CHAPTER – VI

MEDICO-LEGAL EVIDENCE AND ITS

RELEVANCE

6.1 Introduction
In every trial for manslaughter or for the offence of causing hurt to human body,
opinions of medical officers are invited to ascertain the cause of death, injuries,
whether the injuries are anti-mortem or post – mortem, the probable weapon used, the
effect of injuries, medicines, poisons, the consequences of wounds whether they are
sufficient in the ordinary course of nature to cause death, the duration of injuries and
the probable time of death. In such trial sometimes the plea of unsoundness of mind or
minority is taken by the accused. In trials for offences of kidnapping and rape, the
question invariably in dispute is the age of the person kidnapped or of the girl raped.
In all such cases the medical opinion is adduced to establish minority. In rape cases
apart from showing the minority of the girl, the medical opinion is tendered to
establish the offence of rape.

The medical evidence adduced by prosecution has great corroborative value. It proves
that the injuries could have been caused in the manner alleged and the death could
have been caused by the injuries so that the prosecution case being consistent with
matters verifiable by medical science, there is no reason why the medical witness
should not be believed. The use, which the defense can make of medical evidence, is
to prove by it that the injuries could not possibly have been caused in the manner
alleged or death could not possibly have been caused in the manner alleged by the
prosecution.139

The medico - legal work is of a specialized nature. It is entrusted to Medical officers

who have knowledge about it and who have been trained. The quality of medico -
legal work has its repercussions on law proceedings.

139
Singhal M.L., Medical Evidence and its Use in Trial of Cases, J.T.R.I.U.P. Journal – First Year,
Issue-3, Year-July-September,1995

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All cases of burns, tetanus, poisoning and suspicious cases are to be treated as
medico-legal. It may happen that cases at the time of admission may be purely
surgical or medical, but later they may assume medico – legal importance on account
of changed circumstances. Age certificates in many cases are of medico legal
importance. Deaths on the cause of which cannot be certified are medico – legal
cases.140

6.2 Medico-legal Evidence

A medical practitioner will have to frequently give medical evidence to prove the
innocence or guilt of the accused, or to authenticate or disprove a criminal charge of
assault, rape or murder brought against an individual. Medical evidence consists of
doctor’s report of the examination, reports of the chemical examiner and serologist,
and the doctor’s oral evidence.141

6.2.1 Meaning
Medical evidence given before a Court of Law is of two forms –
1. documentary
2. oral

The documentary evidence is the evidence presented by the doctor, i.e.,

a. a medical certificate including the physical and mental state of a person
b. a medico-legal report
c. a dying declaration

In the documented evidence, first the physical injuries are taken into consideration. In
case of rape, more particularly ano-genital injuries as well as extra injuries (injuries
on rest of the body) are examined properly. In other cases, only the victim is
examined. In rape case, both the victim and the accused are examined. In case of
victim, in the medical examination, age of the victim, marks of violence on the body,
blood stains, virginity, depth of the injury, such factors are taken into consideration.
The emotional state is also examined. The victim may be in depressive or maniac

140
Post mortem and Medico – Legal work ref: Hospital Administration Manual (2012) Vol. 1 chapter
XII.
141
Modi Jaisingh P., Modi’s Medical Jurisprudence and Toxicology, ed. by K.Mthiharan and Paranaik
Amrit K., (2005) Lexis Nevis, Butterworths

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state. The intellectual state of the victim may have been hampered. She may be
suffering from illusions, hallucinations, sometimes her behavior may have become
psychopathic.

The mental state of the accused is also examined. Because sometimes it may happen
that the accused wants to prove himself as an insane person, which he may not be. He
may be pretending to get exempted from the punishment.

The samples and specimens are collected from body or clothing, including –
1. Seminal fluids : Semen is a human body fluid, a stain of which is of
then involved in sexual offences. Examination of semen is generally
done for the forensic purpose. The presence of blood stains with or
without seminal stains is caused by the physical violence associated
with sexual offences.

2. Head hair, public hair : With the help of examination of head hair, it
may be possible to understand many things. Examination of public hair
helps in sex determination. The signs like sindoor on the forehead can
be helpful to identify the person's religion.

3. Blood examination : Blood examination helps in understanding the

sexual diseases. In case of poisoning, blood test is very important.
Urine analysis helps when the patient is unconscious.

4. Debris : It means nail pieces or carbon debris. They help examining

the patient.

