Introduction to Forensic Medicine & Toxicology and its scope

Introduction

The application of science to those criminal and civil laws that are enforced by police agencies in a criminal justice system.

Definition:

The application of medical knowledge (all branches of medicine including laboratory  examination) for the administration of law and justice, is called as FORENSIC MEDICINE.

• Forensic comes from latin word FORENSIS which means FORUM.
• During the time of Romans, a criminal charge meant presenting the case before a group of public individuals.

Defined as ‘a branch of medical science that deals with the application of medical knowledge for the administration of law and justice”

Inference: this branch of medical science deals with the medical aspects of law

Development of Forensic Medicine

1. MATHIEU JOSEPH BONAVENTURE ORIFILA (1787-1853)

• • Father of toxicology
  • First to detect poisoning in animal in 1814.

2. ALPHONSE BETRILLON (1853-1914)

• • Anthropometry- taking body measurement as a mean of distinguishing people in 1879.

3. Francis Galton (1822-1911)

• • He was the first to look the “ finger prints”.
  • In 1892, he wrote a book, “ FINGER PRINT”, which is about the science of finger printing.

4. LEONE LATTES (1887-1954)

• • Developed the technique to identify blood type of a sample of dried blood.

5. CALERIN GODDARD (1891-1954)

• • He was the first to refine the science of bullet comparison.

6. ALBERT OSBORN (1858-1946)

• • He was the first to give attention on authority or authenticating documents.
  • Document examination in 1910.

7. WALTER MCLRONE (1816-2002)

• • Perfected the use of microscope in investigation.

8. EDMOND LOCARD (1877-1966)

• • Perfected the use of scientific method in today’s lab.
  • Locard’s  Exchange Principle.

9. SIR ANTH CANNON DOYLE:

• • Introduced physical detection methods in a forensic medicine.

Branches of Forensic Medicne

1. FORENSIC PATHOLOGY:

• • Finding the cause of the death as a result of trauma.
  • Finding the cause of death in sudden/ unexpected death.
  • Interpreting the mechanism of injury and giving medico legal opinions.

Eg : amount of force, position of victim and assailant.

2. CLINICAL FORENSIC MEDICINE :

• • Medico legal examination of rape cases.
  • Determination of age.
  • Assessment of degree of permanent disabilities, following a factory accident of a workman for compensation.
  • Psychiatric assessment of a person for-
    • Insanity in a case of murder.
    • Competency as a witness.

    • Testamentary capacity in executing a will.

    • Validity of consent.

Other Branches of Forensic Medicine:

1. Forensic Toxicology
2. Forensic Thanatology
3. Forensic Psychiatry
4. Forensic Odontology
5. Forensic Anthropology 
6. Forensic Entomology
7. Medical Ethics
8. Medical Negligence
9. Forensic Serology
10. Forensic Science

Roles of Forensic Medicine

1. To prove a point of law.
2. Used as a piece of circumstantial evidence.
3. To check the correctness or relevancy of the statement of a witness.
4. To help in differentiating accident, suicide & homicide.
5. Personal identification of unknown case.
6. To aid law of enforcement forces.

Medical Jurisprudence

(juris= law; prudentia = knowledge) deals with legal responsibilities of the physician with particular reference to those arising from physician-patient relationship, such as medical negligence cases, consent, rights and duties of doctors, serious professional misconduct, medical ethics, etc. In short, it deals with legal aspects of practice of medicine.

Medical ethics

It deals with the moral principles which should guide members of the medical profession in their dealings with each other, their patients and the State. Ethical behaviour is a self-imposed duty upon each doctor. A doctor should not criticise or denigrate the professional ability of another doctor, while dealing with a patient.

Medical Etiquette

Medical etiquette deals with the conventional laws of courtesy observed between members of the medical profession.

1. A doctor should behave with his colleagues as he would have them behave with himself.
2. He should not be influenced in any way by emotional consideration, such as sympathy or antipathy.
3. The doctor must be honest, for confidence is inspired by honesty and success depends upon confidence.
4. The medicolegal aspects of any case must always be secondary to life saving treatment of the patient.
5. It is advisable that the doctor should learn to look from the medicolegal standpoint upon such of his cases as are likely to become the subject matter of judicial investigation.
6. He should acquire the habit of making a careful note of all the facts observed by him.
7. The Court has no special medical knowledge. It relies on his witness for an opinion and expects him to assist it with his special knowledge and experience. The burden of presenting medical facts and medical opinions in the best possible way rests on the doctor.
8. Medical evidence is not a substantive evidence. but is a corroborative evidence.

Medicolegal Cases

• There is no specific or codified definition
• When a doctor receives a case having abdominal pain and the doctor suspects the cause is from any foul play like hitting by a punch
• Then the doctor needs to inform the police for investigation
• Such a case becomes Medicolegal case.
• Involvement of medical profession and law

Registration of MLC

• It is the duty of the doctor to label case as MLC
• It is registered under MLC register and MLC number is given
• The case should be informed to the nearest police station
• The information should be in writing
• In emergency, phone contact can be done

Important points to note

• Treatment of MLC patient should start as early as possible and formalities done later
• The information to the police should be in local (vernacular) language.
• If phone contact is done, entry should be properly done like police station name, name of officer receiving phone, telephone number, date and time

• Never deny a patient in emergency

• Supreme court has passed a judgment which says the life of the patient is important.

• If higher facility is required, give primary care and refer to the appropriate hospital.

Cases which can be labelled as MLC

• As per section 39 of CrPC, doctors are duty bound to inform police of certain cases.
• Cases brought for treatment under sections 272-278 (offence related to food adulteration and drugs), sections 302,303 and 304 (IPC) (offences affecting life of individual)
• Examples:

  • Cases of injuries/assault/burns/poisoning

  • Cases of sexual assault

  • Cases brought dead with improper history

  • Death due to diagnostic or therapeutic or anesthetic procedure

  • Unexpected death on operation table

  • Death due to medical negligence

History of Forensic Medicine

• Dates back to civilization
• In Greece, 460 to 355 BC Hippocrates had description of medical ethics, lethality of wounds, causes of sudden death etc.
• Various codes related to medical practice and examination of criminal death extend from Babylon around 2000 BC from China, Egypt, India, Persia and Greece.
• In Roman, various codes for medical practice and legal practice were formed
• In ancient India, Chanakya wrote treatise called, “Arthashastra”. Which covered topics like King, code of law, foreign policy, occult practices.
• It stated that death can be brought by stopping breathing, by physical injury or assault, by poisoning
• During British rule, modern medicine was introduced
• Crime investigation by police was introduced in India in 1861 and coroner’s system was introduced in Kolkata and Mumbai by coroner act 1871
• Indian penal code came in 1860 and CrPC in 1861
• In 1872 Indian evidence act was enacted
• Medical schools were established to teach modern medicine including medical jurisprudence
• First medical school was established in Kolkata in 1822 later converted to Calcutta medical college on 28 January 1835
• Medical college in madras was established on 1st October 1850 later converted to Madras medical college
• Sir William Herschel of Indian Civil Services first noted dactylography for identification in 1858
• Based on this theory, Sir Francis Galton of England done systemic study of use of fingerprinting
• Fingerprint Bureau was established at Bengal in 1897
• Indian medical council was established in 1933 to regulate medical practice in and medical education
• It was replaced by Indian medical council act 1956