The Essentials of Forensic Medicine and Toxicology 33rd Edition by Narayan Reddy, OP Murty ISBN 8188230308 9788188230303
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Thirtythird Edition
2014
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ISBN 978-93-5152-557-8
K.S.N. REDDY
Hyderabad, A.P.
SOME OPINIONS
(1) Journal of Forensic Medicine and Toxicology
Vol. 15, No. I , Jan- June, 1998
The author, a well-known and reputed medical teacher with long experience, has been very successful in
giving a comprehensive account of all aspects of Forensic Medicine and Toxicology in this book, which in the
opinion of this reviewer is one among the best textbooks that has so far been published by Indian authors. It
provides up-to-date and reasonable material on the subject, and is well suited to undergraduates, postgraduate
students, medical teachers and officers, and lawyers.
O.P.MURTY
(2) Journa,l of Indian Medical Association
Vol. 70. No. 12, 16th June, 1981
The book is a short and concise treatise on Forensic Medicine but providing reasonable coverage of the
subject as a whole. This will be found well-suited and very helpful not only for the undergraduates for whom this
is primarily meant, but also for the postgraduate students and medical officers undertaking medicolegal works.
The author, a reputed professor with long experience, has been very successful in giving a comprehensive
account of all aspects of legal medicine in this book, which in the opinion of the reviewer, is the best that has
so far been published by Indian authors.
D. BANERJEE
(3) Journal of Indian Academy of Forensic Sciences
Vol. 19, No. 2, 1980
The book is well written in a clear concise style. It is designed to provide to the point practical guidance to
teaching of forensic medicine in India. Apart from medical officers, lawyers and members of law enforcement
agencies would find this book useful; the undergraduate medical students, if study texts like this, could learn
a great deal of the pros and cons of the subject. But for the minor fail of perfection, Dr. Reddy has succeeded
in his aim of covering a vast subject in a compendium. On the whole, this is a commendable work, especially
for students and specialists in this field.
B. BATTACHARYA
(4) Criminal Law Journal, August, 1989
This is a very useful and exhaustive work on the subject. It is designed for the use of students, teachers
of Forensic Medicine and Toxicology. It will serve as a useful practical guide to those who are dealing with
medicolegal cases at the investigation stages or in the Court rooms while arguing for the criminal prosecution
or for providing successful defense to an accused. The medical practitioners would find a fund of information
in the book during their work in medicolegal involvement. The book provides sufficient coverage on the
subject. It is very well illustrated, contains useful charts and tables on various aspects of the subject matter
for making the points discussed easily understandable.
L.K.K.
(5) Medical Books news-A Guide to new Books
This is one of the most comprehensive volumes on the subject written by an Indian author and in fact
contains more details than required by an undergraduate. It would, therefore, be helpful when a reference on
any topic becomes necessary.
THE ESSENTIALS OF
FORENSIC MEDICINE
AND TOXICOLOGY
OTHER BOOKS BY THE SAME AUTHOR
(1) THE SYNOPSIS OF FORENSIC MEDICINE AND TOXICOLOGY
Twentyeighth Edition, 2014, 24 em x 18 em, pp 8 + 392, Price Rs. 360/-
(10)~ ~&ifw
Second Edition, 2013, 24 em x 118 em, pp. 200, Price Rs. 200/-
There are two distinct aspects of law-medicine Medical etiquette deals with the conventional
relationship: ( 1) Forensic medicine, and (2) Medical laws of courtesy observed between members of
jurisprudence. They are essentially different subjects, the medical profession. A doctor should behave with
but are closely related. his colleagues as he would have them behave with
Forensic or legal medicine (forensic= forums of himself.
or used in Courts of law) deals with the application Ethical behaviour is a self-imposed duty upon each
of medical and paramedical knowledge to aid in doctor. A doctor should not criticise or denigrate the
the administration of justice. It is used by the legal professional ability of another doctor, while dealing
authorities for the solution of legal problems. Some with a patient.