5. Bones : In case of dead bodies, examination of bones, becomes

important. The age determination is possible with the help of
examination of elbow of a person. Examination of fingers helps
understand the difference between a male and a female body.142

142
Interview by Dr. Arya (ex-Principal, Dhondumama Sathe College, Pune) on 28th July 2013

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Medico legal evidence is collected generally from victim’s body. In any legal action
pursued in relation to her case this evidence is typically used to aid the investigation
and prosecution of the accused.

More specifically, the medico legal evidence taken from a sexually assaulted woman
may be used in determining the occurrence of recent sexual activity and identifying
the assailant and establishing the use of force or resistance.

The medical forensic examination is conducted to collect available medico legal

evidence for potential use in the court. In most regions, all relevant samples are
collected from the victim during the examination.

In some countries the examination provided comprises a number of key components:

1. Consent: Written consent is required from the victim of sexual assault
prior to a medical forensic examination. She is asked to consent to the
release of the evidence to relevant law enforcement, court related
services.
2. Medical History: A medical history is commonly taken to assess the
victim’s state of health and identify any pre existing health problems
that might be relevant to her care. The information taken as a part of
history may or may not be forwarded to the police.
3. Sexual Assault History: The victim is usually asked to recount the
relevant details of the sexual assault including the date, time, location
as well as the details about the assailant. This account of the assault
can be used to guide the medical forensic examination. The victim is
also asked to provide information as whether she bathed, changed her
clothes, etc. since the assault took place.
4. Medico Legal Findings: The clothing worn by the victim at the time
of sexual assault is often collected, if available. It is then secured in a
bag together with any trace evidence found on it. The woman’s hair
may be combed to capture any foreign hairs or materials. She may also
be asked to provide a urine or blood sample. A physical examination
follows in which both the extra neutral and genital injuries and marks
are documented.

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 The abrasions lacerations, swelling, bites and scratches are
documented. A speculum, colposcopes and staining agent like
toluidine blue dye is used to further detect injuries to the genital. The
injuries, if any, may be photographed and included as evidences.

The skin is examined for secretions, such as semen and saliva and
body cavities are swabbed for seruinal fluid. A victim's emotional state
may be observed and recorded.

In some areas a particular focus of the examination is on checking for

evidence of defloration i.e. ruptured beymen.

5. Treatment Guidelines: The victim is frequently offered treatment for

sexually transtruitted infections. She may also be given information on
counseling and available social services and asked to return for follow
up case.143

6.2.2 Purpose of Medico-legal Evidence

The purpose of Medico-legal evidence is to aid the investigation and prosecution of
an accused. With the help of medico-legal evidence, in case of rape, it would be
possible to determine whether a sexual activity occurred or not. The sexual assault or
rape occurred or not can be understood with the help of medical examination only.
When the accused is examined or when more than one suspect are examined, it
becomes easy to identify the assailant. Though the law may not take into
consideration how much resistance was there on the part of the victim. However, to
understand whether the consent of the victim was given or not, the use of force of the
accused or resistance by the victim can be established in the medico-legal evidence.
More particularly, in case of drug related violence, the medical evidence can be used
to indicate an inability to consent due to the influence of alcohol and drugs.

143
Janice Du Mont and Deborab White: The uses and impacted of medico legal evidence is sexual
assault cases. A global review Sexual Violence Research Initiative published by World Health
Organisation 2010.

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The settings where medico-legal evidence is collected are hospitals, forensic institutes
and police stations. From hospitals, one can collect birth certificate, death certificate,
cause of death etc. From forensic institutions, poisoning, firearms etc. can be
examined. From police stations, one can collect panchnamas, so that overall case can
be examined.

Generally, the samples are collected by the officers. The staff deals with the samples
and evidence consists of doctors, police surgeons, forensic examiners, nurses,
sonographist etc. Day by day, with the improvement in technology many other fields
are included in the examination of medical evidence.

The medical forensic examination is usually carried out within 72 hours of a sexual
assault. After the period of 72 hours there is a possibility of not getting proper
evidence from the samples.

Processing of medico-legal evidence is necessary. When the samples are collected

they are air-dried and sealed in separate containers. The possibility of mixing the
specimen with others should be totally avoided. The life span of the sample is very
less, i.e., why immediate processing is advised. The evidence may be stored or frozen
in certain circumstances. In India, it is compulsory for the victim to prosecute and
when the victim goes to the police to file F.I.R. it becomes mandatory for her to go
through necessary medical examination.

