable sperms or in aspermia.
(d) Creatine phosphokinase: Serological typing of the semen is possible by precipitin method.
(e) Ammonium molybdate test: for semen stains.

IMPOTENCE AND STERILITY

Impotence is the inability of a person to perform sexual inter¬course.
Sterility is the inability of the male to beget children, and in the female, the inability to conceive children.
Frigidity is the inability to start or maintain the sexual arousal pattern in the female.
Impotence may be pleaded as a ground for all – Divorce, Adultery, Unnatural sexual offence except rape.

The question of impotence and sterility may arise in:
(A) Civil— (i) nullity of marriage (ii) divorce (S.12, Hindu Marriage Act, 1955; S.24, Special Marriage Act, 1954) (iii) adultery (iv) disputed paternity and legitimacy (v) suits of adoption (vi) claim for damages where loss of the sexual function is claimed as the result of an assault or accident
(B) Criminal— (i) adultery (ii) rape (iii) unnatural offences.
Men with primary impotence associates sex with dirtness and sinfulness. Systemic disease which is most frequently associated with secondary impotence is Diabetes mellitus. Psychogenic or fear of impotence or, fear of inability complete the act are most common causes of temporary impotence.
Impotent quoad is an individual who may be impotent any particular woman (quoad = as regards) but not with others. Vaginismus is involuntary spasm of perineal muscle so that sexual intercourse is not possible. Treatment is psychotherapy. After vasectomy, the person should be advised to abstain from sexual intercourse for about 3 months. A battered child is one who has received injuries as a result of non-accidental violence produced by a parent or guardian.
Sudden infant death syndrome (SIDS or Cot death)—The commonly accepted hypothesis suggests that some infants have prolonged sleep apnoea, which makes them susceptible to hypoxia, which leads to bradycardia and cardiac arrest.

ARTIFICIAL INSEMINATION:
It is artificial introduction of semen into the vagina cervix or uterus to produce pregnancy. One ml. of semen is deposited by means of syringe in or near the cervix.
Indications:
(i) When the husband is impotent (not an indication for A.I.D).
(ii)When the husband is unable to deposit the semen in vagina due to hypospadias.
(iii) When the husband is sterile.
(iv) When there is Rh-incompatibility between husband and wife,
(v) When husband is suffering from hereditary disease such as colour blindness, sickle cell disease.

Legal problems of Artificial Insemination Donor:
1. Adultery—Donor and recipient cannot be held guilty of adultery in India, as Sec. 497 IPC requires sexual intercourse as necessary part of adultery.
2. Legitimacy—such a child is illegitimate and cannot inherit property.
3. Nullity of marriage and divorce—Artificial insemination is not a ground for nullity of marriage or divorce. However, if A.I is due to impotence, it is a ground. If A.I is done without the consent of the husband, he can sue his wife for divorce and the doctor for damages.
4. Natural birth: if a child is born naturally sometime after a child born by A.I, the status of the child born after A.I remains illegitimate unless it is adopted, and the status of the natural born child remains legitimate.

Test tube baby (IVF):
The ovum is removed from the ovary of the woman and is fertilised outside the body. At the stage of blastocyst, the embryo is returned to the uterus, which gets implanted in the endometrium.

 Surrogate birth:

Artificial insemination with the semen of the barren woman’s husband is carried out in a hired woman.

VIRGINITY
A virgin (virgo intacta) is a female who has not experienced sexual intercourse. Defloration means loss of virginity. The question of virginity arises in case of (1) nullity of marriage, (2) divorce, (3) defamation, and (4) rape.

Signs of virginity:
A. Genital findings:
(i) Labia majora — firm, elastic and rounded and lies in close contact with each other even in full abduction of the thighs
(ii) Labia minora — soft and elastic, small and pinkish colour. They lie in close contact and are not visible being under the labia majora.
(iii) Clitoris — not enlarged,
(iv) Vestibule — narrow,
(v) Hymen — intact.
(vi) Vagina — narrow and tight with rugosed pinkish walls, ori is slit like due to the apposition of wall, and due to presence of hymen.
(vii) Perineum — entire.
B. Extra genital findings:
(i) Breast — hemispherical, firm, plump and elastic.
(ii) Nipple — small and pointed surrounded by pink areola.

Narrow and tight vagina is not seen in false virgin. Tears on hymen caused by sexual intercourse or by fore body is usually situated postero-laterally.

Causes of rupture of hymen:
1. An accident—Hymen does not rupture by riding, jump dancing etc.
2. Masturbation.
3. Sola pith introduced into vagina.
4. Sanitary tampoon.
Most important sign of defloration is hymen rupture. Important support of uterus preventing prolapse is transverse cervical ligaments. In women who are used to coitus, and in those who have borne children, the hymen is destroyed and different sized small, round,, fleshy projections or tags, known as carunculae hymenales or myrtiformes are formed round the hymenal ring.

PREGNANCY
Pregnancy is a condition of having a developing embryo or foetus in the female, when an ovum is fertilized by a spermatozoon.
The question of pregnancy has to be determined in the following conditions:
(1) When a woman pleads pregnancy to avoid attendance in Court as a witness.
(2) When a woman convicted of capital crime, pleads that she is pregnant, to avoid execution. The High Court has the power to postpone the execution of death sentence or to commute it as Imprisonment for life (S.416, Cr.P.C).
(3) When a woman feigns pregnancy soon after death of her husband to claim succession to estate.
(4) To assess damage in a seduction or breach of promise of marriage case.
(5) When a woman blackmails a man and accuses that she is pregnant by him, to compel marriage.
(6) In allegations that an unmarried woman, widow, or a wife living apart from her husband is pregnant
(7) When a woman alleges that she is pregnant in order to get greater compensation when her husband dies through the negligence of some person
(8) When pregnancy is alleged to be motive for suicide or murder of unmarried woman or widow
(9) In cases of divorce, the woman may claim to be pregnant to receive more alimony
(10) In cases of alleged concealment of birth of pregnancy and infanticide.

