OVERVIEW

OF
FORENSIC
MEDICINE
Dato Dr. Bhupinder Singh
Consultant Forensic Pathologist
Hospital Pulau Pinang
1

Forensic & Legal Medicine &

Medical Ethics Course.
The course consists of lectures and interactive
discussion in the areas of medical law, clinical
forensic medicine, thanatology and forensic
pathology, prescribing law and toxicology.
Instruction also includes an introduction to
basic concepts in professionalism and medical
ethics with a detailed review of the Code of
Professional Conduct of the Malaysian Medical
Council and of other Codes and Guidelines.
2

Thanatology is the scientific study of

death. It investigates the mechanisms
and forensic aspects of death, such
as bodily changes that accompany
death and the post mortem period. In
brief it is the changes after death.

Forensic & Legal Medicine, Penang

Medical College 2015-2016
Forensic/Legal Medicine (including Forensic
Pathology);
Course structure;
Relevance to medical practice; Recent changes in
Legal Medicine;
Cross reference to other courses;
Recommended Texts.

THANATOLOGY AND FORENSIC

PATHOLOGY.
1. Death; Brain Death and Somatic Death;
establishing the diagnosis; changes after death.

2. The doctors role at the scene of death;

Recognition of violent deaths - Homicide,
Suicide, Infanticide, Accident; Forensic
autopsies; the doctors forensic report.

3. Wounds: contusions, abrasions, lacerations,

incisions, stabbing.

4. Injuries due to firearms and explosives; Major

Disasters.

5. Asphyxia; hanging, strangulation, throttling;

Drowning.

6. Physical Injuries: Heat, Cold, Electrical,

Neglect; Road Traffic Accidents.

7. Forensic and Medico-Legal Death

Investigation and Certification
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CLINICAL FORENSIC MEDICINE.

1. Forensic Psychiatry; Mental Health Act 2001;
Testamentary Capacity; Wills. (DAC).
2. Forensic Psychiatry: Mental Health Act 2001;
Fitness to plead; Insanity as a defence in
Criminal Prosecution; (SS).
3. Alcohol - acute and chronic intoxication;
Forensic and Medico-Legal Aspects including
Driving Under the Influence of Intoxicants.
(DAC).
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4. Rape and other sexual related crimes; Forensic

Evidence. (BS ).
5. Sexual Related crimes (Clinical Application);
Examination of the victim of sexual assault.
(DAC).
6. Forensic Paediatrics; Sudden Infant Death;
Child abuse. (BS).
7. Victims of Violence. (BS).
8. Forensic Laboratories; Blood groups and
DNA Profiling. (DAC).
8

MEDICAL LAW.

1. The Malaysian Legal System and the Courts;

The Federal Constitution of Malaysia; Civil and
Criminal divisions of law; the Legal Profession.
(DAC & DG)
2. The legal framework of the doctor-patient
relationship; Registration and the Medical Act
l971 (Act 50) and Regulations; Malaysian
Medical Council (structure and role); Fitness to
Practice and Ethics. (DAC
.

3. Medical records; Adequacy; Confidentiality;

Privileged communication; Protection of
Medical Data. (DAC)

4. Tort; Tortious liability; Medical Negligence;

Supervision; Delegation ; Current trends. (DAC)

5. The Concept of Consent; Informed Consent;

Consent of Children; Patients with Mental
Disorder; Clinical Research. (DAC)
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6. Medico-Legal Litigation (Pre-Action): The

Litigation Process and System; Extent and
Nature of Liability; Fundaments and Rules of
Evidence; Current Trends and Problems. (DG)

7. Medico-Legal Litigation (The Action):

Commencement of Litigation; Discovery of
Documents; The Role of the Professional and
Expert Witness; The Hearing; The Appeal
System .
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PRESCRIBING LAW AND

TOXICOLOGY.