The medical forensic examination comprises of certain key components, such as

taking medical history of the patient. The history of sexual assault incidence is also
necessary, such as place, nature or duration of the act. In the examination,
documentation of various medico-legal findings is necessary. There is a possibility
that the same doctor or surgeon making the examination, may not be able to stand in
the Court of Law as a medical witness. When in his place, another officer has to be
present in the Court, the documents become important, At the same time, the
treatment guidelines which are provided to the victim must be noted down more
particularly in the document e.g., in a serious rape case, the treatment provided to the
victim, can become a necessary proof of evidence. In the processing of medico-legal
evidence, the evidence given by medical officer is handed over to a law enforcement

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official who may either take it directly to a forensic laboratory or store it at the police
station until it is to be analysed, once submitted to a forensic laboratory, the evidence
is analysed and a report produced and then at the end, laboratory findings and
documented injuries, may be introduced in the Court.144

6.3 Relevancy of Medical Evidence

6.3.1 Types of Medical Evidence
Types of cases labeled as Medico-legal
The following cases are to be considered as “medico-legal” and due police
notifications in all these cases must be done. Where there is death
/injury/debility/infirmity due to:
1. Poisoning
2. Injury with sharp object/fire-arms.
3. Tetanus.
4. Burns
5. Drowning
6. Death on the operation table or immediate postoperative death.
7. Death .injury in a woman within 7 years of marriage.
8. Conditions which require notification as per the laws for the time being
in force.
9. Any other conditions where there is a suspicion of some foul play.
10. Where the cause of death is not certain.

It is a common belief that all deaths, which occur within 24 hours of admission,
become medico-legal cases. This is not true. When there is no doubt in establishing
the cause of death and when there are no reasons to believe that there is any foul play,
a death certificate can definitely be given by the treating physician.

The above mentioned belief was established because in olden days a firm diagnosis as
to the illness /cause of death , of patient could fairly be arrived at after 24 hours, by
which time all the reports of the investigations were available. The scenario is
different today with the advent of better and faster diagnostic means.
144
Interview by Dr. P. Vijaykumar, Medical Officer, at Belgaum on 14th July 2013

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6.3.2 Articles to be Preserved for Medico-legal Cases
Medico-legal evidence on the persons or the patients needs to be preserved and
handed over to the police authorities for evidence in the court as soon as possible.
These articles should be preserved in sealed covers for a maximum period of 3
months and subsequently destroyed after informing in writing to the police authorities
concerned.

In cases of polytrauma:
1. Clothing worn by the patient and showing evidence of stab, cut marks,
firearm injury evidence, blood stains etc.
2. All foreign bodies like bullets etc. recovered from the body of the
patient .

In cases of poisoning:
1. Gastric lavage/gastric contents/ vomitus or soiled clothing should be
preserved for chemical analysis.
2. Blood, urine samples should also be taken for chemical analysis.

In cases of burns:
1. Soiled articles with inflammable substances, burnt pieces of clothing,
scalp hair etc.
2. Blood sample for carbon monoxide levels.

A comparative study had been made about the process of medico-legal evidence and
it is stated as
- Sexual assault victim/survivor is not obliged to submit to a medical
forensic examination (e.g. Canada), in India, it is compulsory for the
victim
- May go to a facility for a medical forensic examination of her own
volition (e.g. parts of France) or upon referral by the police or another
government body (e.g. Iraq). Similar provision is there in India.

In Russian Federation, sexual assault victim/survivor must undergo a mandatory

medical forensic examination. However, in Lesotho, the victim is first presented to a

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police station to have the assault documented, complete a report and or obtain a
medical form or sexual assault kit that is then to be taken to the facility where the
evidence is collected. In Philippines, the doctors have authorization for an
examination from law enforcement, prosecution representative or judge.

In Belize, none in place to guide the collection of medico legal evidence in cases of
sexual assault. The protocols for medico-legal evidence are developed but not widely
implemented in India, South Africa. However, in certain parts of Canada, they are
thoroughly institutionalized.

When the legal outcome studies reviewed, those undertaken specifically to evaluate
the association with legal outcome of distinct types of medico legal evidence (e.g.
anon genital injuries, sperm/semen), 13 retrospective reviews were conducted in
Canada, Denmark, Finland, Norway and the United States and drew on cases of
sexual assault reported to hospitals and their related police and or prosecution files.

Some of the studies intended to evaluate the relationship with legal outcome of other
factors, but which included either “injury to the victim” or “physical or forensic
evidence” as variables in their designs, 31 studies had been conducted in Australia,
Canada, United Kingdom and the United States, which are predominantly published
in social science journals.

Other studies are those that have constructed medico-legal evidence as a single “yes
no” variable and examined its impact on legal outcome, 5 descriptive studies were
conducted in Brazil, Canada and South Africa.