examples are: applying the medical knowledge in Forensic medicine deals almost entirely with
deciding cases of injuries, murder, suicide, accidents, crimes against human beings in which medi cal
sexual offences, poisoning, etc. In short, it deals with examination and evidence are required. Forensic
medical aspects of law. medicine is mostly an exercise of commonsense,
Medical jurisprudence (juris= law; prudentia = combined with the application of knowledge and
knowledge) deals with legal responsibilities of the experience, already acquired in the study of other
physician with particular reference to those arising branches of medicine, surgery, obstetrics, etc. Its aim
from physician-patient relationship, such as medical is to find out the truth. Its particular field of activity
negligence cases, consent, rights and duties of doctors, is judicial investigation, both civil and criminal. All
serious professional misconduct, medical ethics, etc. medical work is of a responsible character, especially
In short, it deals with legal aspects of practice of the medicolegal work, such as issuing certificates of
medicine. lunacy, ill-health, etc. In all cases of crime involving
Forensic pathology deals with the study and the person, e.g. homicide, suicide, assault, sexual
application of the effects of violence or unnatural offences, traffic accidents, poisoning, etc., the help
disease in its various forms in or on the human body, of the medical practitioner is sought by the police. In
in determining the cause and manner of death in case all such cases, the doctor will be required to appear
of violence, suspicious, unexplained, unexpected, as an expert witness in a Court of law. In some cases.
sudden and medically unattended deaths. the doctor is the chief source of evidence upon which
Medical ethics deals with the moral principles legal decisions are made. In cases of sudden death.
which should guide members of the medical the authorities will depend mostly or completely on
profession in their dealings with each other, their medical evidence in establishing the cause of death.
patients and the State. and in case of accident to determine blame.
2 Essentials of Forensic Medicine
A doctor may be called to testify (1) as an ordinary evidence in the case. He should not be influenced
witness who saw an incident, (2) as the medical in any way by emotional consideration, such as
practitioner who treated the patient, (3) as an expert sympathy or antipathy. The doctor must be honest,
to give his opinion on matter of science. In the first for confidence is inspired by honesty and success
two conditions, it is his duty and obligation to testify. depends upon confidence.
In the last condition he may refuse the request:, ( 1) The medicolegal aspects of any case must
if he feels reluctant to undergo what he fears will always be secondary to life saving treatment of
be a painful experience, (2) if he feels that he is not the patient. It is advisable that the doctor should
sufficiently qualified to testify with any conviction in learn to look from the medicolegal standpoint upon
that particular case, and (3) if he feels that he cannot such of his cases as are likely to become the subject
spare the time to prepare properly or to make long matter of judicial investigation. He should acquire
appearances in Court. A properly prepared physician the habit of making a careful note of all the facts
often finds his Court room experience educative and observed by him. Alan Moritz stated "If evidence has
not as traumatic as he would have anticipated. His been properly gathered and preserved, a mistake
introduction to the legal process may be unpleasant, if in interpretation may always be corrected. If the
he is irritated by an aggressive prosecuting or defence facts required for a correct interpretation are not
lawyer. The reluctance of medical practitioners to preserved, the mistake is iiTeversible". Vagueness and
become witnesses is mainly due to the pressures of theory have no place in forensic medicine. He should
their private practice. Other factors include a fear of examine the facts which come to his knowledge in
merciless cross-examination. harassment, and even his special capacity, draw his conclusions logically
the recall. and correctly after a detailed consideration of the
All forensic science expert witnesses must strive pros and cons of the case, and indicate to the Court
to achieve respect, understanding and credibility that interpretation, along with the grounds on which
in Court. They must give the appearance, the aura it is based. Presumption is not proof, and conjecture
of being independent, non-partisan witnesses. is not evidence. The Court has no special medical
The appearance and projected image of neutrality, knowledge. It relies on his witness for an opinion and
impartiality and objectivity are as important as expects him to assist it with his special knowledge
the authentic characteristics. A doctor should not and experience. The burden of presenting medical
become partisan. Once a theory is embraced, it is facts and medical opinions in the best possible way
only human nature to eagerly search for facts which rests on the doctor. Forensic pathologist testifies on
support that theory, and reject those which indicate so-called "fact issues", such as cause and manner
some other theory. Brouardel, the French medico- of death , rather than "ultimate issue" of guilt or
legal authority wrote, "if the law has made you innocence, so that opinion based upon reasonable
(the physician) witness, remain a man of science; medical certainty is adequate to support the testimony
you have no victim to avenge, no guilty person to of the forensic pathologist. Medical evidence is not a
convict, and no innocent person to save. You must substantive evidence. but is a conoborative evidence.
