The general public is fast becoming law conscious and the doctors are being sued from time to time in a Court of law for their acts of omission or commission. Therefore, it is incumbent upon doctors must  have a good knowledge of the law governing their profession, in order not to transgress the law.

History: The Code of Hammurabi, King of Babylon (about 4000 to 3000 B.C) is the oldest known medico-legal code. The first medico-legal autopsy was done in Bologna (Italy) in 1302, by Bartolomeo De Varignana. The first book on Forensic Medicine was published in 1602 by an Italian physician, Fortunato Fedele. Orfila (professor of chemistry and legal medicine at Paris) is considered the founder of modern toxicology. Paulus Zacchias — written "medico-legal questions", questions Medico legalis."

a. In the 18th century, study in legal Medicine as a subject was established by appointing professorship in Germany.
b. In England Mc Naughten's (who was aschizophrenic) rule has been established to deal with legal matters in cases of insanity or like situations whatsoever

Forensic medicine: is the application of medical and paramedical knowledge in the administration of law and justice. Legal medicine and state medicine are other names for it.

Medical jurisprudence: deals with the legal rights, privileges, duties and obligations of medical practitioner.

LEGAL PROCEDURE

Inquest: is the legal or judicial inquiry to ascertain matter or fact. (Cr.P.C. 174)
It is the investigation into the cause of death. It is conducted in cases of murder, suicide, accidents and suspicious deaths.
1) Police inquest: done by the Officer-in-charge of the police station (S.174, Cr.P.C). Medico-legal autopsy is ordinarily done on requisition of the sub-inspector of police. The inquest report is signed by the police officer and two witnesses.
2) Coroner’s inquest: in Bombay till 1999. Coroner’s court is a court of enquiry and not of trial.
3) Magistrate’s inquest: done by an Executive Magistrate (Collector, Deputy collector, Tahsildar, etc) in cases of death in police custody, death due to police firing, death in prison, dowry death & exhumation (S.176, Cr.P.C).

Courts of law: Criminal and Civil.
1) Supreme Court: is the highest court and has power of supervision over all courts of law. It is purely an appellate court. A supreme court Judge can pass any sentence authorized by law.
2) High Court: highest court for state. It may try any case and pass any sentence authorized by law.
3) Sessions Court: can pass any sentence authorized by law, but a death sentence passed by it must be confirmed by the High court (S.366, Cr.P.C). An Assistant Sessions court can pass a sentence of imprisonment up to 10 years.
4) Magistrate Courts are of 3 types:
  a) Chief Judicial Magistrate: can pass a sentence of imprisonment up to 7 years and any amount of fine.
  b) I Class Judicial Magistrate: can pass a sentence of imprisonment up to 3 years and fine up to 5000 rupees.
  c) II Class Judicial Magistrate: can pass a sentence of imprisonment up to 1 year and fine up to 1000 rupees.

Offence may be Cognisable or non-cognisable.
Cognisable offence: It is an offence in which a police officer can arrest a person without warrant from the Magistrate, e.g., rape, murder, robbery, etc.

The common punishments allowed by law awarded are:
(i) Death (hanged by neck till death)
(ii) Imprisonment for life. (Max. up to 20 years)
(iii) Imprisonment of sometime but less severe than life imprisonment. This may be the form of simple or rigorous imprisonment.
(iv) Monetary fine (Sec.53, I.P.C)
(v) Detentions in reformatories. DRC

The death sentence can be commuted by the President of India (on mercy appeal), by Supreme Court of India (on appeal or by the High Court by merits).

Subpoena or Summons: is a written document issued by the court and served on the witness under a penalty in all cases by the Police officer to attend the court for giving evidence on a particular day and time (S.174, I.P.C; S. 87, Cr.P.C). It may be served from a criminal or civil court. The witness will be excused from attending the court, if he has a valid and urgent reason. If the witness fails to attend the Court: (1) in a civil case, he will be liable to pay damages, and (2) in a criminal case, to fine or imprisonment (S. 172, I.P.C).

Conduct money is fee paid to a witness at the time of serving the summons to cover the expenses for attending the court. Given only in civil cases. In no case the medical practitioner should insist on conduct money when he receives a subpoena from Criminal court because he is liable to be charged with contempt of court.

Perjury means giving willful false evidence while under oath, or failure to tell what he knows or believes to be true (S.191, I.P.C). The witness is liable to be prosecuted for perjury, and the imprisonment may extend to 7 years (S. 193, I.P.C).

Record of evidence: (S. 137, I.E.A)
(1) Oath
(2) Examination-in-chief (direct examination)
This is the first examination of a witness and consists of questions put to him by the lawyer (counsel or advocate) for the side which has summoned him. In government prosecution cases, the public prosecutor first examines the witness. Leading questions are not allowed except when the witness is hostile.
(3) Cross-examination
In this, the witness is questioned by the lawyer for the opposite party, i.e., lawyer for the accused (defense lawyer). Leading questions are allowed. The court has the power to disallow questions which are intended to insult or annoy or offensive in form (S. 152, I.E.A)
(4) Re-examination (Re-direct examination) (S. 137, I.E.A)
This is conducted by the lawyer for the side which has called the witness. The opposite lawyer has the right of re-cross examination on the new point raised. Leading questions are not allowed.
(5) Questions by judge
The court is also empowered (S. 311, Cr.P.C), to recall and reexamine any witness already examined, if his evidence appears to the Court to be essential to the just decision of the Court. The judge may ask any questions at any stage of the examinations to clear up doubts.