1. Prescribing; Dangerous Drugs Legislation;

Controlled Drugs; Cannabis. (DAC).
2. General Principles of Diagnosis and
Treatment of Drug Overdose, Poisoning;
Malaysian National Poison Centre; Drug
Addiction (SA).
3. Analgesics; Anti-inflammatories; Hypnotics. (
SA).

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4. Barbiturates; Tranquillisers; Antidepressants;

Cannabis; Narcotics (SA).

5. Corrosives; Irritants; Metals (including lead);

Household poisons; Insecticides; Poisoning in
Children. (SA).

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Professionalism and Medical Ethics

1. Basic concepts and Ethical Codes.
Professionalism in Medical Practice.

2. Malaysian Medical Council Code of

Professional Conduct. Disciplinary Inquiries.

3. Infamous Conduct. Neglect or disregard of

professional responsibilities. Standards of
medical care. Other professional responsibilities.
Abuse of privileges and skills.
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4. Infamous Conduct. Conduct derogatory to

the reputation of the profession. Advertising,
canvassing and related professional offences.
Good Medical Practice (2000), Malaysian
Medical Council.

5. Malaysian Medical Council Codes and

Guidelines. Guidebook for House Officers.

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6. Principles in Medical Ethics. Specific

medico-ethical issues. Health carer-patient
relationship. Confidentiality. Definition of
death. The advance directive. Medical care
decisions and human life. Euthanasia.

7. Organ donation. Assisted reproduction.

Health care resource allocation.
8. Specific medico-ethical issues (conclude).

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Overview of Forensic Medicine

Forensic medicine includes

medical jurisprudence, the
legal aspects of medical
practice and many other
ethical issues pertaining to
medical practice.
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Overview of Forensic Medicine

CAUSES OF

DEATH

Natural
Accidental
Suicide
Homicide
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Overview of Forensic

Medicine

CONSENT:
Consent in the practice of medicine concerns
the following three situations:

Examination of the living patient for the

purpose of diagnosis and subsequent treatment.
Examination of the living person for
medico-legal purposes.
Post-mortem examination and removal
of tissues for transplantation
25

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Overview of Forensic Medicine

Types of consent :

Implied consent
Expressed consent (1) oral
(2) written
Informed consent
Chaperon

27

Overview of Forensic Medicine

Consent for Post-mortem examination:

Medico-legal Post-mortem

referred from police

do not need to get consent

next of kin are called in to identify the body only

Clinical Post-mortem

need consent

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Overview of Forensic Medicine

Transplantation of organs and tissues come from

several sources :

homologous transplantation

tissue is moved between sites on the same body.

live donation

tissue taken from a living donor

cadaveric donation

- major source of tissue for transplantation

xenographs

- grafting of animal tissue into humans ( in research stage )

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Overview of Forensic Medicine

Blood transfusion is the oldest

practical form of tissue transplantation
Bone marrow transplant
Corneal grafting
Kidney
Heart
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Overview of Forensic Medicine

Lung
Liver
Bone
Skin
Hair
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Overview of Forensic Medicine

Sudden Natural Death

Causes-

CENTRAL NERVOUS SYSTEM

1)

2)
3)

SAH
Cerebral Haemorrhage
Epilepsy

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Overview of Forensic Medicine

CARDIOVASCULAR
1.
2.
3.
4.

SYSTEM

Coronary artery disease

Hypertensive heart disease
Aortic stenosis
Cardiomyopathies
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Overview of Forensic Medicine

RESPIRATORY SYSTEM

( LUNGS )

Pulmonary embolism
Haemoptysis
Asthma
Viral Pneumonia
37

Overview of Forensic Medicine

GREAT VESSELS
Atheromatous aneurysm
2) Dissecting aneurysm
3) Syphilitic aneurysm
1)

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Overview of Forensic Medicine

ABDOMEN
(1)
(2)
(3)
(4)

Perforated viscus
Mesenteric embolism
Gastrointestinal Haemorrhage
Ruptured ectopic pregnancy
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Overview of Forensic Medicine