bear testimony within the limits of science". The The medical evidence does not itself prove the case
attitude of a scientific witness should be the same of prosecution. Other things being equal, the better
whether he is called by the prosecution or by the the presentation of medical evidence, the better is
defence. The doctor really testifies neither for nor the administration of justice. A good command of
against the prosecution or the defence. The doctor's language. clear presentation, and ability in expressing
expertise is in the application of science to a legal a relatively firm opinion are necessary for the success
controversy and the proper interpretation of scientific of the medical witness. The presentation of findings
findings. His sole obligation is to present the truth as involves both writing skills and an ability to express
he sees it, adding nothing, withholding nothing and in the courtroom while being examined by trained
distorting nothing. He should not concern himself with lawyers. Demeanour, appearance, professional
the previous character of the accused or with other manner and general behaviour of the expert witness
Introduction 3
are almost equal in importance to forensic ability the victim of a homicidal attack dying with peritonitis
during testimony. The doctor should avoid talking following abdominal injuries and surgery should
too much, talking too soon, and talking to the wrong be certified as homicide victim and not as surgical
persons. Prejudicial and sensational statements should complications. The doctor must be alert to where
not be made prior to trial. The pathologist should evidence should be looked for, and how it should
never overlook an opportunity to remain silent. The be interpreted. His failure may make the difference
doctor must be guarded in what he says and how he between life and death or between freedom and
says it. imprisonment of a suspected person. It may deprive a
The medicolegal expert is not a detective. He widow of compensation to which she is entitled, may
may use his knowledge and intelligence to help the cause an itmocent person to be prosecuted or punished,
police to solve a crime. His role should be to furnish may permit a murderer to escape punishment, or may
the police with specific information on matters of cause some person or institution to be held financially
which he has specialised knowledge. Because of his liable to damages for which they were not responsible.
special knowledge, a non-medical clue may have a William Osler wrote : "Medicine is a science
significance to him, which even an experienced police of uncertainty and an art of probability. Absolute
officer has not grasped. The medical expert should be diagnoses are unsafe and are made at expense of
very careful when he is examining living people. He the conscience". One thing that makes medicine so
should not encourage an accused person to talk difficult is that there is no such thing as the average
about the crime with which he is charged, or about man. We can only say the reading is 'within the range
the events that led to his arrest. If, during a medical of normal" . Medicine is a biological science with the
examination, an accused says anything that might variability inherent in biological matters. Forensic
incriminate himself, it should be neither recorded medicine is not an exact science. Unexpected results
nor reported. However, occasions may arise when are produced due to biological variations. In every
a doctor may use an admission to direct the police to case, there is an element of uncertainty, and absolute
certain lines of inquiry and action without actually proof is a rarity in any medical problem. There is
disclosing what has been said. always a possibility for a difference of opinion among
Three things are needed for success : (1) the doctors. The most extraordinary events occur in
the power of observation, (2) a wide range of medicolegal practice, and a careful evaluation must
exact knowledge, (3) the power of deduction. always be made to ensure that dogmatic statements
The power of constructive imagination is also by medical witnesses do not mislead the investigating
essential when there are no more facts to be officers. No possibility is wholly excluded in medical
observed, and no further inferences to be drawn. experience. Doctors should bear in mind the essential
There is no substitute for basic intelligence and difference between probability and proof. The medical
clinical competence. Experience, commonsense, witness should not be dogmatic about his opinion, and
and willingness to consider other possibilities are also lawyers should not expect him to be so. They
as essential in the practice of forensic medicine as a should be reasonable in their opinions and should
wide range of theoretical knowledge. The attributes not overstate the likelihood of a relationship between
of the physician are : (1) caution, (2) foresight, and cause and effect. The doctor should be ready to defend
(3) wisdom. every finding and conclusion on the report on clinical
The doctor should develop a fair understanding, and scientific grounds. The doctor should put before
satisfactory appraisal and high index of awareness of the court all the materials which are the basis of his
the medical, philosophical and legal problems related conclusions. He should be aware of profess ional and
to the determination of the manner of death. He should scientific viewpoints which might differ from hi . and
be thoroughly familiar with the problems of causality should be familiar with the latest scientific literature in
and manner of death. He should realise that total relation to the subject involved. Forensic pathologi t
complications of extraneous injuries do not change have an ethical obligation to contribute to fu rther
the manner of death from unnatural to natural , e.g., knowledge, research and education in their field. For
4 Essentials of Forensic Medicine
the purpose of illustrating and clarifying his testimony, about the examination of dead bodies in unnatural
the medical expert may employ photographs, maps, deaths. Abortion, sexual offences, kidnapping, etc.