Medical evidence: Evidence means all legal means, which help to prove or disprove any matter in question.
Types: Oral, Documentary, Direct, Indirect or circumstantial, Hearsay

A. Documentary evidence. 3 types: MC, DC, Dying declaration.
1. Medical certificate: it refers to ill-health, insanity, death, etc. they are accepted in a Court of law, only when they are issued by a qualified RMP. A medical practitioner is legally bound to give a death certificate, stating the cause of death without charging fee, if a person whom he has been attending during his last illness dies (Registration of Birth and Deaths Act, 1970). The certificate should not be given if the doctor is not sure of the cause of death, or if there is the least suspicion of foul play. In such cases, the matter should be reported to the police. Issuing or signing a false certificate is punishable under S. 197, I.P.C.
Death certificate: In India, the International Statistical Classification of Death,
Injuries and Causes of Death is used.

2. Medico-legal reports: are reports prepared by a doctor on the request of the investigating officer for his guidance, usually in criminal cases, e.g., assault, rape, murder, poisoning, etc. These are admitted as evidence in court only when the doctor gives oral evidence on oath.

3. Dying declaration: It is a written or oral statement of a person, who is dying as a result of some unlawful act, relating to the material facts of cause of his death or bearing on the circumstances. A magistrate should be called to record the declaration. If the patient’s condition is serious, and there is no time to call a Magistrate, the doctor should take the declaration in the presence of two witnesses. The person need not take oath, because of the belief that a dying person tells the truth. Leading questions should not be asked. It should be read over to the declarant, and his signature or thumb impression is taken. The doctor and the witness should also sign the declaration. If the declarant survives, the declaration is not admitted, and the person is called to give oral evidence.

4. Dying deposition is a statement of a person on oath, recorded by a Magistrate in the presence of the accused or his lawyer, who is allowed to cross-examine the witness. It has greater value than dying declaration bcoz the accused has an opportunity of cross-examining the dying person. Not followed in India.

B. 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 facts under enquiry (S. 60, I.E.A). it must be evidence of a person who saw, heard or percieved it by that sense or in that manner. Oral evidence is more important than documentary evidence, as it permits cross-examination.
Exceptions to oral evidence:
(1) Dying declaration (S. 32 & 157, I.E.A)
(2) Expert opinion expressed in treatise (S. 60, I.E.A)
(3) Evidence of a doctor recorded in a lower Court (S. 291, I.E.A)
(4) Evidence of a witness in a previous judicial proceeding (S. 33, I.E.A)
(5) Reports of certain govt. scientific experts: Chemical examiner, Chief Inspector of Explosives, Director of Finger Print Bureau, Director of CFSL or SFSL, Director of Haffkine institute, Bombay and Serologist to the Govt. (S. 293, Cr. P.C)
(6) Public records, E.g., Birth and death, certificates of marriage.
(7) Hospital records: Routine entries are admissible without oral evidence.

Types of Witness
Common and Expert.
Common witness: (witness of fact; occurrence witness) is a person who gives evidence about the facts observed or percieved by him. “ First hand knowledge rule”

Expert witness: is a person who has been skilled in technical or scientific subject, and capable of drawing opinions and conclusions from the facts observed by himself, or noticed by others, e.g., doctor, firearms expert, finger prints expert, hand-writing expert, etc (S.45, I.E.A)
Hostile witness: is one who is supposed to have some interest or motive for concealing part of the truth, or for giving completely false evidence (S.191, I.P.C)

MEDICAL LAW AND ETHICS
The medical profession is governed by legislation and by a Code of ethics and Etiquette. Medical ethics deals with the moral principles which should guide members of the medical profession in their dealings with each other, their patients and state. Enforcement of the code is done by the medical councils. (CCH).

Central Council of Homoeopathy Act, 1973. (19th December, 1973)
Amendment vide Homoeopathy Central Council of Amendment Act, 2002. Gazette of 9th December, 2002.
Schedule I: No: of elected members from each state.
(a) No: of RMP exceeds 100 – not exceeding 10000 = 1 seat
(b) No: of RMP exceeds 10000 – not exceeding 20000 = 2 seats
(c) No: of RMP exceeds 20000 – not exceeding 30000 = 3 seats
(d) No: of RMP exceeds 30000 – not exceeding 40000 = 4 seats
(e) More than 40000 RMP = 5 seats.

Schedule II: Recognized medical qualifications granted by Universities, Board or Medical Institutions in India.
Schedule III: Qualifications granted by medical institutions outside India.

Functions:
1. Medical Register: the council maintains a register of medical practitioners who are enrolled on any State Medical Register.
2. Medical Education:
3. Recognition of foreign medical qualifications
4. Appeal against disciplinary action
5. Warning notice for serious misconduct.

