SURVEY COMMITTEE  REPORT ON MEDICO-LEGAL PRACTICES IN INDIA 1964

I.-Constitution of the Committee and its terms of reference                                                                           1

II.-Introduction                                                                                                                                                   3

III.-The Present Position of Medico-legal Service in India                                                                            5

IV.-Teaching of Forensic Medicine:                                                                                                                 13

V.-Mudaliar Committee's Recommendations on the Creation of a Separate Cadre of Medical Jurists      17

VI.-Medico Legal Institutes                                                                                                                               19

VII.-Medico Legal Advisor to Government                                                                                                      22  

VIII.-Standardization of Official Medico-Legal Report Forms                                                                        23

IX.-Planning of Mortuaries and Post-mortem Accommodation                                                                        24

X.-Conclusion                                                                                                                                                       26

XI.-Summary Of Report                                                                                                                                      28

Appendices                                                                                                                                                           31  

Central Medico-legal Advisory Committee                                                                                                         72


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CHAPTER I

Constitution of the Committee and its terms of reference

1.The Central Medico-legal Advisory Committee at its Second Session held at Delhi, during March 1957 decided to appoint a Survey Committee to conduct a survey of Medico-legal practice in the country for an assessment of the existing conditions to provide a correct appraisal of the deficiencies at various levels and to help formulate measures for the correction of remediable deficiencies. For this purpose, they appointed a Survey Committee consisting of:

  1. Dr. K.V. Venkatraman - Chairman.

  2. Dr. K.C. Jacob.

  3. Dr. H.S. Mehta.

  4. Dr. N. Ghatak.

  5. Lt. Col. S.D.S. Greval.

  6. Shri A.R. Jayavant.

  7. Dr. I. Bhooshana Rao - Secretary.

The committee was requested to address for the Government of India and through them the State Governments for facilities for the Survey Committee to make the survey and submit the report in one year.

2. The Survey Committee met for the first time on 26th February, 1959, at Hyderabad in the office of the Professor of Forensic medicine Osmania Medical College. It could not meet earlier on account of administrative delays in receiving appropriate sanctions from the state Governments till late in 1958 and also due to the reconstitution of the Central Advisory Committee towards the possible methods of effectively carrying out a pilot survey. The Committee met at Madras in July, 1959 in the Office of I.G. of Police and discussed with the concerned Officers of the State and also visited several places in two Districts. The Chairman of the Central Medico-legal Advisory Committee retired from service and the committee could not meet 24th March 1961, when the survey Committee was reconstituted as follows:

1.Dr. Bhooshan Rao-Convener.

2.Dr. H.S. Mehta.

3.Dr. N. Ghatak.

4. Dr. K.C. Jacob.

5. Dr. H.S. Mahal.

6.Dr. A R. Natarajan.

7.Shri D.B. Kulkarni.

3. The Survey Committee met on 25th March, 1961 and considered the possible methods of effectively carrying out the survey of the procedures and practices followed in different parts of the country and a draft questionnaire was prepared and sent to the Heads of the State Medical Departments, Principals of Medical Colleges, Directors of Forensic Sciences Laboratories, Chemical Examiners to Governments and Inspectors-General of Police.

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4. From the replies received, an interim report of the Survey Committee was submitted to the seventh session of the Central Medico-legal Advisory Committee held on 4th November, 1961 at Bangalore. The interim report was accepted with suggestion to conduct a further consecutive post-mortem and injury reports and draw up a list of standard equipment for mortuaries.

5. An interim report was accordingly submitted to the Eighth Session of the Central Medico-legal Advisory Committee when it met at Delhi on 28th May,1963 and they authorised the following members of the Survey Committee to meet at Hyderabad and submit its report within three months:

  1. Dr. I. Bhooshana Rao-Convener.

  2. Dr. H.S. Mehta.

  3. Dr. K.C. Jacob.

  4. Dr. A. R.Natarajan.

  5. Dr. H.S. Mahal.

6.The Survey Committee in finally drafting its report at Hyderabad in the Institute of Medical Sciences, on 1st, 2nd and 3rd August, 1963 has the information and views obtained through questionnaires, visits, scrutiny of articles published by Jurists in the country, the proceedings of the Central Medico-legal Advisory Committee and Central Advisory Committee on Forensic Sciences, the proceedings of the conference of Medical Education, the Bhore and Mudaliar Committee's reports.

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CHAPTER II - Introduction

Although medico-legal practice is purely a medical subject and practiced only by graduates in medicine yet it has not been with any stress either in the Bhore Committee report (1946) or the Mudaliar Committee report (1962) . Understandably both Committee's reports pertain to health survey in which medico-legal practice, in a way, has no direct bearing. Medico-legal practice is directly concerned more with the Home and Law Department of the Government than with the Health Department except that the practitioner is invariably a qualified medical man. A question is sometimes raised as to whether the medico-legal practitioner should be under the ministry of Law, Home or Health. The Committee is of the view that the services should continue to remain under the Ministry of Health as if feels that the incumbents should in no sense be dependent upon departments which are concerned with the process of trial or the investigation of crime.