diagrams, charts, X-rays, skeletons, models, slides, were punishable offences. Law-medicine problems
films, tapes, etc., when they are properly verified. are found in the written records in Egypt, Sumer,
Medicolegal practice requires knowledge, skills Babylon, India and China dating back 4000 to 3000
and attitudes. The skills needed are: (l) Clinical : B.C. A Chinese materia medica of about 3000 B.C.
the ability to elicit a history, to examine for injuries gives information on poisons. Imhotep (27th century
and to perform the appropriate investigations. (2) B.C.), Grand Vizir, Chief Justice and chief physician
Precision in recording the findings. (3) The ability to of King Zoser of Egypt, enacted rules for medical
present the findings in a clear, concise, correct and practice, which was brought under law. The Code of
meaningful manner. (4) Attitudes: (a) Proper respect Hammurabi, King of Babylon (about 2200 B.C.), is
to the patient. (b) Maintain objectivity in recording the the oldest known medicolegal Code. Rig Veda and
findings. other Vedas (3000 to 1000 B.C.) mention about crimes
Forensic medicine can be mastered only by like incest, adultery, abduction, killing an embryo,
an extensive practical experience acquireq by an murder, drunkenness, etc. and their punishments.
application and study of medicolegal problems. Physicians were identified as professional people.
Courts of law are open to the public. Medical Atharva Veda gives details about remedies for various
students and newly qualified doctors should attend conditions. Hippocrates (460 to 377 B.C.), the "Father
the Courts, where they can follow the proceedings, of Western Medicine" was born and practiced in the
hear the evidence given by medical witness, and note island of Kos in Greece, discussed the lethality of
the questions put and the replies given. This will wounds. His contribution to medical ethics is by far
familiarize the doctor with legal procedures and help his greatest in our field. About 300 B.C., the Rabbis
to lessen the painful experience of giving evidence. of the Rabinical Court, responsible for implementing
The general public is fast becoming law conscious the Jewish laws, sought the aid of medical expert
and the doctors are being sued from time to time in a in the administration of justice. Later, Greek and
Court of law for their acts of omission or commission. Roman jurists and medical men collaborated in the
Therefore, it is incumbent upon doctors to have good development of the principles of forensic medicine.
knowledge of the law governing their profession, in Shushruta (father of Indian surgery), between 200 to
order not to transgress the law. Doctors should avoid 300 A.D. in his treatise Shushruta Samhita dealt with
special efforts to "cover up" medical negligence or various medicolegal problems. Duties of physicians
intentional wrong doing. were defined. Wounds and fractures were classified.
HISTORY: Medicine and law have been related Poisons and snakes were classified and treatment
from the earliest times and the bonds which united prescribed. Modes of administration of poisons was
them were religion, superstition and magic. The described. In the sixth century A.D. the Justinian
Charaka Samhita (about seventh century B.C.) lays Code (Roman emperor) and Institutes regulated the
down on elaborate code regarding training, duties, practice of medicine and surgery, and established the
privileges and social status of physicians. It gives function of the medical expert for legal procedure.