Serious professional misconduct: (Infamous conduct in professional respect)
It is any conduct of the doctor which might reasonably be regarded as disgraceful or dishonourable. The conduct of the doctor is judged by professional men of good repute and competence. The main cause for penal erasure is serious professional misconduct. It deprives the doctor of all the privileges of a registered practitioner.

Warning notice
The following are some of the offences contained in the warning notice:-
1. Adultery (voluntary sexual intercourse between a married person, and a person married or not, other than his or her spouse)
2. Conviction by a court of law
3. Issuing false certificates
4. Performing criminal abortions or illegal operations
5. Dichotomy or fee splitting, i.e., receiving or giving commission to a professional colleague or a manufacturer or trader in drugs or appliances, or a dentist, chemist etc.
6. Covering, i.e., assisting some person who has no medical qualification to attend, treat or perform an operation on some person.
7. Advertisement – Repeated advertisement in a newspaper by a medical practitioner is an example of ethical negligence.
8. Using touts or agents for procuring patients.

Duties of Medical Practitioners
A. Doctor should:
1. Exercise reasonable degree of skill and knowledge
2. Attend a patient as long as he requires treatment
3. Prescribe or furnish suitable medicines
4. Warn patients of the dangers involved in the use of a prescribed drug or device
5. Inform patient of risk
6. Notify communicable diseases to the health authorities.
7. Maintain professional secrecy.

Privileged communication: It is a statement made bonafide upon any subject matter by a doctor to the concerned authority, due to his duty to protect the interests of the community or of the State.

Examples of privileged communication
1. A syphilitic taking bath in public pool
2. Engine or bus driver found to be colour blind
3. A person with infectious diseases working as a cook.
4. A doctor’s duty is to notify birth, death, infectious disease to public health authority.

Professional negligence (Malpraxis)
It is defined as absence of reasonable care and skill, or willful negligence of a medical practitioner in the treatment of a patient, which causes bodily injury or death of the patient. Negligence is defined as doing something that is not supposed to do, or failing to do something that one is supposed to do.

Medical negligence falls under following section – sec. 304 A, IPC 312, Indian contract act. (except – IPC 351.)
I. Civil negligence: Liability for negligence arises if the following conditions are satisfied:
a) Duty – Existence of a duty of care by the doctor
b) Dereliction – Failure of the doctor to maintain care and skill
c) Direct causation – The failure to exercise a duty of care must lead to damage
d) Damage – the damage which results must be reasonable anticipated.
A civil wrong is known as – ‘Tort”

The doctrine of res ipsa loquitor: It means the thing or fact speaks for itself.

Novus actus interveniens: It means an unrelated action intervening. A person is responsible for his actions and also for its consequences. This principle applies to cases of assault and accidental injury. If the doctor is negligent, which results from the logical consequence of events, then the responsibility for the subsequent disability or death may pass from the original incident to the later negligent action of the doctor by the principle of “novus actus interveniens”.

II. Criminal negligence: (Sec. 304A IPC). It occurs when the doctor shows lack of competency, gross inattention, criminal indifference to the patient’s safety, or gross negligence in the selection and application of remedies. It is practically limited to cases in which the patient has died. The doctor may be prosecuted by the police and charged in criminal court with having caused the death of the patient by a rash or negligent act not amounting to culpable homicide. The doctor can be punished with imprisonment up to 2 years, or with fine, or with both.

Contributory negligence: It is any reasonable conduct or absence of ordinary care on the part of the patient, or his personal attendant, which combined with the doctor’s negligence.

Therapeutic misadventure: It is a case in which an individual has been injured or had died due to some unintentional act by a doctor or agent of the doctor or hospital.
It may be subdivided into:
1) Therapeutic (when treatment is being given)
2) Diagnostic (where diagnosis only is the objective at the time)
3) Experimental (where the patient has agreed to serve as a subject in an experimental study).

Vicarious liability: (liability for act of another) An employer is responsible not only for his own negligence but also for the negligence of his employees, if such acts occur in the course of the employment and within its scope, by the principle of respondent superior (let the master answer).

Euthanasia (Mercy killing): It means producing painless death of a person suffering from hopelessly incurable and painful disease. It has no legal sanction in India.

Consent: means voluntary agreement, compliance or permission.
It may be: (i) Express (verbal or written) or (ii) Implied.

Reasons for obtaining consent:
(i) To examine, treat or operate upon a patient without consent is assault in law.
(ii) If there is no informed consent the doctor may be charged for negligence.

Rules for consent:
1. Oral consent should be obtained in the presence of a third party, e.g., nurse.
2. Written consent should be taken for court presentation.
3. The consent should be free, voluntary, clear, intelligent, informed, direct, and personal.
4. In medico-legal cases such as rape, pregnancy, delivery, abortion the woman should not be examined without her consent.
5. In case of a female, the examination should be made only by a or under the supervision of a female medical practitioner (S. 53, IPC)
6. An arrested person at his request may be examined by a doctor to detect evidence in his favour (S.54, IPC)
7. A person above 18 years can give consent to suffer any harm, which may result from an act not intended or not known to cause death or grievous hurt (Sec. 87, IPC).
8. A person can give valid consent to suffer any harm which may result from an act, not intended or not known to cause death, done in good faith and for its benefit (S.88 IPC)
9. Consent is not a defense in cases of professional negligence.
10. A child under 12 years cannot give valid consent to suffer any harm which may result from an act done in good faith and for its benefit. The consent of parent or guardian is taken (S. 89, IPC)

Malingering or shamming means conscious, planned feigning or pretending a disease for the sake of gain. Malingering can be diagnosed by keeping the patient under observation and watching him without his knowledge.