Diagnosis of pregnancy: the signs and symptoms are usually classified into three groups:
(1) The Presumptive signs, (2) The Probable signs, (3) The Positive signs.

(1) The presumptive signs are amenorrhoea, changes in breast, morning sickness, quickening, pigmentation of the skin, changes in the vulva, urinary disturbances, fatigue and sympathetic disturbances.
Amenorrhoea is the earliest and one of the most important symptom of pregnancy. Breast changes are quite characteristic in primi-gravidas but are of less value in multiparas. Morning sickness usually appears about the end of the first month and disappears 6 to 8 weeks later. Nausea and vomiting are usually present in the morning, and pass off in a few hours. From about 16th to 20th week, the pregnant woman feels slight fluttering movements in her abdomen (Quickening). The vulva, abdomen and axillae become darker due to the deposit of pigment, and a dark line extends from the pubis to beyond the umbilicus, the so called linea nigra. The mucous membrane of the vagina changes from pink to violet, deepening to blue as a result of venous obstruction, after the fourth week (Jackquemier’s sign or Chadwick’s sign). Enlarging uterus exerts pressure on the bladder and produces frequent micturition. Easy fatigue is very important. Salivation, perverted appetite and irritable temper are common.

(2) The probable signs of pregnancy are enlargement of the abdomen, Hegar’s sign, Goodell’s sign, Braxton-Hick’s sign, Ballottement, uterine souffle, biological tests and immunological tests.
During pregnancy, abdomen gradually enlarges in size after the 12th week. Hegar’s sign is positive at about the sixth week. This is the most valuable physical sign of early pregnancy. Goodell’s sign is the progressive softening of the cervix from below upwards, well marked from the fourth month. Intermittent, painless uterine contractions are easily felt after the fourth month known as Braxton-Hick’s sign. They are present even when the fetus is dead. Ballottement is positive during the fourth and fifth month of pregnancy as the fetus is small in relation to the amount of amniotic fluid present. This can be negative if the amniotic fluid is scanty. Uterine souffle is a soft blowing murmur, which is synchronous with the mother’s pulse. It is due to passage of blood through the uterine vessels.
The biological tests are (1) The rapid rat test (2) The Aschheim-Zondek test (3) Friedman test (4) Hogben or female toad test (5) male frog test (6) Galli-Mainini test.
The immunological tests are (1) Inhibition (indirect) latex slide test (2) Direct latex slide test.

(3) Positive signs of pregnancy: They are fetal movements, fetal heart sounds, X-ray diagnosis and Sonography.
Fetal movements are felt by placing the hands on the abdomen by 24 weeks. Fetal parts can be identified by abdominal palpation by 36 weeks. Fetal heart sounds are important and definite sign of pregnancy. They are heard between 18 to 20 weeks for the first time. Rate is usually about 160 at fifth and 120 at the ninth month, not synchronous with the mother’s pulse.
Fetal sounds are not heard: (a) when the fetus is dead, (b) when there is excessive amount of liquor amnii, (c) when abdominal wall is very fatty, (d) when examination is made before 18 weeks of pregnancy. At about 15 to 16 weeks, fetal parts can be detected with certainty. Usually the skull and spine are seen at 15 to 16 weeks.
Radiological signs of fetal death are (1) Spalding’s sign, (2) Collapse of the spinal column due to absence of muscle tone, (3) presence of gas in the heart and great vessels.

Pseudocyesis (spurious or phantom pregnancy): is usually observed in patients nearing the menopause or in younger women who intensely desire children.
Signs of pregnancy in the dead: The presence of an embryo, foetus, placental tissue, membranes or any other product of conception is a positive proof.

Period of gestation: Average is 280 days from the first period of the last menstrual period, so that the actual period is about 270 days or less. Maximum period concluded for medico-legal purpose is 354 days from the coitus to live-birth. The maximum period accepted by English courts on medical evidence is 349 days. Child born at or after 210 days of uterine life are viable, i.e., are born and able to survive.
Posthumous child: It is a child born after the death of its father, the mother being conceived by the said father.

Superfecundation: it means the fertilisation of two ova which have been discharged from the ovary at the same period by two separate acts of coitus committed at short intervals.
Superfoetation: This means the fertilisation of a second ovum in a woman who is already pregnant.

Legitimacy and paternity:
Legitimacy is the legal state of a person born in lawful marriage. If a person is born during the continuance of a legal marriage, or within 280 days after the dissolution of a legal marriage by divorce or death of the husband, his birth is presumed to be legitimate (S.112, I.E.A).
Atavism – The child does not resemble its parents, but resembles its grandparents.

Wife battering: A battered wife is a woman who has received a deliberate, severe, and repeated demonstrable physical injuries from her husband. Faulk has categorised the involved men into five groups: (1) Dependent passive, (2) Dependent suspicious, (3) Violent and bullying, (4) Dominating, (5) Stable and affectionate.

Delivery means the expulsion or extraction of the child at birth. The question of delivery arises in (1) abortion, (2) infanticide, (3) concealment of birth, (4) feigned delivery, (5) legitimacy, (6) nullity of marriage, (7) divorce, (8) chastity, and (9) blackmail.

Signs of recent delivery in the living: For the first 2 or 3 days the woman is pale, exhausted and ill-looking with increase in pulse and slight fever. Breasts are full, enlarged and tender with a knotty feeling, and colostrum or milk may be expressed. The areolae are dark, nipples enlarged, and superficial veins prominent, and Montgomery’s tubercles are present. The abdominal walls are pendulous, wrinkled and show striae gravidarum especially in flanks which appear as irregular, pink, subcutaneous scars. The uterus feels like hard muscular tumour, the upper border of which lies about 3 cm. below the umbilicus. It then diminishes in size by about 1.5 cm a day. The labia are tender, swollen and bruised or lacerated. The vagina is relaxed and capacious. Perineum may be lacerated. Cervix is soft and dilated and its edges torn and lacerated transversely.