a detailed description of various poisons and their The first medicolegal autopsy was done in Bologna
treatment. In fourth century, B.C., Manu (King and (Italy) in 1302, by Bartolomeo De Varignana. In the
law-giver) in his treatise, Manusmriti, laid down thirteenth century, a manual was prepared to aid in
various laws including punishment for various sexual the investigation of death in China. George, Bishop
and other offences, and recognised mental incapacity of Bamberg, proclaimed a penal code in 1507,
due to intoxication, illness and age. Between fourth and where medical evidence was a necessity in certain
third century B.C. Arthashastra of Kautilya defined cases. Caroline Code was proclaimed in 1553 in
penal laws and regulated medical practice. Physicians Germany by Emperor Charles V. With this expert
were punished for negligence. Medical knowledge medical testimony became a requirement rather
was utilised for the purpose of law. It mentions than an option to give opinions in cases of murder,
Introduction 5
wounding, poisoning, hanging, drowning, infanticide Father of Legal Medicine as well as Father of Forensic
and abortion, etc. It recognised that there were several Psychiatry. In Questiones Medicolegales, he declared
types of homicide which were not punishable under that physicians should have exclusive competence in
certain conditions, one of which was an offender who the field of pathological mental states, amentias. He
was 'deprived of his understanding'. The first book on provided a classification of mental disorders keeping
Forensic Medicine was published in 1602 by an Italian in mind the legal issues at that time. Around the end of
physician, Fortunato Fedele. The greatest of all works the sixteenth century, autopsies in medicolegal cases
was the "Questiones Medicolegales" (medicolegal began to be generally practised. In the eighteenth
questions), written by Paulus Zacchias, who was century, professorships in legal medicine were
principal physician to Pope Innocent X, and Alexander founded by the State in Germany. Orfila (1787 to
VII, and an expert before the Rota Romana, the Court 1853), professor of chemistry and legal medicioe
of Appeal. This was published in seven volumes from at Paris introduced precise chemical methods into
1621 to 1635 and two additional volumes in 1666, toxicology. He is considered the founder of modern
at Amsterdam. This work remained an authority toxicology. In 1843, the law regarding the criminal
in medicolegal matters until the beginning of the responsibility of insane persons was established in
nineteenth century. Paulus Zacchias is considered the England in Me Naughten's case.
LEGAL PROCEDURE
INDIAN PENAL CODE (I.P.C.), 1860: It deals with due to anaesthesia or operation and unidentified or
substantive criminal law of India. lt defines offences and skeletonised bodies. Two types of inquests are held
prescribes puni shments. in India.
CRIMINAL PROCEDURE CODE (Cr.P.C.), 1973: (1) POLICE INQUEST: The officer-in-charge
It provides the mechanism for punishment of offences (usually sub-inspector) of a police station conducts
against the substantive criminal law. It deals with police
the inquest (S.l74, Cr.P.C.). The police officer
duties in arresting offenders, dealing with absconders, in the
production of documents, etc. and in investigating offences.
making the inquest is known as Investigating Officer
It provides for different class of Courts. It deals with actual (1.0.). When the officer-in-charge of a police station
procedure in trials, appeals, references, revi s ions, and receives information that a person has committed
transfer of criminal cases. suicide, or has been killed by another or by an animal
INDIAN EVIDENCE ACT (I.E.A.), 1872: It deals or by machinery or by an accident, or has died under
with Law of Evidence (different categories of evidence, the circumstances raising a reasonable suspicion that some
procedure of collection, preservation and use of different other person has committed an offence, he immediately
evidences) and applies to all judicial proceedings in any gives intimation about it, to the nearest Executive
Court. lt is common to both the criminal and civil procedure.
Magistrate empowered to hold inquests, and proceeds
CRIMINAL LAW deals with offences which are
to the place where the body of such deceased person
considered to be against the public interest, such as offences
is. There, in the presence of two or more respectable
against the person, property, public safety, security of the
State, etc. Here the State is a party represented by public persons (panchas) makes an investigation (S.l75,
prosecutor, and the accused is the other party. Cr.P.C). He prepares a report of the apparent cause
CIVIL LAW deals with disputes between two of death, describing wounds, fractures, bruises, and
individuals or parties. The party bringing the action in a civil other marks of injury found on the body, and stating
case is called "plaintiff". The accused is called "defendant" in what manner, or by what weapon or instrument,
in both criminal and civil cases. such injuries appear to have been inflicted. The
COMMON LAW is made by judges when they deliver inquest report (panchanama) is then signed by the
decisions in individual cases. investigating police officer and by the panchas. If no
INQUEST: An inquest is an inquiry or foul play is suspected. the dead body is handed over
investigation into the cause of death. It is conducted to the relatives for disposal. In cases of suspected
in cases of suicide, murder, killing by an animal or foul play or doubt, the body is sent for postmortem
machinery, accidents, deaths due to torture or ill- examination to the nearest authorised Government
treatment, occupational diseases, suspected medical doctor, together with a requisition and a copy of the
negligence, suspicious (unnatural) deaths, deaths inquest. The report is forwarded to the Magistrate.