Consumer Protection Act (COPRA) passed on 1986, came into force in 1987.

IDENTIFICATION
Identification is the determination of the individuality of a person based on certain physical characteristics, i.e., exact fixation of personality.

Corpus delicti: (body of offence, essence of crime) means, the elements of any criminal offence. E.g., murder. The main part of corpus delicti is the establishment of identity of the dead body, and infliction of violence in a particular way, at a particular time and place, by the person or persons charged with the crime and none other.

Race: It can be determined by complexion, colour of eyes, hair, clothes and skeleton.
Cephalic index = Maximum breadth of skull / Maximum length of skull x 100.
It divides skull into (DOMBA)
1. Dolico-cephalic (long-headed) C.I. 70 to 85 – seen in pure Aryans, Aborigines and Negroes.
2. Mesati-cephalic (medium-headed) C.I. 75 to 80 – seen in Europeans and Chinese.
3. Brachy-cephalic (short-headed) C.I. 80 to 85 – seen in Mongolisms (Max C.I)

Sex: It has to be determined in cases of (1) Heirship, (2) Marriage, (3) Divorce, (4) Legitimacy, (5) Impotence, (6) Rape, etc.

Sex chromatin: is a small plano-convex mass, lying near nuclear membrane (Barr body).
Accuracy of sex determination from pelvis and skull is 98%. Barr body was first demonstrated by Dixon and Tarr. In buccal smear, barr body is present in 20 to 80 % of cells in the female (more than 25% cells are determined) and 0 to 4% in males. Buccal smear is used in determination of sex. Examination of blood is used in determination of sex. Neutrophil leucocytes contain a small nuclear appendage of drumstick form (Davidson body – help in sexing) in upto 6% of cells in the female but is absent in males.
Sex of a developing foetus can be determined at the end of 4th month of I.U life.

Intersex: It is an intermingling in one individual of characters of both sexes, in varying degrees, including physical form, reproductive organs and sexual behaviour. It results from some defect in the embryonic development.
It can be divided into four groups:
1) Gonadal agenesis – In this the testes or ovaries have never developed. The nuclear sex is negative.
2) Gonadal dysgenesis – External sexual structures are present, but at puberty the testes or ovaries fail to develop.
a) Klinefelter syndrome – The anatomical structure is male but the nuclear sexing is female. Sex chromosome is XXY (47 chromosomes). There is delay in onset of puberty, behavioral disorders and mental retardation. Small testis, infertility, gynaecomastia, azoospermia. Increased urinary gonadotropins.
b) Turner’s syndrome – The anatomical structure is female but the nuclear sexing is male. The sex chromosome pattern is XO (45 chromosomes). Earliest feature in newborn girl is oedema of hands and feet and loose nuchal folds. Other features – short stature, webbed neck – shield chest, renal defects – horse shoe kidney and duplication of renal pelvis, cardio-vascular defect – co-arctation of pelvis, skeletal disorder – cubitus vulgus, gonodal streaks – seen in turner’s syndrome, mental status – normal.
3) True hermaphroditism – In this an ovary and testis or two ovotestis are present within the external genitalia of both sexes.
4) Pseudo-hermaphroditism – Internally gonadal tissue of only one sex is seen, but external appearance is of the opposite sex.
a) Male pseudohermaphroditism: Nuclear sex is XY, but sex organs and sexual characteristics deviate to female form, because of testicular feminisation.
b) Female pseudohermaphroditism: Nuclear sex is XX, but deviation of sex organs and sexual characteristics towards male are seen, due to adrenal hyperplasia.
Skeleton: Recognizable sex differences do not appear until puberty except in pelvis, and the accuracy from this bone is about 75 to 80%. The determination of sex is based mainly upon the appearance of the pelvis, skull, sternum and the long bones.

AGE
Age can be determined from teeth, ossification of bones, secondary sexual characteristics, and general development in case of children.

1. Teeth: Teeth are useful for age determination (a) by the stage of development, and (b) by secondary changes.
Temporary teeth: these are 20 in number – 4 incisors, 2 canines, 4 molars in each jaw.
In ill-nourished children and in rickets, dentition may be delayed. In syphilis, dentition appears premature or even present at birth. Eruption of temporary teeth is for 2 - 2½ years. The temporary teeth begin to fall at about the sixth or seventh year after the eruption of first permanent molar. In children mixed dentition remains at 6 – 12 years of age.
Age 9: 12 permanent teeth, 8 I, and 4 1st molars + deciduous molars and canines.
Age 11: 20 permanent teeth, 8 I, 8 Pm and 4 M.
Age 14: 28 permanent teeth, and no deciduous teeth.
Permanent teeth are 32 in number: 4 incisors, 2 canines, 4 premolars, and 6 molars in each jaw.
Developmentally, teeth are divided into two sets:
(1) Superadded permanent teeth: Are those which do not have deciduous predecessors. (all permanent molars, 6 in each row)
(2) Successional permanent teeth: are those which erupt in place of deciduous teeth. (Permanent premolars in place of deciduous molars, 10 in each row).
Temporary teeth eruption (in months) – Total 20.
Eruption of permanent teeth (in years) – Total 32.