The lochia is a discharge from the uterus which lasts for 2 or 3 weeks. During the first 4 to 5 days, the discharge is bright-red and contains large clots (lochia rubra). During the next 4 days, it becomes serous and paler in colour (lochia serosa). After the ninth day, colour becomes yellowish-green or turbid (lochia alba) until its final disappearance.
It the blood or urine gives a positive pregnancy test, it is strong corroborative evidence that pregnancy has recently terminated.
Oligohydramnios is seen in renal-agenesis. In pregnancy, trace element not supplemented from diet is iron.
Signs of Remote delivery in the dead include:
1. Uterus is larger, thicker, and heavier.
2. Walls are concave from inside.-
3. Top of the fundus is convex, and at a higher level than that of broad ligaments.
4. The body of uterus is twice the length of cervix (same length in virgin).
5. The cervix is irregular in form, shortened, its edges show cicatrices.
6. External os is enlarged, and Internal os is not so well defined.

ABORTION
Legally, abortion (miscarriage) means the premature expulsion of the fetus from the mother’s womb at any time of pregnancy, before full term of pregnancy is completed.

Classification: (1) Natural: (a) Spontaneous (b) Accidental (2) Artificial (a) Justifiable (b) Criminal.

 Natural abortion
is the abortion occurring at any time due to natural causes.
Justifiable or therapeutic abortion: Abortion is justifiable only when it is done in good faith to save the life of a woman, if it is materially endangered by the continuance of pregnancy. The World Medical Association in 1970, adopted a resolution on therapeutic abortion, known as Declaration of Oslo.
Criminal abortion is the induced destruction and expulsion of the foetus from womb of the mother unlwfully, i.e., when there is no therapeutic indication for the operation.

Under S.312, IPC, whoever voluntarily causes criminal abortion is liable for imprisonment up to 3 years, and/or fine; and if the woman is quick with child, the imprisonment may extend up to 7 years.
If the means used to abort do not succeed, it is punishable under S.511, IPC with imprisonment up to half of the punishment under S.312.
Under S.313, IPC, if the miscarriage is caused without the consent of the woman, the imprisonment may be up to 10 years.
Under S.314, IPC, if a pregnant woman dies from an act intended to cause miscarriage, the offender is liable to be punished with imprisonment up to 10 years.
Under S.315, IPC, a person doing an act intended to prevent the child from being born alive or to cause to die after its birth is liable to be punished with imprisonment up to 10 years.
Under S.316, IPC, causing death of quick unborn child by any act amounts to culpable homicide, and the punishment may extend up to 10 years imprisonment.

The medical termination of pregnancy act was passed in 1971. Under this act, pregnancy can be terminated under the following conditions: (1) Therapeutic (2) Eugenic (3) Humanitarian (4) social.
Therapeutic abortion is indicated when the continuation of pregnancy endangers the life of a woman or may cause serious injury to her physical or mental health.

Eugenic: When there is risk of the child being born with serious physical or mental abnormalities. This may occur: (A) If the pregnant mother in the first three months suffers from German measles, small-pox or chicken-pox, viral hepatitis, toxoplasmosis, any severe viral infection (B) If the pregnant mother is treated with drugs like thalidomide, cortisone, etc (C) Mother is treated by X-rays or radio-isotopes (D) Insanity of the parents

Humanitarian: when pregnancy is caused by rape
Social: (A) Failure of contraceptive techniques in case of a married woman (B) when social or economic environment, actual or reasonably expected can injure the mother’s health.

Only a qualified RMP possessing experience can terminate pregnancy. A RMP can qualify if he has assisted in performance of 25 cases of M.T.P in a recognised hospital. The consent of the woman is required before conducting abortion; written consent of the guardian is required if the woman is a minor or lunatic. Consent of husband is not necessary. The age of women for abortion is over 18 years. MTP act, 1971 allows termination of pregnancy up to 20 weeks. If the period of pregnancy is below 12 weeks, it can be terminated on the opinion of a single doctor. If the period of pregnancy is between 12 and 20 weeks, two doctors must give opinion that there is an indication. The doctor is protected from any legal action for any damage caused or likely to be caused in terminating pregnancy, provided he has acted in good faith and exercised proper care and skill.

Methods of procuring criminal abortion:
(I) Abortifacient drugs: which produce congestion of the uterine mucosa and then uterine bleeding, followed by contraction of the uterine muscle and expulsion of the foetus, or they cause the uterine contraction by stimulating the myometrium directly.
(i) Drugs that act directly on the uterus:
(A) Ecbolics: They increase uterine contraction and are likely to cause abortion. Eg., Ergot, Hydrastis canadensis, Quinine, Lead in the form of pills made from diachylon (lead oleate) or lead palster is commonly used.
(B) Emmenagogues: They produce or increase menstrual flow. The chiel of these are savin, borax, apiol, rue, laburnum, oestrogens, sanguinarin, senacio, caulophyllin, hellebore, etc.
(iii) Irritants of the Genito-urinary tract: They produce reflex uterine contractions, e.g., oil of pennyroyal, oil of tansy, oil of turpentine, cantharides, etc
(iv) Irritants of the Gastro-intestinal tract: Any substance which causes irritation of the colon may produce hyperaemia and contractions of uterus. Saline cathartics, such as magnesium sulphate or drastic purgatives, such as, aloes, calomel, castor oil, croton oil, jalap, colocynth etc are commonly used.
(v) Drugs having poisonous effects on the body: (a) Inorganic irritants: e.g., lead, copper, iron, mercury, and antimony (b) Organic irritants: e.g., cantharides, unripe fruit of pappaya, unripe fruit of pineapple, seeds of moringa, juice of calotropis, bark of plumbago rosea, saffron, etc.
(II) General violence: It acts directly on the uterus, or indirectly producing congestion of pelvic organs, or hemorrhages between uterus and membranes.
(i) Intentional: (1) Severe pressure on abdomen by blows, kicks, jumping, etc and massage of the uterus through the abdominal wall. (2) Violent exercise like horse riding, cycling, jumping from height, running upstairs, etc. (3) Cupping.
(ii) Accidental:
(III) Local violence: (1) Syringing (2) Rupture of the membranes (3) Dilation of the cervix (4) Abortion stick (5) Air insufflations (5) Electricity (6) Curettage (7) Pastes.