In many studies attrition in the processing of sexual assault cases was associated with
the victim/survivor’s:
a. Age(older)
b. Socioeconomic status(poorer)
c. Reputation(e.g. psychiatric history)
d. Prior to an assault( e.g. drinking)
e. During an assault ( e.g. lack of resistance)
f. Following an assault ( e.g. promptness of report)

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With the studies of medico-legal evidence in socio-cultural context, certain outcomes
are noticed -
1) Male dominance, gender inequality, anti-woman and rape-supportive
attitudes can influence the allocation of resources for sexual assault
services and ultimately the existence, quality and effectiveness of
medico-legal evidence.
2) These forces may determine the availability of trained staff, adequate
facilities for the collection of evidence and the effective interagency
co-ordination necessary for its processing
3) They may negatively influence the ways in which medico-legal
protocols and technologies are constructed, as well as the practices of
the professionals responsible for their use.
4) There are no formal rules related to corroboration of a sexual assault
victim/survivor’s testimony, but there is a continued demand in legal
practice for corroboration based in part on widespread distrust of
women.
5) Staff is not adequately prepared to collect and testify to medico-legal
evidence and specimens are mishandled leading to results usually
being unreliable.
6) Post sexual assault professionals (e.g. police, prosecutors, judges)
attack woman’s character and use her prior sexual history to discredit
her (even where clearly irrelevant or prohibited)

These studies have put forth certain questions and certain recommendations can
accordingly be made. The minimum amount of medico-legal evidence is necessary to
aid in the adjudication of a case. In circumstances of rape cases and murder cases,
medico-legal evidence is most valuable.

Recommendations
There is a possibility of having direct influences of socio-cultural factors on the
operations of services, the development of protocols, and the practices of sexual
assault professionals, which may hamper the evidence. The improved training of
sexual assault personnel will enhance the value of medico-legal evidence. The

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medico-legal policies and protocols will certainly improve the efficacy of medico-
legal evidence. The value and meaning of the medical forensic examination for sexual
assault victim/survivors is to be understood.

There is a need to further examine viable alternative measures for enhancing justice
for victim/survivors of sexual assault. The measures be prioritized in terms of
resources allocation vis a vis existing criminal justice and medico-legal practices.145

6.3.3 Importance of Medical Evidence at Various Stages of Investigation

The doctor, being a witness in the Court has to be careful and cautious while
delivering a judgment. However, according to Indian Penal Code, the doctor is held
liable under the following sections.

The Indian Penal Code

Section 191-“Giving false evidence”.

Section 192-“Fabricating false evidence”

Section 193- “Punishment for false evidence”.

Section 197- “Issuing or signing false medical certificate”.

Section 291: “Deposition witness.”

The deposition of a civil surgeon or other medical witness taken and attested by a
magistrate in the presence of the accused may be given in evidence in any injury or
other proceeding under this section of law.

Section 293: “Reports of certain government scientific experts”

Such reports may be provided in person, or a responsible officer, who is conversant
with the facts of the case, may be deputed to satisfactorily depose in court on his
behalf.

145
Janice Du Mont & Deborah White “Women’s Worlds” Madrid, Spain, July 8th 2008.
Sexual Violence Research Initiative, The uses and impacts of medico-legal evidence in sexual assault
cases: A global review, Available from: http://www.svri.org/

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The Indian Evidence Act 1872
Section 45: Opinion of experts
When the court has to form an opinion upon a point of foreign law, or of science or
art, or as identity of handwriting [or finger impressions], the opinions upon that point
of persons [experts], who are specially skilled in such issues are relevant facts.

Section 61:Proof of contents of documents

It means that the contents of documents may be proved either by primary or by
secondary evidence.

Section 62: Primary evidence

It means that the document itself is produced in court.

Medical witness
Medical witness also plays an important role as an expert in case of injured patients.
He owes an onerous duty towards maintenance of a proper case record, that involves:
a) Noting down of injuries.
b) Making entries in the accident register.
c) Intimating to the police instances of accidents and deaths.
d) Postmortem certificates, wound certificates etc.
e) In addition, patient’s own statement of injuries or dying declaration needs
to be recorded diligently.

6.3.4 Post–Mortem Report

The concept of a medico – legal autopsy has been mentioned in the Sections 174 and
176 of criminal Procedure code.