Gustafson’s method – The age estimation of adult over 21 years 9between 25 – 60 years) depends on the physiological age changes in each of the dental tissues such as attrition, pqaradentosis, secondary dentin, cementum apposition, root resorption, transparency of the root (The most reliable criteria).

2. Growth of individual bones:
The bones of skeleton are performed in hyaline cartilage. The earliest centres of ossification appear at the end of second months of pregnancy. At the eleventh intrauterine week, there are 806 centres of bone growth, at birth about 450, while the adult skeleton has 206 bones. Tarsus and carpus bones ossify from a single centre. Typically, a long bone such as tibia, has become ossified throughout its shaft (diaphysis) at birth; whereas its two ends (epiphysis) are later ossified by secondary centres. The process of union of epiphysis and diaphysis is called fusion. In an individual bone once union has begun, it will be completed by 12 to 18 months.

For determining the age, skiagrams of the shoulder, elbow, wrist, hip, knees, ankle, pelvis and skull, should be taken in antero-posterior position. Union of epiphysis in cartilaginous bones occurs slightly earlier by about 1 year in the female than in the male, but reverse is seen in the closure of the sutures of the skull.
The symphysis pubis is probably the single best criterion for determining age from third to fifth decades. If male criterion is used for females, the age would be underestimated by about 10 years.

Sternum: Four pieces of body of the sternum fuses with one another from below upwards between 14 and 25 years. At about 40 years the xiphoid unites with the body. The manubrium fuses with the body in old age.

The greater cornu of the hyoid bone unites with the body between 40 and 60 years.
Skull: Bones of calvaria are 8 in number: parietal 2, frontal 1, temporal 2, occipital 1.
Bones of the face and jaw are 14 in number: maxilla 2, zygomatic 2, nasal 2, lacrimal 2, palatine 2, inferior nasal concha 2, mandible 1, and vomer 1. Lateral and occipital fontanelles usually close within the first two months. The anterior fontanelles and the two halves of the mandible unite at the second year. The basioccipital fuses with the basisphenoid at about 18 to 21 years. In the vault of the skull, closure of the sutures begins on the inner side 5 to 10 years earlier than on the outer side. Closure of all sutures indicates age more than 60 years. Suture closure in skull occurs later in females than in males.
Sacrum: the sacrum becomes a single bone between 21 and 25 years.

3. Secondary sexual characters:
In males:
(i) At about 14 years – fine hair begins to appear at pubis.
Testes – large, firmer.
Penis – begins to enlarge.
(ii) At about 15 years – pubic hair thick, extends upto umbilicus, dark
- axillary hair appears.
(iii) At about 16 years – appearance of hair at face.
(iv) Between 16 – 18 years – voice becomes deep.
In females:
(i) At 13 – 14 years – Sequence of puberty is (i) breast begins to develop (ii)
hair on mons veneris (iii) menstruation starts.
(ii) At 14 – 15 years – Female public hair thin; straight tops above mons veneris;
hair appears in axilla.

Doctor’s estimation of age is not proof but merely an opinion.

Medico-legal importance of age:
1) Criminal responsibility: Any act done by a child under 7 years is not an offence (S. 82, IPC). It is an offence if done before 7 years according to Railways act. A child between 7 and 12 years is presumed to be capable of committing an offence, if he attains sufficient maturity (S. 83, IPC).

2) Judicial punishment: According to the Juvenile Justice Act, 1986, “juvenile” means a boy who is below the age of 16 years, or a girl who is below 18 years. No delinquent juvenile shall be sentenced to death or imprisonment.

3) Rape: Sexual intercourse by a man with a girl under 15 years even if she is his own wife, or with any other girl under 16 years even with her consent is rape (S. 375, IPC)

4) Kidnapping: It is an offence
(a) to kidnap a child with the intention of taking dishonestly any movable property, if the age of child is under 10 years (S. 369, IPC)
(b) to kidnap a minor from lawful guardianship if the age of a boy is under 16 and that of a girl under 18 years (S. 361, IPC)
(c) to procure a girl for prostitution, if her age is under 18 years (S. 366-A, IPC), and
(d) to import into India from a foreign country a female for the purpose of illicit intercourse, if her age is less than 21 years (S. 366-B, IPC).

5) Employment: A child below 14 years cannot be employed to work in any factory or mine or in any other risky employment. A person completing 15 years (adolescent) is allowed to work in a factory as an adult.
6) Attainment of majority: A person attains majority on the completion of 18 years. (S. 3, Ind. Majority Act, 1875)
7) Evidence: A child of any age can give evidence if the court is satisfied that the child is truthful (S. 118, IEA)
8) Marriage contract: A female under 18 years and a male under 21 years, cannot contract marriage (Child marriage restraint act, 1978)
9) Infanticide: The charge of infanticide cannot be supported, if the infant can be proved under the age of 6 months of intra-uterine life.
10) Criminal abortion: A woman who has passed the child-bearing age cannot be charged of procuring criminal abortion.