INJURY and DEATH FROM

PHYSICAL AGENTS

Electrocution
Burns
Hyperthermia
Hypothermia
40

Overview of Forensic Medicine

WOUNDS

Abrasions
Bruises (contusions)
Lacerations
Incised wounds
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Overview of Forensic Medicine

HEAD INJURIES
Extradural Haemorrhage
Subdural Haemorrhage
Subarachnoid Haemorrhage

42

Overview of Forensic Medicine

FIREARM INJURIES

Smooth bore weapons

Rifled weapons

43

Overview of Forensic Medicine

ROAD TRAFFIC ACCIDENTS

Injuries to the:
(1) driver, passengers,
(2) Motor cyclist
(3) Pedestrian

Seat belt injuries

44

Overview of Forensic Medicine

Hanging
Drowning - fresh water ,sea water
Suffocation
Manual Strangulation
Ligature Strangulation
Pressure on the neck
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Overview of Forensic Medicine

SEXUAL ASSAULT

Rape is defined as non-consensual

penetration of the vagina, mouth, or
anus by the penis.
Assault by penetration is non-consensual,
intentional insertion of objects such as
bottles, or body parts other than the penis,
into the vagina or anus.
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Overview of Forensic Medicine

Rape

Indecent assault
Indecent exposure
Incest
Homosexual offences( Sodomy)
BESTIALITY

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Overview of Forensic Medicine

INFANT DEATHS
Sudden Infant Death Syndrome
( SIDS )
Child Abuse
Infanticide

48

Overview of Forensic Medicine

POISONING

SUICIDE
ACCIDENTAL
HOMICIDE

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Asphyxia - Strangulation

50

Brain Hemorrhages & edema

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Brain haemorrhages & oedema

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Fat embolism in the lung

53

Drowning: Middle ear haemorrhage

haemorrhage of petrous bone in middle ear

55

Bullet entry Wound

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Contact wound

Cruciate shaped laceration

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Abrasion ring contact wound

impression of weapon seen on the wound

58

Powder tattooing

unburnt carbon particles

which cannot be washed
cos embedded in skin, just
like tattooing

59

Powder tattooing : close range

60

Slit like exit wound

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Entry and exit wounds

62

gunshot wound from a

shot gun
.
shot gun has small
pellets while rifle has
single pellet

abrasions

Burns

68

Incised wound- defense

wound

69

Defense wound

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Incise wound

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Stab wound hilt mark.

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Stab wounds

Contusion: 1 week. (Yellowish

green)

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Blunt Trauma Liver rupture

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Abrasion
must know colour to determine how old the wound is

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Laceration

77

Atherosclerosis

78

Atherosclerosis

79

Atherosclerosis

80

Aneurysm

81

Coronary Thrombosis

82

Myocardial Infarction

83

Coronary Thrombosis

M. I.

Coronary
Thrombosis

Petechial
haemorrhages
84

Coronary Occlusion
occluded vessels due to atheroma

85

Haemorrhage in a plaque

86

Pulmonary Embolism

87

Pulmonary Embolism

88

Pulmonary Embolism

89

Embolism

90

Diabetes Glomerulonephorosis

91

Ecchymosis
common in elderly ppl / young cos they have fragile tissues
can be mistaken as abuse

92

Multiple Stab Wounds

93

Fat Embolism

94

Fat Embolism - Kidney

95

Fat Embolism - Lung

96

Drowning - Vegetable Matter

97

Amniotic Fluid Embolism

maternal deaths

98

Carbon Monoxide Poisoning

nright red discolouration

of periphery

99

Semi Automatic

100

Revolver

101

Bullets

102

Semi Auto Rifle

103

Semi Automatic Pistol

normally has a magazine

to store bullets

104

Slugs with markings

105

Contact wound - blood on hands

instant rigor - not possible to put gun in the hand of victim after death
106

Contact wound

107

Retinal Haemorrhages

108

Gunshot - Skull

109

Haemopericardium
one of the causes is due to
ruptured myocardial infarct

110

Bruising

111