Medical jurisprudence, identification Flashcards
Parts of MCI act
The MCI act 1956 has three schedules
- Doctors from India
- Doctors outside India
- Two parts: those not included in schedule 1 and those not included in schedule 2
Functions of MCI
- Medical education
- Medical register
- Disciplinary control
- Qualification exam for FMG for their recognition
- Appellate tribunal
Members of IMC
Number of members elected from various states and universities of India, and some members nominated by the government of India
They hold office for 5 years
They elect a President and Vice President among themselves
They appoint a Registrar and a Secretary four day to day functioning
Functions of SMC State medical Council
- Medical register
- Disciplinary control
- Warning notice
Functions of the SMC with respect to infamous conduct or serious professional misconduct
The SMC can:
- Issue a warning notice
- penal erasure or professional death sentence (erasure of name of the doctor from the medical register) which has to be confirmed by the MCI and can be appealed to the health ministry
Making of a false document by a doctor is punishable
197 IPC
Examples of professional misconduct
A. Alcoholism addiction adultery abortion advertisement association B. Bribe C. Covering D. Dichotomy F. False document (197 IPC)
Examples of privileged communication
C. Crime-police/ magistrate 39 CRPC I. Infectious disease relative V. veneral disease I. interest of patient-eg.,suicide C. court of law S. Servant life endangering I. Interest of self N. negligence notifiable disease
Therapeutic privilege
Exception to full disclosure
Example suicidal tendencies
COPRA act is of which year
Consumer protection act of 1986
Compensation for various redressal forums
District level: 20 lakh
State level: 20 lakh-one crore
National level: more than one crore
Only paid patients get compensation
351 IPC
Examining a patient without consent
Negligence comes under the IPC section
336: life in danger
337: simple hurt
338: grievous hurt
Abortion with consent of mother comes under the IPC
312 IPC
Burden of proof in cases of civil negligence falls on
The punishment in these cases is
The patient
The punishment is only money as a compensation unlike criminal negligence where 304A IPC is also considered
Res ipsa loquitor
Cases which speaks for itself and proves negligence by doctor
No contributory evidence is required
It is applicable for both civil and criminal negligence
Novus actus intervieniences
Cases where both the doctor and the accused are responsible for the death of the patient or victim
Res judicata
In civil negligence the same case cannot be discussed twice in the same court
Res indicata
The patient can file a negligence case within only two years of the incident
Defenses for the doctor against medical negligence case if civil
- Informed consent
- Res indicata
- Res judicata
- Therapeutic misadventure
- Contributory negligence and corporate negligence
- Error of judgement
- Products liability
- Calculated risk doctrine
- Vicarious liability
Exceptions of contributory negligence
- Last clear chance doctrine:
If doctor misses the last chance to inform the patient - Avoidable consequence doctrine
Patient not following doctors instructions adequately leading to damage. Patient is held more responsible
Vicarious liability
Respondent superior
Let the master answer
Employer is responsible for negligence by the employee
Only applicable in civil cases involving monetary compensation.