Rule of Haase: A rough method of calculating the age of the foetus.
(1) Upto 5 months, age of foetus = √length (in months)
(2) › 5 months = length (in cm)/ 5 = (months).
Length of an infant: At birth = 50 cm, end of 6 months = 60 cm, end of 1st year = 68 cm, end of 4 years = 100 cm (double).
Birth weight doubles by 5months, triples by 1 year.
For the confirmation of age between 6 and 12, best means is dental examination.

Fusion of bones / joints:
(ii) 15 to 16 years – Elbow joint.
(iii) 16 to 17 years – Ankle joint
(iv) 17 to 18 years – Hip joint
(v) 18 to 19 years – Knee, shoulder, knee joint. Centre appears for inner end of clavicle.
(vi) 18 to 20 years – Iliac crest fuses.
(vii) 21 years – Fusion of ischial tuberosity and inner end of clavicle. Patella completely ossifies at 14 years.
(viii) 2nd and 5th decades – Age of 20 years is determined by pubis.
(ix) 14 to 25 years – Sternum fusion takes place below upwards.
(x) Bertellion system – for greater than 21 years.
(xi) Epiphseal union of sternal end of clavicle occurs at the age of 22 years.

1st ossification centre to appear is clavicle, and lower jaw at 2nd week of intra uterine life.
In post – maturity, ossification centres appear in capitate, hamate.

Stature: By applying Karl – pearson formula, we will be able to calculate stature of the individual from long bones. Multiplying factor of estimating stature: from femur (males) is 3.6 to 3.8, from humerus (males) is 5 to 6.

Dactylography, (finger-print system, dermatoglyphics, Galton system)
Most reliable method of identification of a person. Finger prints are impressions of pattern formed by the papillary ridges of the fingertips.
Finger prints are classified primarily as: (i) Loops 67%, (ii) whorls 25%, (iii) arches 6 to 7% (iv) composite forms – 1 to 2% (least common).

In practice, 16 to 20 points of fine comparison are accepted as proof of identity. The patterns are not inherited. The pattern is different in identical twins.
Ridge alterations occurs in eczema, acanthosis nigricans and scleroderma.
Permanent impairment of the finger print pattern occurs in leprosy, electric injuries, and after exposure to radiation.

Poroscopy – This is the further study of fingerprints described by Locard.
M.L.I:
(i) Recognition of impression at the scene of crime.
(ii) Identification in case of accidental exchange of new-born infants.
(iii) Prevention of impersonation
(iv) Cheques, bank notes and other legal documents.

Cheiloscopy: is the study of lip-prints.
Superimposition: It is the technique applied to determine whether the skull is that of the person in the photograph. A life sized negative of the skull is prepared. The negatives of the photograph and the skull are superimposed by aligning the characteristic point in negative. A negative result is having more credibility because, it can definitely be stated that the skull and the photograph are not those of the same person.

Hair: Study of hair is known as Trichology.
Medullary index of hair is used to determine the species.
Human hair is fine, thin, cuticular scales are short, broad, not continuous; cortex – thick, 4 to 10 times as broad as medulla; medulla – thin, pigment evenly distributed; precipitin test specific for human.
Animal hair is coarse, thick, cuticular scales very large, step-like projection; cortex thin.

Scalp hair grows at 3 mm a week.
Hair becomes loose after 72 hours of death.
ABO groups can be determined in a single hair from any part of the body by a modified absorption – elution technique with 100 % accuracy.


DEATH AND ITS CAUSE
Thanatology deals with death in all its aspects. Death is of two types: (1) somatic, systemic or clinical, and (2) molecular or cellular.
Somatic death is the complete and irreversible stoppage of the circulation, respiration and brain functions, but there is no legal definition of death.
Autopsy means, post-mortem examination of a body (whole body).

Objectives:
(1) To find out the time since death.
(2) To find out the cause of death.
(3) To find out the manner of death, whether accidental, suicidal or homicidal.
(4) To establish the identity.
(5) In new-born infants to determine live birth and viability.

Rokitansky’s method is autopsy technique for infants.
Before doing the post-mortem, body should be identified by policeman.
Exhumation: is the digging out of an already buried body from the grave. There is no time limit for exhumation in India. The body is exhumed only when there is a written order from the First Class Magistrate (Chief Judicial Magistrate). It should be conducted in natural light in early morning. Average number of sample of earth taken is 6 to 7. Disinfectants should not be sprinkled on the body. In suspected mineral poisoning, hair, nails and long bones, e.g., femur should be preserved for chemical analysis. It is not done for Hindus. Performed for Christians, Muslims and Parsies.

Molecular death means the death of cells and tissues individually, which takes place usually one to two hours after the stoppage of vital functions.

Brain death consists of: (1) Deep unconsciousness with no response to external stimuli or internal need; (2) No movements, no spontaneous breathing; (3) Cessation of spontaneous cardiac rhythm without assistance; (4) No reflexes (except occasionally spinal reflexes), (5) Bilateral dilatation and fixation of pupils; (6) Flat iso-electric EEG; provided that (a) all of the confirmatory mentioned are present for a 24 hour period; (b) patient’s body temperature should not be below 320C. (c) metabolic and endocrine disturbances, which can be responsible for coma should be excluded.