Methods for therapeutic abortion: The common methods are
(1) Low rupture of membranes
(2) Utus paste injection
(3) Dilatation of cervix and oxytocic infusion, or a direct injection of 10 units of oxytocin into the uterus causing abortion
(4) Dilatation of the cervix and evacuation of the uterus by curettage, during the first three months.
(5) Prostaglandins
(6) Amniotic fluid replacement therapy
(7) Vaccum aspiration.
(8) Abdominal hysterectomy

Doctor’s duties in a case of criminal abortion:
The doctor should keep all the information obtained by him as a professional secret. He must ask the patient to make a statement about the induction of criminal abortion. He must treat her to the best of his ability. He must consult a professional colleague. If the woman’s condition is serious, he must arrange to record the dying declaration. If the woman dies, he should not issue a death certificate, but he should inform the police.

INFANTICIDE
According to the Infanticide Act of England (1938), infanticide means the unlawful destruction of a child under the age of one year. In India, there is no such special Act, and as such there is no difference between the murder of newborn infant and that of any other individual. Foeticide is the killing of a fetus at any time prior to birth.

A Stillborn child is one, which is born after 28th week of pregnancy, and which did not breathe or show any other signs of life, at any time after being completely born.
Causes of still birth are: prematurity, anoxia of various types, birth trauma especially intracranial hemorrhage due to excessive moulding, placental abnormalities, toxaemias of pregnancy, erythroblastosis foetalis, and many types of congenital defects.

A dead-born child is one which has died in utero, and shows one of the following signs after it is completely born.

Signs of dead-born are: (1) Rigor mortis at delivery (2) Maceration (3) Mummification.

Maceration is a process of aseptic autolysis, and is the usual change. This occurs when the dead child remains in the uterus for about 3 or 4 days surrounded with liquor amnii but the exclusion of air. The earliest sign of maceration is skin slippage, which can be seen in 12 hours after the death of the child in utero. The body of a macerated fetus is soft, flaccid and flattens out when palced on a level surface. It has a sweetish, disagreeable odour.

Spalding’s sign: Loss of alignment and over-riding of the bones of the cranial vault occurs due to shrinkage of the cerebrum after the death of the foetus. The sign will develop within a few days of death of the foetus, but often takes much longer time, sometimes even 2 to 3 weeks.
Mummification occurs when the fetus dies from deficient supply of blood, when liquor amnii is scanty, and when no air enters uterus.

Viability of the infant: Viability means the physical ability of a fetus to lead a separate existence after birth apart from its mother, by virtue of a certain degree of development.
Livebirth means that the child showed signs of life when only part of the child was out of the mother, though the child may not have breathed or completely born. The causing of death of such a child is homicide.

Live-birth is probable when:
(1) All the lobes of the lungs are fully expanded with or without obstructive emphysema
(2) There is oedema of the lungs, especially gross
(3) An alveolar duct membrane is present and has widespread distribution in the lungs
(4) Pulmonary atelectasis due to obstruction of an alveolar duct membrane is present
(5) Contusions of the lung are present.

 Tests for live birth:

(A) Static test o Fodere’s test: Average weight of both lungs before respiration varies; 30 to 40 gm and after respiration 60 to 66 gm.
(B) Hydrostatic test: The specific gravity of lungs before respiration varies from 1040 to 1050 and after respiration about 940, so it floats in water.
(C) Plocquet’s test: Weight of lungs to body. 1:70 – unrespired lung, 1:35 – respired lung
(D) Wredin’s test: For air in the middle ear.
(E) Breslow’s sign: For air in stomach and duodenum.
Still-birth is probable in the presence of:
(1) Maceration of the infant
(2) Flooding of the lung with liquor amnii, and especially evidence of phagocytosis of meconium by the cells lining the cells
(3) Desquamation of the bronchial epithelium
(4) Distension of large bowel with meconium indicating a struggle to breathe.

Meconium is the green viscid substance consisting of thickened bile and mucus.
Caput succedaneum: is an area of soft swelling that forms in the scalp over the presenting part of the head in vertex presentations.

Cephalhematoma: is a localised accumulation of blood deep to the scalp, between the periosteum and bone surface.
Umbilical cord attached to the child shrinks and dries in 12 to 24 hours, and an inflammatory ring forms at the base in 36 to 48 hours. It mummifies on second to third day. The cord falls off on the fifth or sixth day and leaves an ulcer, which heals and forms a scar in 10 to 12 days.
Contraction of the umbilical arteries starts in about 10 hours and is completely closed by third day. The umbilical vein and ductus venous are closed on the fourth day. The ductus arteriosus closes by tenth day, and foramen ovale by second or third month.

Causes of death of the fetus may be due to (1) Natural causes, and (2) Unnatural causes.

Natural causes: (i) Immaturity (ii) Debility due to lack of genera development (iii) Congenital diseases (iv) Malformations (v) Haemorrhage from the umbilical-cord, genital organs, stomach, rectum, etc (vi) Post-maturity (vii) Pre-eclamptic toxaemia (viii) Disease of the placenta or its accidental seperation from the uterine wall (ix) Placenta praevia or abnormal pregnancy (x) Neonatal infection (xi) Intrapartum or ante-partum anoxia (xii) Cerebral birth trauma (xiii) Erythroblastosis foetalis.
Unnatural causes: These may be (1) Accidental, and (2) Criminal

(1) Accidental causes: (a) During birth: Prolonged labour, prolapse of cord or pressure on the cord, twisting of the cord around the neck or knots of the cord, injuries to the mother, death of the mother. (b) After birth: Suffocation.