Common drugs used for active euthanasia
- Phenobarbitone
- Thiopentone
- Insulin
- Opium
- KCl
Euthanasia in India
In India, only passive euthanasia is legalised (first in Maharashtra in 2015)
It can be conducted with the permission of Supreme Court(by a panel of doctors)
Countries where both active and passive euthanasia is legalised
Netherlands (first country)
Belgium, Sweden, Switzerland
Thailand
Indian contract act and consent
Indian contract act was formed in 1872
Consent is given in section 13
Types of consents
- Expressed consent (written or oral)
- Implied consent
- Informed consent :
bidirectional
Medical procedure then surgery is informed - (Blanket/ Blind/ Open consent)
- Substituted consent
Exceptions to consent
- Emergency
- Mass immunisation
- Examination of rape accused
87, 88, 89 IPC
- A person above 18 can give consent for surgery or invasive procedure
- Valid consent to suffer any consequence given in good faith
- A child below 12 cannot give consent even for physical examination
90, 92 IPC
- Consent not valid when given due to fear of injury
92. In emergency (life threatening conditions consent is not required
351 IPC
Examination of patient without consent amounts to assault
Conditions in which the consent has to be obtained from both husband and wife
Contraception sterilisation artificial insemination
Informed refusal
Patient can refuse treatment after receiving complete information about his/her condition
Non fit injuria
Patient cannot claim compensation for damages when consent is given willingly
Borrowed servant doctrine
The person who borrowed an employee is responsible for negligence by that employee
In loco parentis
Consent given by police/ guardian/ principle in absence of parents
Medical etiquette
Courtesy of doctor towards one another
Medical ethics
Moral principles of a doctor towards patient, society and state
Decided by MCI
Self imposed
First centre that appears
Clavicle at 5-6 weeks
Appearance of ossification centre
Clavicle 5-6 weeks
5m - Calcaneum
7m - Talus, (2nd and 3rd pieces of sternum)
9m - Lower end of femur, cuboid, capitate bones
10m - upper end of tibia
Fusion of patella or xiphoid
Patella - 14 years
Xiphoid - 40 years
The bones fused between 20 and 22 years
I. Iliac crest - 20 years
I. Inner end of clavicle - 21 years
T. Ischial Tuberosity
Fusion of carpal bones
First and last
First- capitate within 1 year
Last- pisiform 12 years
Fusion of sternum bones
Manubrium+4 pieces + xiphoid Going upwards: 40y. Xiphoid fuses at 15y. The next two pieces 20y. “ ” 25y. “ ” Old age. Upper piece and manubrium
Fusion of pieces of sacrum and that of greater cornua with hyoid
All pieces of sacrum fuses between 20-25 years
Greater cornua fuses with the body of hyoid between 40-60 years
Fusion of sutures of skull
1y. Metopic / frontal suture
80y. Masto-occipital suture
Coronal suture 25-40y
Sagittal suture 25-(40-50)y (best)
Inner table of skull bone fuses 5-10y earlier than outer table
Fusion of bones of skull other than the sutures
L. Lambdoid = 45y A. Asterion = 50y P. Pterion = 65y Ant fontanelle 2 years Post fontanelle at birth Basisphenoid + Basi-occiput at 18-21y
X-rays of skull used for age estimation
Oblique X-ray
Lateral skiagram
The halves of mandible fuse at
2 years
Anterior fontanelle also fuses at 2 years
Rule of Haase
Modified Morrison rule
Age of foetus in first 5 months= square root of length of foetus in cm
(Modified Morrison rule - part 2 of rule of Haase):
Next 5 months, age of foetus in months = length of foetus/5
Important events occurring in foetus Part 1 (first 4 changes)
2m. Limb bud appears
3m. Nail star
4m. Lanugo appears, sex differentiated
6m. Vernix caseosa
2,4,8 L
Important changes occurring in foetus
Part 2
7m. Testis in external inguinal ring
8m. Testis in left scrotum
9m. Testis in right scrotum
10m. Nail growth till tip
Qualitative methods for bone age estimation
- Greulich Pyle atlas method (M/C)
2. Tanner Whitehouse method (most accurate)
First teeth (temporary) to erupt is
Lower central incisors
Then upper then upper lateral then lower lateral
Sequence of eruption of temporary teeth is
I (1st lower central incisor)
M.
C.