S. 174 is related to that when the police officer receives information that a person has
committed suicide, or has been killed by another or by an animal or by machinery or
by an accident, or has died under circumstances raising a reasonable suspicion that
some other person has committed an offence he shall immediately give information to
the nearest Executive Magistrate, empowered to hold inquests and proceed to the
place where the body of such deceased person is and shall make an investigation and
draw up a report of the apparent cause of death, describing such wounds, fractures,

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bruises and other marks of injury as may be found on the body and stating in what
manner or by what weapon or instrument (if any) such marks appear to have been
inflicted.

When the case involves suicide by a woman within 7 years of her marriage or the case
relates to the death of a woman within seven years of her marriage in any
circumstances raising a reasonable suspicion that some other person committed an
offence in relation to such woman or the case relates to the death of woman within
seven years of her marriage and any relative of the woman has made a request in this
behalf or there is any doubt regarding the cause of death or the police officer for any
other reason considers it expedient to do so.

He shall, to its being examined, to the nearest Civil Surgeon, or other qualified
medical man appointed.

S. 176 states that when the case is of the nature, as mentioned in S. 174, the nearest
Magistrate empowered to hold inquests shall make an inquiry into the cause of death.
Where in certain circumstances, mentioned particularly in the section.

The objective of the post – mortem examination is to establish the identity of the body
when not known, to ascertain the time since death and the cause of death, and whether
the death was natural or unnatural and if unnatural, whether it was homicidal, suicidal
or accidental. A medico – legal post – mortem can be conducted only after a written
request has been made by the police or by the order of the court. It can be conducted
only by a medical officer who has been authorized to do so.

Medical officer should always try to study all the available facts of the case prior to
post mortem examination, from inquest report, hospital records, summary of the death
etc. The condition of the deceased before death must be perused to know his clinical
condition, treatment and terminal events for taking precaution for self as well as staff
of the mortuary in case of high risk infectious diseases like AIDS, rabies etc. in
hospital deaths.

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As per settled principles of law, post mortem report is not a public document. The
opinion of Medical officer contained in the post mortem report is to aid the
investigating officer in investigation. Post mortem report being an expert opinion can
be given only on specific orders of the court on clear direction regarding issuing of
the same, whether the post mortem report is to be supplied to the applicant or not.146

Medical officers should remember that it is on the basis of case paper only, that they
will be able to give evidence in the court of law and to stand the rigors of cross
examination. The notes on case papers are essential for issue of medico – legal
certificates.

Before starting a post –mortem examination the Medical officer should read
panchnama and the Police Report carefully. If either of them is illegible the fact
should be brought to the notice of the police. If the Medical Officer finds any major
discrepancy between the injuries as described in the documents and as found out by
him, he should cause a fresh Panchanama to be made by a Magistrate.

The Medical officer must do this at most to arrive at the cause of death or the
probable cause of death. For this he must take into consideration all the findings. The
cause of death is to be based only on the basis of findings and not on extraneous
factors.

Evidence in Court of Law

It is important for the Medical Officer to realize that giving proper evidence in the
court of law is necessary not only for projecting a good image of the medical
department but also in the interest of law, order and justice.

A person suffering from an injury may secondarily get tetanus infection as the result
of which the patient may die. The original injury may also be a severe one. The
Medical officer is called upon to give an opinion in the court of law, as regards
whether the injury was primarily fatal. In this case the Medical Officer has to consider

146
Sirohiwal Basantal, Sharma Luv, Paliwal P. K., Critics and Skeptics of Medico – legal Autopsy
Guidelines in Indian context, Indian Acad Forensic Med. (Oct. Dec. 2013) Vol. 35 no. 4.

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whether the injury, though severe by itself, could have given rise to fatality and
whether it was not the secondary infection by tetanus bacilli that caused the fatality.
The Medical Officer’s opinions so important in this case that the life of person may
well depend upon it. If the wound was not primarily fatal, the charge against the
accused is mitigated. If a contrary opinion is given, the charge would be very serious.

The important classification of injuries, besides that given above, is-

a) Wounds which are necessarily fatal.
b) Wounds, sufficient in the ordinary course of events to cause death.
c) Wounds likely to cause death.
d) Grievous hurts, and
e) Simple hurts.

According to the rules of evidence, an ordinary witness is not supposed to state his
conclusions but only facts. In the case of Medical Officer, however, he is considered
as an expert witness and therefore, there is a great amount of significance attached to
the opinion given by him.

Medical Officers should not presume that the magnitude of the importance at their
evidence parallels the magnitude of injuries. Even very ordinary injuries may be of
very great medico-legal significance.147

147
Post mortem and Medico-Legal work Ref. Hospital administration Manual (2012) Vol. 1 chapter
XII.

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