(2) Criminal causes: These may be (1) Acts of commission, and (2) Acts of omission
(a) Acts of commission: Suffocation, strangulation, drowning, burning, blunt head injury, fracture and dislocation of cervical vertebrae, wounds, poison.
(b) Acts of omission or neglect.

The abandoning of infants: If the father or mother of a child under the age of 12 years, or anyone having the care of such child, leaves such a child in any place with the intention of abandoning the child, shall be punished with imprisonment up to 7 years (S. 317, IPC).

Concealment of birth: Whoever, secretly buries or otherwise disposes of the dead body of a child, whether such child dies before or after or during its birth, intentionally conceals the birth of such child, shall be punished with imprisonment up to 2 years (S. 318, IPC).

 Sudden infant death syndrome
(SIDS), or cot death or crib death is defined as the sudden and unexpected death of seemingly healthy infant, whose death remains unexplained even after a complete autopsy. Accepted hypothesis is sleep apnoea.

Battered baby syndrome: A battered baby is one who has received injuries as a result of non-accidental violence, produced by a parent or guardian. The classical features are the obvious discrepancy between the nature of injuries, and explanation given by the parents, and delay between the injury and medical attention which cannot be explained.

Diagnosis of BBS: (1) Nature of injuries (2) time taken to seek medical advice (3) recurrent injuries.
DD of BBS: Scurvy, congenital syphilis and osteogenesis imperfecta, (except – osteomyelitis).

BLOOD STAINS
The source of the blood (human or animal) is determined by the Serologist of the Government of India at Calcutta. All stains should be sent to the SFSL.

The chemical tests depend on the presence in the blood stains of an enzyme peroxidase, which in the presence of hydrogen peroxide, oxidises the active ingredient of the reagent and produces the characteristic coloured compound.

I. Benzidine test: Most reliable chemical test for blood. Add a drop of saturated solution of benzidine in glacial acetic acid and then a drop of 10 volumes hydrogen peroxide. If blood is present, dark blue colour is produced immediately. A positive reaction is given by blood of almost any age, blood that has been exposed to heat or cold. It detects blood when present in a dilution of one part of blood in 3 lakhs. If a negative reaction is obtained it is certain that the stain is not blood. After death, up to 150 years the test which is positive is Benzidine test.

II. Micro chemical examination:
1. Red corpuscles.
2. Haemin crystal test (Teichmann’s Test)—A small crystal of sodium chloride and 2 to 3 drops of glacial acetic acid are placed on a glass slide. Brownish-black rhombic crystals of haemin or haematin chloride arranged singly or in clustors are seen if blood is present.
3. Haemochromogen crystal test (Takayama test) – Place a small piece of suspected material on a glass slide and add 2 or 3 drops of Takayama reagent (sodium hydroxide, pyridine, glucose), and cover with a coverslip. Pink, feathery crystals of hemochromogen or reduced alkaline hematin arranged in clusters, sheaves, etc., appear in one to six minutes. It is delicate and more reliable.

III. Spectroscopic examination:
— It is the most delicate, specific and reliable test for detecting the presence of blood in both recent and old stains.
IV. Serological examination: This determines whether the blood is derived from human being or from a lower animal.
(A) Immunological methods: (1) Precipitin test (2) Antiglobulin consumption test (3) Gel diffusion (4) Double diffusion in agar gel (5) Precipitation-electrophoresis
(B) Isoenzyme methods

For Blood Stains
1. Magrath test—If blood is present, luminescence is seen.
2. Takayama’s test—Haemochromogen crystal test. Delicate and reliable test. Pink, feathery structure.
3. Tiechmann’s test—Haemin crystal test, microscopy test
4. Precipitin test—Confirm blood of human origin.
5. Phenolphthalein test—Kastle-Mayer test -> pink-purple, ex mely delicate.
6. Benzidine test—Best preliminary test, blue colour.
7. Chromatography—Absorption spectroscopy is the best te
8. Guicum test—Deep blue.
9. Leuco malachite test—Peacock-blue colour.

FORENSIC PSYCHIATRY

Psychiatry deals with the study, diagnosis and treatment of mental illness. Forensic psychiatry deals with the application of psychiatry in the administration of justice.

Insanity or soundness of mind can be defined as a disease of the mind or the personality, in which there is derangement of the mental or emotional processes.
Aphasia: The loss of ability to express meaning by the use of speech or writing (motor aphasia), or to understand spoken or written language (sensory aphasia).

Delirium: It is a disturbance of consciousness in which orientation is impaired, critical faculty is blunted or lost and thought content is irrelevant or inconsistent. It occurs in physical disease with high fever, overwork, mental stress, metabolic disease, cerebral neoplasm or drug intoxication. Such persons are not responsible for their criminal acts.

Delusion: It is a false belief in something which is not a fact, and which persists even after its falsity has been clearly demonstrated. It is a disorder of thought.

Types:
(i) Grandeur or exaltation—A man imagines himself to be very rich while in reality he is a pauper.
(ii) Persecution—Person imagines that attempts are being made to poison him by his near relatives,
(iii) Reference—The person believes that people, things, events etc. refer to him in a special way.
(iv) Influence—His thought, feelings and actions are being influenced and controlled by some outside agencies.
(v) Infidelity—A man imagines his wife to be unfaithful while in fact she is chaste.
(vi) Nihilistic—The person declares that he does not exist or that there is no world seen in major depression.
(vii) Hypochondriacal—The person believes that there is something wrong with his body, though in fact he is healthy.
Such person is not responsible for his antisocial act.