M. (Last molar at 2 1/2 - 3 years)
Sequence of eruption of permanent teeth
M 6 years (molar) I 7 I 8 P 9 P 10 C 11 (not in expected order) M 12 M 18-25
Superadded and successional teeth
Superadded:
3 permanent molars in every quadrant (not the premolars)
Successional teeth:
Erupt in place of predecessor teeth
All other permanent teeth
The temporary molars are replaced by premolars
Age of temporary and mixed dentition
Age of temporary dentition: 6-7 years
Age of mixed dentition: 6-12 years
Permanent teeth = (age-5)*4 where age is 7-12
Demirjian method
Estimation of age using 3rd molar
Dental charting/ Formula
- Palmar notation
- Universal formula
- FDI
- Modified FDI method
- Zsigmondy method: Roman numeral
- Anatomical charting marks
- Haderup formula
Palmar notation and Haderup formula
Palmar notation: 1➡️8 every half jaw from centre
Haderup formula:
Palmar notation + upper teeth +ve/ lower teeth -ve
Universal formal of teeth notation
1➡️16 from right upper
17➡️32 from left lower
FDI and modified FDI notation for teeth notation
FDI :
quadrant number (from right upper ➡️ lu ➡️ ll ➡️ right lower) + palmar notation (1➡️8)
Example 11,…18,21,…
Modified FDI:
Quadrant numbers for lower jaw are replaced by the reverse (4➡️3 and 3 ➡️4)
Right ➡️ odd 1,3
Left ➡️ even 2,4
6 X-ray criteria for age determination using teeth used in Gustafson method
S. Secondary dentine C. Cementum apposition R. Root resorption I. attrItion P. Peridontosis T. Translucency: best >30 years
Gustafson method
Age by teeth X-ray
Used when >25 years
Best tooth is incisor whereas worst tooth is molar
Methods similar to Gustafson method for determining age using teeth
- Daliz method: modification of Gustafson method
- Stack method: for infant
- Boyd method:
For neonates
Incremental lines on teeth - Lamendin method
- Miles method: wear and tear of tooth
Stack method
Age of infant is calculated using teeth height and weight
Lamendin method
Age of person is calculated using:
- Gum regression
- Translucency/ transparency of tooth
Multiplication factors (for calculating stature of a person) are given by
- Karl-Pearson
- Trotter-Gleser
- Dupertius-Hadden
- Jit-Singh
Multiplication factors given for different bones (for calculating stature) are
Femur: 3.7 \+0.8 Tibia/ fibula: 4.5 \+0.8 H. Humerus: 5.3 \+0.8 U. Ulna: 6.1 \+0.4 R. Radius: 6.5 Bone length is measured using Hepburn osteometric board
Barr body was discovered by
Bar and Bertam
Davidson body
Drumstick body present in 6% of neutrophils of females
X chromosome is identified using
Y chromosome is identified using
Fuelgen reaction using acriflavine stain
Fuel for next generation
Quinacrine reaction is used
Frontal sinus X-ray is used for
Identification when age >15 years
Colonel Victor Barker was as case of
Concealed sex
For lip print , stains used are:
Aquaprint
Cyanoacrylate
For identification of any body, we use
- DNA 🧬
- Blood 🩸 group
- Maple 🍁 method: lines on 2nd molar
- Aspartic acid
- Mg-Zn ratio
Stelle method for identification
When is it used
When fragments of bones are only available, the stature is determined by Stelle method
Minimum age at which a child is responsible for a crime
According to 82 IPC: 7 years
According to Railway act: 5 years
Minimum age at which a child is punishable for the offence
12 years according to Railway act
366 B IPC
Importation of a girl (<21 years of age) from foreign country for prostitution
Not <18 years
Age of scar
5-6 days: red blue (angry) scar
2 weeks - 2 months: pale (tender and soft)
2 month - 6 month: brown (tender and tough)
> 6 months: white (non tender)
Scar is vascular/ soft till 2 months
Describe the best method for criminal identification
Fingerprint (dermatoglyphics/fingerprinting/ Galton-Henry system)
Discovered in 1858 by William Herschel
First fingerprint bureau in India- Kolkata (writer building)
Development of fingerprints and Quetelet rule
Starts developing in foetus- 12-16 weeks Completes by 24 weeks Fingerprints are papillary ridges Quetelet rule: Fingerprints are not identical even in identical twins
Henry classification
Classification of fingerprints Loop: 70% Whorls Arches Composite: 1-3%
Permanent loss of fingerprints can be caused by
Radiation
Leprosy
Charring
For histo section of fingerprints, what depth of skin is taken
For histo section 0.6 mm depth of skin is taken
The best and worst finger for fingerprinting
Best finger: thumb
Worst finger: little finger
For comparison of fingerprints a minimum match of 10-12 corresponding points is required
Types of fingerprint
