Torture

The World Medical Association's Declaration of Tokyo in 1975 defined torture as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason (9). The declaration also established guidelines for doctors when faced with cases of suspected torture. Clinicians view torture in two main contexts first, torture that is...

Diabetes

It is often desirable to obtain a baseline blood glucose measurement when detainees with diabetes are initially assessed and for this to be repeated if necessary throughout the detention period. All doctors should have the means to test blood glucose, using either a strip for visual estimation or a quantitative meter. Several small portable meters are now available. Oral hypoglycemics and insulin should be continued and consideration given to supervision of insulin injections. Regular meals and...

Antidepressants

There are many side effects associated with the use of the tricyclic antidepressants (TCAs) (e.g., amitriptyline), that are relevant to the ability to drive, such as blurred vision, slow visual accommodation, disorientation, and eye-hand coordination the most important are the induction of drowsiness, lethargy, and sedation. An analysis of 500 road traffic accidents showed that victims who had taken TCAs had a relative accident risk 2.2 times greater than non-TCA users and that patients using...

Anabolic Steroids

Anabolic steroids may be taken orally or intramuscularly by body builders or other individuals who want to enhance their physical appearance. Research has shown that injections of testosterone enanthate increase muscle size and strength, especially when combined with exercise (83). To achieve the desired effect, different steroids are taken in cycles, with rest periods in between, a regime known as stacking, or, alternatively, increasing doses of the same steroid are taken, a so-called drug...

Drink Drugs Driving Impairment Assessment Form

ASSOCIATION OF FORENSIC PHYSICIANS SECTION 4 RTA ASSESSMENT FORM (Version 6 1 1 04) Note This form has been designed by Dr Ian F Wall on behalf of the Education and Research Committee of the Association of Police Surgeons for use by Police Surgeons (also known as Forensic Medical Examiners or Forensic Physicians) who have been trained in the use of Standardised Impairment Tests, The form is provided to assist Police Surgeons in determining whether a person has a condition, which may be due to...

Treatment of Opiate Withdrawal

Symptomatic treatment of the opiate withdrawal syndrome can often be achieved using a combination of drugs, such as benzodiazepines for anxiety and insomnia loperamide or diphenoxylate and atropine for diarrhea promet-hazine, which has antiemetic and sedative properties and paracetamol or non-steroidal antiinflammatories for generalized aches. Substitution treatment may be required in more severe cases of opiate dependence using a choice of methadone, buprenorphine, or dihydrocodeine. Because...

Alcohol Withdrawal

Many alcoholics develop symptoms of withdrawal when in custody. Their acquired tolerance to and physical dependence on alcohol is a manifestation of compensatory neuropsychological changes that offset the drug's CNS depressant effects. When alcohol intake is abruptly stopped on incarceration, the compensatory changes give rise to signs and symptoms of withdrawal (176). The severity of the symptoms depends mainly on the amount and duration of alcohol intake, although other factors, such as...

Alcohol Dependence

Alcohol abuse and dependence is a major risk factor for serious health, social, and economic problems (167). Early identification of those who are dependent on alcohol increases the possibility of successful treatment, and brief intervention by the forensic physician seems both feasible and acceptable (124,168). Although not yet validated in police custody, brief interventions show a high acceptance among drinkers in licensed premises (169). However, obtaining accurate and reliable information...

Complications of Alcohol Withdrawal

Several complications of alcohol withdrawal have been recognized, any one of which may be encountered when alcoholics are detained in police custody (176). Seizures are typically single and generalized. They usually occur between 6 and 48 hours after the last drink and although in themselves are not life threatening, their importance lies in the fact that about one-third of those with seizures will go on to develop alcohol withdrawal delirium. 4.6.3.2. Alcoholic Hallucinosis This is an...

Alcohol Withdrawal Delirium

The essential diagnostic feature of this disorder is a delirium that develops after recent cessation of or reduction in alcohol consumption. Traditionally referred to as delirium tremens, this withdrawal state typically begins 72-96 hours after the last drink, so it is uncommon within the normal span of detention in police custody. The delirium is characterized by impaired attention and memory, disorganized thinking, disorientation, reduced level of consciousness, perceptual disturbances, and...

Uncomplicated Alcohol Withdrawal

This is the most frequent and benign type, usually occurring some 12-48 hours after alcohol intake is reduced, although it can develop as early as 6 hours after drinking has stopped. The essential features are a coarse tremor of the hands, tongue, and eyelids, together with at least one of the following Autonomic hyperactivity (raised blood pressure and tachycardia). Anxiety, depressed mood, and irritability. Transient hallucinations and illusions. If symptoms are mild, it is safe to recommend...

Cocaine and Crack

Cocaine occurs naturally in the leaves of the coca plant Erythroxylum coca, which grows predominantly in South America. Cocaine hydrochloride is a white powder that is usually snorted but can be taken orally. Crack is prepared by mixing cocaine hydrochloride with sodium bicarbonate and water and heating it. The cocaine base precipitates out and forms small rocks as it cools. Crack may be smoked in a pipe or heated on foil with the vapor inhaled. Both crack and cocaine may be injected. The...

References

Medical diagnosis of the sexually abused child. Child Abuse Negl. 17 91-110, 1993. 2. Heger, A., Emans, S. J., Muram, D., eds. Evaluation of the Sexually Abused Child. Oxford University Press, New York, NY, 2000. 3. Royal College of Physicians. Physical Signs of Sexual Abuse in Children. RCP, London, UK, 1997. 4. General Medical Council. Intimate Examinations. GMC, London, UK, 1996. 5. Hicks, D. J. Rape Sexual assault. Am. J. Obstet. Gynecol. 137 931 935, 1980. 6....

Anal Fissures Tears and Lacerations

The most frequent injuries that are documented after allegations of nonconsensual anal penetration are anal fissures, tears, and lacerations. Use of these different terminologies is confusing and makes comparing the different data impossible. A consensus should be reached among forensic practitioners worldwide regarding what terms should be used and what they mean. Clinically, an anal fissure refers to a longitudinal laceration in the perianal skin and or mucosa of the anal canal. Anal fissures...

Oleum Capsicum

Autopsy Vomitus Irritation Face

OC selectively stimulates nociceptors in exposed mucous membranes, releasing substance P, bradykinin, histamine, and prostaglandins. The physiological effects of these mediators' results in vasodilation, increased vascular permeability, pain, and altered neurotrophic chemotaxis. Other common symptoms are listed in Table 2. Table 2 Common Clinical Findings With Exposure to Crowd-Control Agents Table 2 Common Clinical Findings With Exposure to Crowd-Control Agents a Initial response believed to...

Injuries From Handcuffs

Injuries from handcuffs either reflect relative movement between the cuff and wrist or are the result of direct pressure from the cuff to the tissues of the wrist. It is important to remember that injuries may be unilateral, especially where there has been resistance to their application. The most common injuries found are erythema, abrasions, and bruising, particularly to the radial and ulna borders of the wrist 2 . The erythema is often linear and orientated circumferentially around the wrist...