Hallucination is a false sense of perception, without any external object or stimulus to produce it. They are purely imaginary and may affect any or all the special sense organs.
Types:
(i) Visual: A person imagines of being attacked by a lion when no lion exists (most commonly seen in delirium).
(ii) Auditory: A person hears voices, when no one is present (schizophrenia).
(iii) Olfactory: A person smells pleasant or unpleasant odour when none is present.
(iv) Gustatory: A person feels different types of taste in the mouth though no food actually is present.
(v) Tactile: A man imagines rats and mice crawling into his bed (Magnan symptom or, cocaine bug).
Hallucinations occur in fevers, intoxications and insanity. Visual and auditory hallucinations are most common. A person suffering from unpleasant hallucination may commit suicide or homicide. Olfactory hallucination is seen in temporal epilepsy.

Illusion is a false interpretation by the senses of an external object or stimulus which has a real existence e.g. a lion for a dog, or hears the notes of birds to human voice, imagines a string to be snake, stem of a tree for a ghost in dark. A sane person may experience illusion, but is capable of correcting the false impressions. An insane person continues to believe in the illusions even though the real facts are clearly pointed out.

Impulse:
This is a sudden and irresistible force compelling a person to the conscious performance of some action without motive or fore-thought. A sane person is capable of controlling an impulse, but an in¬sane person may do things on impulse.
Types:
(i) Kleptomania—An irresistible desire to steal articles of little value.
(ii) Pyromania—An irresistible desire to set fire to things.
(iii) Mutilomania—An irresistible desire to mutilate animals.
(iv) Dipsomania—An irresistible desire for alcoholic drinks at periodic intervals.
(v) Sexual impulses—including sexual perversions.
(vi) Suicidal and Homicidal impulses.

Obsession: In this, a single idea, thought or emotion is constantly entertained by a person which he recognises as irrational, but persists inspite of all efforts to drive it from his mind. It is a disorder of content of thought. Any attempt to resist makes them appear more insistent. It is a borderline between sanity and insanity e.g. continuous checking of bolting of door of husband’s room, a wife may continuously believe her husband to be unfaithful.

Phobia: It is an excessive or irrational fear of a particular object or situation.

Lucid Interval: This is a period occurring in insanity during which all the symptoms of insanity disappear completely. The individual is able to judge his acts soundly and he becomes legally liable for his acts. If he commits an offence, he cannot be completely held responsible, because it is difficult to know whether he was suffering from some mental abnormality at the time of committing the offence. In mania and melancholia, lucid intervals are common.

Difference between Psychosis and Neurosis
Trait                           Psychosis                                        Neurosis
1. Nature A disease entity with physical basis which determined genetically—— A reaction to stressful circumstances due to adverse childhood experience
2. Severity                   Major                                             Minor
3. Empathy                  Absent                                            Present
4 Contact with reality    Absent                                            Present
5. Insight                     Absent                                            Present

Psychopath: A person who is neither insane nor mentally defective, but fails to conform to normal standards of behaviour.

 Psychopathic disorder:
It is a persistent disorder or disability of mind which results in abnormally aggressive or seriously irresponsible conduct or a part of the person.

Psychopathic personality: An antisocial person who has been emotionally unstable from childhood or adolescence, but has normal intelligence. He lacks foresight and fails to learn from punishment.

Psychoses: They are characterised by a withdrawal from reality; a living in a world of fantasy.
Neuroses: The patient suffers from emotional or intellectual disorders, but he does not lose touch with reality.
Neurasthenia: It is a condition of nervous exhaustion due to physical or mental conditions. There is abnormal fatigue and irritability of the nervous system.

Mutism: It is complete loss of speech. It is seen in hysteria, catatonic schizophrenia, depression, organic brain lesion and malingering.

Causes of Insanity:
(i) Hereditary, e.g. Huntington’s chorea and amaurotic family idiocy.
(ii) Environmental factors e.g. faulty parental attitude and lack of mental hygiene.
(iii) Psychogenic e.g. unsuccessfully repressed mental conflicts.
(iv) Precipitating e.g. financial and business worries, frustrations and disappointment in sexual affairs, death of close relatives, senile degeneration, myxoedema, pernicious anemia etc.

Classification of Insanity (W.H.O. 1965)
I. PSYCHOSES
(A) Organic psychoses: (1) Senile and presenile dementia (2) Alcoholic psychosis (3) Associated with intracranial infections, e.g. epidemic ence¬phalitis, abscess, meningitis, tuberculosis, G.P.I, etc. (4) Associated with cerebral arteriosclerosis, epilepsy, intra¬cranial tumours, degenerative diseases, brain anomalies etc (5) Associated with other physical conditions such as endocrine, metabolic and nutritional disorders etc.
(B) Functional psychoses:
(a) Schizophrenia: 1. Simple type 2. Hebephrenic type, 3. Catatonic type, 4. Paranoid and other atypical or unspecified form.
(b) Affective type: 1. Involutional melancholia. 2. Manic-depressive 3. Paranoid states 4. Other atypical forms.

II. NEUROSES: 1. Anxiety neurosis 2. Hysterical-neurosis 3. Phobic 4. Obsessive-compulsive 5. Depressive 6. Depersonalisation syndrome 7. Hypochondriacal 8. Unspecified neurosis.

III. PERSONALITY DISORDERS.
IV. SEXUAL DEVIATION.
V. DRUG DEPENDENCE.

Mental Subnormality: (Oligophrenia, amentia)
1. Idiocy: Idiots are defined as persons so defective in mind from birth or an early age, that they are unable to guard themselves against ordinary physical dangers. Their mental age does not exceed that of a normal of 3 years. Intelligent quotient (I. Q) 0-20 (profound retardation).
2. Imbecility: Imbeciles are persons who are so defective in mind birth or an early age, that they are incapable of mane themselves or their affairs. An imbecile child is incapable of being taught. Their mental age ranges between that of normal child of 3 to 7 years. I.Q. 20-50 (moderate retardation).
3. Feeble minded (Moron): In these mental defects, not amounting to imbecility exists from birth or an early age, and they require care, super¬vision and control for their protection. Mental age 6 to 11 years. I.Q. 50-75 (Mild retardation).
4. Normal I.Q: It is more than 90. Mental retardation is I.Q. less than 70.