- Plastic: soap, cheese
- Latent: invisible
- Visible: blood stain/other stain
Latent fingerprint is made visible through which methods
- Fabric: AgNO3
- Paper: iodine/osmium tetra oxide
- Glass: scanning e- microscope
Other chemical used are:
Barium products
Ninhydrin
Cyanoacrylate
Best method: OFTIR (Optical frustrated total internal reflection)
Major methods of identification other than fingerprinting
- Poroscopy
- Palatography (rugoscopy for anterior 1/3rd)
- Cheiloscopy
- Podoscopy
- Superimposition technique
Describe poroscopy and palatography
- Poroscopy:
Discovered by Edmund Locard (exchange principle)
Pores are found in skin tissue with 1mm ridge having 9-18 pores - Palatography:
Discovered by Allen
Hard palate specimen is taken from decomposed bodies
Anterior 1/3rd is important-rugoscopy
Describe cheiloscopy and podoscopy
3. Cheiloscopy: Use of lip print Discovered by Suzuki 7 types of lip print 4. Podoscopy: Use of footprint for identifying children
Superimposition technique
Skull X-ray is used for identification
Screening test (not confirmatory)
Discovered by Glaister
Skull X-ray is compared to corresponding points in negative of a photograph
Difference in corresponding points suggests that both don’t belong to the same person
Anthropometry
Bertillion’s system/Portrait Parle Used when no biological specimen is available 1. Body marks 2. Body measurement 3. Descriptive data
Tattoo marks
types and identification
- Live
- Dead
- Decomposed
Can be detected upto lymph node level
Made visible via UV lamp
For old tattoo, infrared photography is used
Famous case: Sydney Shark arm case
Dyes used for tattoo
- Prussian blue
- Cinnabar
- Malachite green
- Vermilion
- India ink
Tattoos are erased by
B. Burn, beam
C. Corrosive
D. Dry ice (CO2)
E. Enzymes (like papain) , excision, electrolysis
Corpus Delecti
Body of offence
aka essence of crime
When there is a crime, identification of the body is most important
Other evidences are clothes, traces of evidences, weapons,…
Race cephalic index
CI=(breadth of skull/ length of skull) *100 DuMB head D: 70-74.9 M: 75-79.9 B: 80-85
Various cephalic indices
1. Dolicocephalic: Negro, pure Aryan 70-74.9 2. Mesaticephalic: Indian 75-79.9 3. Brachycephalic: American, Japan, Mongol 80-85 Due to early fusion of coronal suture
Indices for race
B. Brachial= (radius length/ humerus)*100 C. Cephalic C. Crural= (tibia length/femur)*100 I. Intermembranal= (H+R)/(T+F)*100 Humo-femoral index
Identification of race based on orbits
Shape of orbit is used
- Square: Negro
- Triangular: caucasoid
- Round: Mongol
Identification of race based on the medulla of their hair
1. Kidney: Negro Cuticle absent 2. Oval: caucasoid 3. Non fragmented: Mongol Round
Special features of teeth of the Caucasian and Negro races
1. Caucasian race: Carabelli cusp- Maxillary molar 2. Negro race: Large teeth More cusps in molar teeth
Specific characteristics of Mongol teeth
- Shovel shaped incisor
- Pointed canine
- Bull like tooth (taurodontism)
- Enamel pearl (premolar)
Sequence of secondary sexual character
The. Testis and penis development P. Pubic hair G. Growth spurt Must. Moustache All. Axillary hair Boys. Beard
Sequence of appearance of sexual characteristics in female
The. Thelarche (breast bud) P. Pubarche G. Growth spurt Must. Menarche All. Axillary hair Girls
Krogman’s table
Sex determination by bones is via Krogman’s table
Pelvis: 95%
Skull: 92%
Pelvis and skull: 98%
Long bones: 80%
Whole skeleton: 100%
Bony prominence more prominent in female is
Frontal eminence
Rest is opposite
Shape of pelvic inlet in respective genders
Heart shaped in males
Round shaped in females
Bony angles more in female
Angle of mandible
Sub pubic angle
Tertiary sexual character
Preauricular sulcus which is present in female pelvis (only rarely in males)
Best bony parameter to determine sex
Greater sciatic notch
Small, deep and narrow in males, which is opposite in females
Chilotic line and sex determination
Line connecting sacrum to pelvis
In males, sacral part is prominent
In females pelvic part is prominent
Best bony index to determine sex
Property of bony indices
Sciatic notch index
4-5 in males, 5-6 in females
Bony indices are usually higher in female (like Washburn index (ischiopubic index))except corpobasal index
Corpobasal index
The bony index which is higher in males
Breadth of 1st sacral vertebra)/ (breadth of base of sacrum
Ashley rule
Hyrtl’s law
Ashley rule:
Sternum length is more in males
Hyrtl’s law:
Length of body of sternum is higher in males