Legal Procedure 7
Private medical institutions can undertake (1) The Supreme Court is the highest judicial
medicolegal examination and treatment of the tribunal , and is located in New Delhi. It has power
living, but autopsies can be conducted only with the of supervision over all Courts in India. The law
permission of the State Government. declared by it is binding on all Courts (Article 134 of
(2) MAGISTRATE'S INQUEST: This is Constitution of India).
conducted by a District Magistrate (Collector/Deputy (2) The High Court is usually located in the
Commissioner), Sub-divisional Magi strate(RDO) , capital of every State and is the highest tribunal for the
Tahsildar or any other Executive Magistrate (S.20 State (Article 214. Constitution of India). It may try
to 23 Cr. PC), especially empowered by the State any offence and pass any sentence authorised by law
Government (Executive Magistrates). It is done in (S.28,(1) Cr.P.C.). Judges of High Court are appointed
case of (1) death in police custody, and while under by the president of India.
police interrogation, (2) death due to police firing, Supreme Court and High Courts act as Courts of
(3) death in prison, reformatories, Borstal school, (4) appeal only in criminal cases, and do not hold trial
death in a psychiatric hospital, (5) dowry deaths, (6) prima facie.
exhumation. (7) Any person dies or disappears, or (3) The Sessions Court is established by the State
rape is alleged to have been committed on any woman, Government (S.9, Cr.P.C.) and is usually located at
while such person or woman is in the custody of the the district headquarters. It can only try cases which
police or in any other custody authorised by the court have been committed to it by a Magistrate (S.l93,
(S. l74(4), S.176 and 176, 1-A, Cr.P.C.). In any case Cr.P.C.). It can pass any sentence authorised by
of death, a Magistrate may conduct an inquest, instead law, but a sentence of death passed by it must
of or in addition to the police inquest (S.l76, Cr.P.C.). be confirmed by the High Court (S.28 (2) and S.
CORONER'S INQUEST : This is a type of inquest 366, Cr.P.C.). District Court: deals with civil cases.
done in U.K., some States in U.S.A., and some other An Assistant Sessions Court can pass sentence of
countries, but not in India. Coroner conducts inquest imprisonment up to ten years and unlimited fine (S.28
in all unnatural and suspicious deaths. The doctor is (3), Cr.P.C.).
summoned to his Court to give evidence at the inquest. (4) Magistrates courts : Magistrates are of
Coroner's Court is a Court of enquiry, wherein Jurors three types (S.ll to 19 Cr.P.C.)
are sworn to give a true verdict according to the
(1) Chief Judicial Magistrate (S. 12, Cr.P.C.).
evidence. He has some judicial powers.
MEDICAL EXAMINER'S SYSTEM: This is a type (2) First Class Judicial Magistrate.
of inquest conducted in most of the States in the United (3) Second Class Judicial Magistrate.
States of America, Japan, Canada, etc. but not in India. In metropolitan cities with more than one million
A medical practitioner known as Medical Examiner is population, the Chief Judicial Magistrate and First
appointed to perform the functions of Coroner. He does Class Judicial Magistrate are designated as Chief
not have any judicial functions similar to the Coroner Metropolitan Magistrate and Metropolitan Magistrate
and he has no authority to order the arrest of any person. respectively (S.8, 17, 18 and 19 Cr.P.C.).
As the doctor visits the scene of crime and conducts the Sessions judges and magistrates are appointed by
inquest, it is superior to Coroner's and police inquest.
the High Court.
JURY : Jury is a group of responsible, educated
When a person is convicted at one trial for two
persons of good social position called "jurors". It is
composed of an nneven number of persons. Their verdict or more offences, twice the amount of punishment.
is binding on the Judge, but if the Judge differs, the which a Magistrate is authorised can be passed (S.3l.
matter is referred to the High Court. Trial by jury has Cr.P.C.).
been abolished in India. Any sentence awarded by a Court may be
COURTS OF LAW: Sections 6 to 25 ofCr.P.C. enhanced or decreased by a higher Court. Governmem
deal with constitution ofCtiminal Coutts and Offices. has power to suspend. repeal or commute any sentence
Courts of law are of two types : (1) Civil, and (2) passed by a Court of law (S.432 and -+33 Cr.P.C. ).
Criminal. The Criminal Courts in Indi a are of four JUVENILE COURTS: They are established
types. based on the theory that children differ mentall y
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