I.Q. = M.A/C.A x 100 (M.A.-Mental age; C.A – Chronological age)

Psychosis associated with Organic diseases:
1) Pre-senile dementia: Dementia is a condition in which there is degeneration of mental faculty after they have been fully developed.
2) Senile dementia: It is caused due to arteriosclerosis and old age. It usually starts after 65 years.
3) Cerebral tumours.
4) Cerebral trauma: It causes concussion and post-traumatic automatism.
5) Drug induced Psychosis: Dependence on barbiturates, amphetamines, cannabis, heroin, cocaine etc. lead to Psychosis. Cocaine, LSD, amphetamines and mescaline can produce clinical symptoms similar to schizophrenia.
6) Toxic Psychosis: Heavy metals, such as arsenic and mercury produce mental degeneration.
7) Deficiency states: (i) Deficiency of cyanocobalamin—pernicious anemia, (ii) Nicotinic acid—pellagra. (iii) Thyroxine—myxoedema. (iv) Pituitary hormones—hypopituitarism. (v) Hypoglycemia produces mental degeneration.

8) Alcoholism:
a. Alcoholic blackouts—Amnesia of several hours for events during a drinking session.
b. Delirium tremens—It usually occurs in a chronic drunkard, (i) One-two days after sudden withdrawal of alcohol. (ii) Due to heavy drinking. (iii) Injuries, infection and shock act as precipitating factor. This is the commonest type of Psychosis in the chronic alcoholic. The patient becomes sleepless, restless, irritable and then develops disorders of perception and coarse muscular tremors of face, tongue and hands. Disorientation and hallucinations of sight and hearing are common. He may be incited to commit suicide, homicide or violent assault. Symptoms usually last for 3 to 7 days. Such persons are not criminally responsible.
c. Alcoholic hallucinosis.
d. Korsakov’s psychosis: It is characterised by loss of memory for recent events both retrograde and antero-grade. The physical component of this syndrome consists of ophthalmoplegia, ataxia, and peripheral neuritis and is known as Wernick’s encephalopathy.
9) General Paralysis of insane: This is a chronic progressive condition leading to paralysis and dementia. It is usually associated with meningo-vascular syphilis and tabes dorsalis. The memory is impaired and thought retarded.
10) Epileptic Psychosis.

Functional Psychosis: This is a disease of hereditary origin affecting young adults and forms a major group of all psychiatric illnesses.

I. Schizophrenia: It is a condition of split personality, in which the patient loses his contact with environment. It is primarily a disorder of thinking (cognition).
It is characterised by splitting of different psychic functions: (1) Disorders of behaviour: withdrawal from reality, pre-occupation with the self (narcissism), depersonalization, passivity of thought. (2) Disorders of thought: confused thoughts leading to thought block, neologism. (3) Disorders of affect: depression, elation, inappropriate moods, anxiety and blunting of emotions. (4) Delusions: of grandeur, paranoid, hypochondriac and influence. (5) Hallucinations—commonly auditory, sometimes visual and tactile. (6) Personality deterioration: affecting his work, family and social relationships.

Schizophrenia is the commonest type of insanity in homicidal crimes.
The types are:
(1) Simple schizophrenia: It begins in early adolescence. There is a gradual loss of interest in the outside world from which he withdraws. He becomes emotionally flat and apathetic and has difficulty in forming social relationships.
(2) Hebephrenia: it begins in adolescents or young adults. Thinking process is disturbed. Wild excitement, illusions, hallucinations and bizarre delusions are present.
(3) Catatonia: This is characterised by alternating stages of depression, excitement and stupor, impulsive suicidal or homicidal attacks and auditory hallucinations are common.
(4) Paranoid schizophrenia: Paranoid schizophrenia develops insidiously in the fourth decade. It is characterised by suspicion, delusions of persecution and auditory hallucinations. At first delusions are indefinite, but later they become fixed on some person.

II. Affective types:
Manic-depressive psychosis:— The primary disturbance is of affect. The mood varies between extremes of joy and sadness. It occurs periodically.

In diagnosis of Insanity, person should be kept under observation up to a maximum 30 days.
Feigned Insanity—Insanity may be feigned by criminals to evade sentence of death or long term prison, by soldiers and policemen to leave the service, and by businessmen to avoid contract.

Neurosis: This forms a group of personality disturbances resulting from reactions to life situations. They may occur singly or in combination.

1. Anxiety Neurosis
2. Hysterical Neurosis: It is common in young females but may occur in old ladies whose nervous system starts degenerating. The patient shows deafness, blindness, loss of smell, anaesthesia, paraesthesia, paralysis, aphonia, amnesia, fainting fits, anorexia etc
3. Phobic Neurosis

Type of Phobia Fear of
(i) Agaraphobia —» Fear of open spaces
(ii) Claustrophobia —> closed spaces
(iii) Necrophobia —» dead bodies
(iv) Nyctophobia —> darkness
(v) Phonophobia —» sound
(vi) Thanatophobia —> death
(vii) Pathophobia —> disease
(viii) Toxiphobia —> being poisoned
(ix) Hydrophobia —> fear of water, seen in rabies
(x) Acrophobia —» fear of height
(xi) Sitophobia —> fear of eating
(xii) Social phobia —> public performance
(xiii) Aerophobia —> Air
(xiv) Algophobia —> Pain.
It interferes with daily activity.
4. Depressive Neurosis.
5. Obsessive compulsive neurosis.