Modes of death: (1) Coma, (2) Syncope, (3) Asphyxia.
Coma is the insensibility, which involves the central portion of the brain stem, and may result in death.
Syncope is sudden stoppage of action of the heart, which may prove fatal. It is due to vaso-vagal attacks resulting from reflex parasympathetic stimulation.

Asphyxia is a condition caused by interference with respiration or due to lack of oxygen in respired air due to which the organs and tissues are deprived of oxygen. (together with the failure to eliminate CO2 ), causing unconsciousness or death.

The cause of death is the disease or injury responsible for starting a sequence of events, which are brief or prolonged and which produce death. It may be divided into: (1) Immediate cause, (2) Basic cause, (3) Contributory cause.

Negative autopsy:
When gross and microscopic examination, toxicological analysis and laboratory investigations fail to reveal a cause of death, the autopsy is considered as negative. It may be due to (1) Inadequate history, (2) Inadequate external examination, (3) Inadequate or improper internal examination, (4) Insufficient laboratory examinations, (5) Lack of toxicological analysis, (6) Lack of training of the doctor.

Obscure autopsies: are those which do not show a definite cause for death, in which there are minimal, indefinite or obscure findings, or even no positive findings at all.
Sudden death: Death is said to be sudden or unexpected, when a person not known to have been suffering from any dangerous disease, injury or poisoning is found dead or dies within 24 hours after the onset of terminal illness.

Natural death means that the death was caused entirely by the disease, and the trauma or poison did not play any part in bringing it about.


POST-MORTEM CHANGES
The signs of death appear in the following order:
(I) Immediate (somatic death).
(1) Insensibility and loss of voluntary power
(2) Cessation of respiration
(3) Cessation of circulation.
(II) Early (cellular death).
(4) Pallor and loss of elasticity of voluntary power
(5) Changes in the eye
(6) Primary flaccidity of muscles
(7) Cooling of the body
(8) Post-mortem lividity
(9) Rigor mortis
(III) Late (decomposition and decay)
(10) Putrfaction
(11) Adipocere formation
(12) Mummification.

Complete stoppage of respiration for more than 4 minutes usually causes death.
Suspended animation: In this condition, signs of life are not found, as the functions are interrupted for sometime, or are reduced to minimum. However, life continues and resuscitation is successful in such cases. Voluntarily, practitioners of yoga can pass into a trance, death like in character. Involuntary suspension of animation lasting from a few seconds to half-an-hour may be found in new-born infants, drowning, electrocution, cholera, after anesthesia, shock, sunstroke, cerebral concussion, insanity, etc.

Changes in skin: Skin becomes pale and ashy-white and loses elasticity within a few minutes of death. Lips appear brownish, dry and hard due to drying.
Changes in eye: Loss of corneal reflex is not a reliable sign of death. Opacity of cornea may occur in diseases like cholera, wasting diseases before death. If the lids are open, cornea remains clear for about 2 hours. The retina is pale for the first 2 hours. At about 6 hours, the disk outline is hazy and becomes blurred in 7 to 10 hours.

Cooling of the body (Algor mortis): The body heat is lost by conduction, convection and radiation. The curve of cooling is sigmoid in pattern. Internal organs take 24 hours to cool. The temperature of the body rises up for the first two hours after death by sunstroke, septicemia, tetanus, strychnine poisoning called post-mortem caloricity.

A rough idea of time in hours after death can be obtained by the formula, (Normal body temperature – Rectal temperature) / Rate of temperature fall per hour.

The rate of cooling of the body in first six hours is 2.50F per hour, the rate in next hours is 1.5 – 20F.
Factors affecting rate of cooling: In India, during summer, cooling is very slow. In tropical climates, the heat loss is roughly 0.5 to 0.70C per hour. Children and old people cool more rapidly than adults. Fat bodies cool slowly than lean bodies. Cooling is more rapid in humid atmosphere than in dry atmosphere. A body immersed in cold water cools rapidly; the rate of fall being almost twice as fast as by air cooling. Bodies buried in earth cool rapidly than that in air, but more slowly than those in water.

Post-mortem hypostasis: This is the bluish-purple or purplish-red discoloration which appears under the skin of the dependent parts of the body after death, due to capillo-venous distension. Also called post-mortem staining, sub-cutaneous hypostasis, livor mortis, cadaveric lividity, suggilations, vibices and darkening of death. The intensity of the colour depends on the amount of reduced haemoglobin in the blood.

Post-mortem lividity begins shortly after death, but it may not be visible for about half to one hour after death in normal individuals, and for about one to 4 hours in anaemic persons. It is usually well developed within 4 hours and reaches a maximum between 6 and 12 hours. It is more marked in asphyxia and is less marked in death from wasting diseases, hemorrhage and from anaemia and lobar pneumonia.

In a body lying on its back, it first appears in the neck, and then spread over the entire back except parts directly pressed on, i.e., shoulder-blades, buttocks, calves and heel.

Post-mortem stains can occur in some cases before death in cholera. The location of the lividity indicates the position of the body during post-mortem interval. Hypostasis lasts for hours. Blood clots after ½ hour of death.