THE MENTAL HEALTH ACT, 1987
Indian Lunacy Act was passed in 1912. It was repealed by the Mental Health Act. 1987. The Mental Health Act was enacted by parliament to consolidate and amend the law relating to the treatment and care of “mentally-ill person” to make better provision with respect to their property and affairs and for matters concerned with”.

Mental Disorder and Responsibility
: Responsibility, in the legal sense, means the liability of a person for his acts or omissions, and if these are against the law, the liability to be punished for them.

Civil responsibility: the question of civil responsibility arises in the following conditions.
(1) Management of property and affairs: If on enquiry, a person is found incapable of managing his property and affairs, but is not dangerous to himself or to others, the Court appoints a manager to look after his property, granting him necessary power.
(2) Insanity and contracts: A contract is invalid if one of the parties at the time of making it was incapable of understanding what he was doing due to insanity. The mental disorder of partner does not itself dissolve the partnership, unless steps are taken for dissolution.
(3) Insanity and marriage contract: A marriage is considered invalid, if at the time of marriage either party (1) is incapable of giving valid consent due to insanity, or (2) though capable of giving valid consent, has been suffering from such a kind or degree of mental disorder as to be unfit for marriage and procreation, or (3) has been suffering from recurrent attacks of insanity or epilepsy.
(4) The competence of insane to be a witness: An insane person is not competent to give evidence if he cannot understand the necessity of telling the truth due to insanity. An insane person is competent to give evidence during the period of lucid interval.
(5) Consent and insanity: Consent to certain acts like sexual intercourse or hurt is not valid if such consent is given by a person who from unsoundness of mind, is unable to understand the nature and consequences of that of which he gives consent.
(6) Insanity and testamentary capacity: Testamentary capacity (testament = will) is the mental ability of a person to make a valid will. The requirements of a valid will are follows. A written and properly signed and witnessed document must exist. The testator must be major, and of sound disposing mind, at the time of making the will. No force, undue influence, or dishonest representation of facts, should have been applied by others. Persons can make valid wills during lucid interval. The most common symptom of absence of legal capacity is impairment of memory. The most important thing to determine is whether at the time of making the will, the testator understood the business in which he was engaged, and knew how he wanted to dispose of his property.

Criminal responsibility:
The law presumes that every person is sane and responsible for his actions. The defense has to prove that the accused is insane. The law presumes that for every criminal act, there must be criminal intent or mind = mens rea (mens = mind; rea = criminal) motivating it.
The following are the tests for detecting criminal responsibility of an insane person.
1. Mc Naughten Rule (the right or wrong test; the legal test): English courts, in dealing with the responsibility of the insane in criminal cases are guided by the rules laid down after the Mc Naughten trial in 1843. The most important of this rule is as follows:—“an accused person is not criminally responsible, if it is clearly proved, that at the time of committing the crime that he was suffering from such a defect of reason from abnormality of mind, that he did not know the nature and quality of act he is doing, or that what he was doing was wrong”. This legal test has also been accepted in India as the law of criminal responsibilities under sec. 84, IPC.
2. Durham rule: “An accused person is not criminally responsible, if his unlawful act is the product of mental disease or mental defect”.
3. Curren’s rule: “An accused person is not criminally responsible, if at the time of committing the act, he did not have the capacity to regulate his conduct to the requirements of the law, as a result of mental disease or defect.
4. The irresistible impulse test: “An accused person is not criminally responsible, even if he knows the nature and quality of his act and knows that it is wrong, if he is incapable of restraining himself from committing the act, because the free agency of his will has been destroyed by mental disease”.
5. The American law institute test: “A person is not responsible for criminal conduct, if at the time of such conduct, as a result of mental disease or defect, he lacks adequate capacity either to appreciate the criminality of his conduct, or to adjust his conduct to the requirements of the law”.

Automatism:
It is the conduct of a person whose consciousness is impaired to such an extent that he is not fully aware of actions. Main factors producing automatism: (i) Epilepsy (ii) Concussion (iii) Hypoglycemia (iv) Somnambulism (Non-insane automatism).

Somnambulism: It means walking during sleep.
Somnolentia (semisomnolence): It is often called sleep-drunkenness and is midway between sleep and walking.

Impulse: Some crimes are committed due to an impulse in which the person loses self control, such as sudden violent anger. Such persons are criminally responsible unless insanity is present.
Hypnotism or Mesmerism: This is a sleep like condition produced by artificial means or, by suggestions
Delirium: A delirious person may commit violent criminal acts due to delusions and hallucinations. He is not legally responsible for the acts committed during delirium.

Drunkenness:
(i) An intoxicated person (voluntary drunkenness) is criminally responsible if he has intention or knowledge of committing a crime.
(ii) Mental disorder brought about by drugs and delirium tremens due to drink frees one of criminal responsibility. Also in post-traumatic automatism, twilight state and paranoid states, the person is free from criminal responsibilities.

Types of personality disorders:
(a) Paranoid—suspicious
(b) Schizoid—withdrawn, emotional coldness
(c) Schizo-typal—oddities of thinking
(d) Histrionic—attention seeking
(e) Narcissistic—self-centered
(f) Antisocial—flouting norms
(g) Avoidant—low self esteem
(h) Borderline—unpredictable
(i) Dependent—seeking human contact
(j) Compulsive—perfectionist
(k) Passive aggressive—procrastination. — There is no definite treatment.

Psychic dependence: (i) Cocaine (ii) Marijuana (iii) Amphetamine (iv) LSD

Physical dependence and Psychic both: (i) Opiates (ii) Alcohol (iii) Barbiturates.

Clinical toxicity in alcohol: (i) Fatty liver (ii) Cirrhosis (iii) Pancreatitis (acute chronic)
(iv) Wemicke-Korsakoff syndrome (v) Peripheral neuropathy (vi) Gynecomastia (vii) Amenorrhea.

Psychiatric emergencies are: (i) Delirium (ii) Bereavement (iii) Suicide (iv) Mania (iv) Panic attack.

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