Post-mortem staining gets fixed after 5 – 6 hours. A contusion can be differentiated from post-mortem staining by doing incision test.
 
In carbon-monoxide poisoning, the colour is cherry-red.
In hydrocyanic acid poisoning, the colour of stain is bright-red.
In poisoning by nitrates, potassium chlorate, potassium bicarbonate, nitrobenzene and aniline (causing methaemoglobinaemia) the colour is red-brown, or brown
In poisoning by phosphorus, the colour is dark – brown. (Blue in P.V.Chadha)
In case of aniline or CO2 poisoning, it is deep blue, due to excess of reduced Hb.
In asphyxia, the colour of stains is deeply bluish-violet or purple.
In septic abortion caused by Cl. Welchii, the colour is often greyish-brown.
In hanging, hypostasis, will be most marked in the legs, and hands. In drowning, PM staining is usually found on the face, the upper part of chest, hands, lower arms, feet and calves, as they are the dependent parts. If the body is constantly moving its position, as after drowning in moving water, the staining may not develop.
As decomposition progresses, the lividity becomes dusky in colour and turns brown and green before finally disappearing with destruction of the blood.

Muscular changes: After death, muscles of body pass through three stages:
(1) Primary relaxation or flaccidity,
(2) Rigor mortis or cadaveric rigidity,
(3) Secondary flaccidity.
Primary flaccidity: During this stage, death is somatic only, and it lasts for one or two hours.

Rigor mortis (cadaveric rigidity): This is a stage of stiffening of muscles, sometimes with slight shortening of the fibres. Individual cell death takes place at this stage.
 
Mechanism:
ATP is responsible for elasticity and plasticity of muscle. The lost ATP (during muscle contraction) during life is resynthesized. After death there is no resynthesis of ATP. The PM alteration of ATP is due to dephosphorylation and deamination. When ATP is reduced to a critical level (85% of the normal) the overlapping portions of myosin and actin filaments combine as a rigid link of actomyosin, which is viscous and inextensible, and causes hardness and rigidity of muscle rigor. The rigidity is maximum, when the level of ATP is reduced to 15%. Rigor persists until decomposition of the proteins of the muscle fibres makes them incapable of any further contraction.

The order of appearance of rigor mortis:
All the muscles of the body, both voluntary and involuntary are affected. It first appears in involuntary muscles; the myocardium becomes rigid in an hour. It begins in the eyelids, neck, and lower jaw, and passes upwards to the muscle of the face, and downwards to the muscles of the chest, upper limbs, abdomen and lower limbs. It passes off in same order.

When rigor is fully developed, the entire body is stiff, the muscles shortened, hard and opaque. Rigor of erector pilae muscles may cause roughness of skin – known as cutis anserina or goose skin. Rigor is tested by trying to lift the eyelids, depressing the jaw, and gently bending the neck and various joints of the body. RM may occur in amputated limbs and diseased parts.

Time of onset of RM:
In India, it begins 1 to 2 hours after death and takes further 1 to 2 hours to develop.
Duration of RM:
In India, usually it lasts for 24 to 48 hours in winter and 18 to 36 hours in summer. When rigor sets in early, it passes off quickly and vice versa.

Conditions altering duration and onset:
In death from diseases causing great exhaustion and wasting, e.g., cholera, typhoid, tuberculosis, cancer, etc and in violent deaths as by cut-throat, firearms or by electrocution, the onset of RM is early and duration is short.
In Strychnine and other spinal poisons, the onset is rapid and the duration is longer. In deaths from asphyxia, severe haemorrhage, apoplexy, pneumonia, nervous disease causing paralysis of muscle, and perfusion with normal saline, the onset is delayed.
The onset is slow and duration is long in cold weather. The onset is rapid due to heat, because of the increased breakdown of ATP but the duration is short. RM may persist for 3 to 4 days in refrigerated conditions.

Conditions simulating RM:
(1) Heat stiffening: When a body is exposed to temperatures above 650C rigidity is produced, which is much more marked than that found in RM. It is seen in deaths from burning, high voltage electric shocks and from falling into hot liquid. The stiffening remains until the muscles soften from decomposition.
(2) Cold stiffening: When the body is exposed to freezing temperatures, the tissues become frozen and stiff, simulating rigor.
(3) Cadaveric spasm or Instantaneous rigor or cataleptic rigidity: In this condition, the muscles that are contracted during life, become stiff and rigid immediately after death without passing into the stage of primary relaxation. It occurs especially in cases of sudden death, excitement, fear, severe pain, exhaustion, sudden asphyxial death, cerebral haemorrhage, injury to the nervous system, firearm wound of the head, etc. this is usually limited to a single group of muscles and frequently involves the hands. No other condition simulates cadaveric spasm and it cannot be produced by any method after death. It may be explained on the basis of diminished or exhausted ATP in the affected muscles.

MLI: in case of suicide the weapon, e.g., pistol or knife is seen firmly grasped in victim’s hand which is a strong presumptive evidence of suicide. In case of drowning, materials such as grass, weeds or leaves may be found firmly grasped in the hand which shows ante mortem drowning.

Secondary relaxation: Muscle becomes soft and flaccid due to breaking down of actinomyosin due to putrefaction.

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