2. The Survey Committee notes with regret the lack of uniformity in the practice and procedures followed in different parts of the country. There are no adequate arrangements for the investigation of the majority of medico-legal cases, There is a fine uniform judicial procedure throughout the country, which makes it absolutely incumbent on us to regularise our heterogeneous, irregular medico-legal practice immediately. The standard of medico-legal practice of a country could best be judged from the extent to which this important branch of medicine is exploited in determining the cause and manner of death, and in collecting evidence pertaining to the identity of the deceased, the identity of the assailant, and the time, place and circumstances of death. The Survey Committee therefore concerned itself to the study of crime figures, examination of medico-legal records and certificates, judgement copies, etc., to determine as to how far the medico-legal practitioner has been of help in the administration of Justice. We have to admit most regretfully that the medico-legal practice throughout deplorable condition for the following reasons:-

  1. Shortage of trained personnel in the profession ;

  2. Absence of even ordinary facilities, e.g. transport, cold storage, mortuaries, instruments, etc, for the practice of the profession;

  3. Absence of any incentive for the practitioner to take interest in the so-called "dirty" work;

  4. Want of literature, standards and research on the subject with an Indian bias which is very important as in many cases foreign standards cited in literature do not apply to our conditions, e.g., time of death, age determination, etc.

Consequently suspects may not get fair and it is possible that criminals may escape or innocent convicted.

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3.The appalling conditions in medico-legal practice that has come to our notice during our survey and their likely consequences on society have been never brought to the notice of the Government of Indian and State Governments in sufficiently convincing manner to attract their due attention. The subject needs more serious attention than it has received hitherto and measures to be taken by the Governments shall have to be more through. The standard of medico-legal practice of a country in a way reflects its civilisation and with the rapid advances our country is making in all other fields it is but essential to raise the standard of our medico-legal work as well.

4. The one important single factor in the stalemate in the medico-legal practice in our country is the lack of Medico-legal Institutes or full-time Departments of Forensic Medicine in Medical Colleges imparting post-graduate training in Forensic Medicine. This has resulted in the paucity of regularly qualified experts. The work has been carried on by "untrained or ill-trained" State Medical Officers. We would urge and emphasize that forensic medicine is as much a specialty as any specialised branch in medicine or surgery and medico-legal work cannot be lightly thrown on the shoulders of any every medical man. The fact that all medical jurists in the United Kingdom are experienced forensic pathologists might be followed in India with advantage.

5. The Crime figures in India has been rising every year. In the year 1960 there have been 10.910 cases of murder alone, an increase of 1.8 per cent over the figure for the previous year. Though exact figures were not available yet there has been an appreciable increase in other crimes as well, such as road accident, offences against morality, poisoning, etc. Although inefficiency in medico-legal practice is in no way directly responsible for the increase in crime figure s yet a well organised and efficient medico- legal service is indispensable for the proper investigation and trial of all crime cases which would have a deterrent effect on the criminals and make them realise that science does not permit crime to pay.

6.It is hoped that the present report will correctly interpret to the Government, Central as well as States, the position regarding medico-legal practice in the country to enable them to take a bold step in removing the serious handicaps now hampering full growth of the specialty.

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CHAPTER III - The Present Position of Medico-legal Service in India

The state of medico-legal practice has not changed since the publication of the Bhore Committee Report (1946) which has very lucidly and correctly summarised as follows:

"The present position in regard to the investigation of medico-legal problems is very unsatisfactory. Every medical; practitioner in charge of a remote dispensary whatever his qualification or experience, is asked to undertake medico-legal postmortem in complicated cases of crime and he is liable to be held in question thereafter, the presumption being that every medical man is competent to undertake these responsibilities, but unfortunately neither the profession nor the judiciary nor the State have stopped to consider the absurdity of such a presumption."

A. MEDICO-LEGAL INVESTIGATION SYSTEMS

Two types of medico-legal investigation systems are allowed namely, the police inquest under Section 174, Criminal Procedure Code (Act No. V of 1898) and the Coroners inquest under the Coroner's Act (IV of 1871). The Police inquest is followed throughout the country except in the Cities of Bombay and Calcutta where the Coroners inquest prevails.

The Police Inquest- On receipt of information of an accident or other unnatural death of any person, an officer, usually of the rank of a Sub-Inspector of Police, informs the concerned magistrate of the same, and proceeds to the place of the incident. The police officer holds an inquest in the presence of two or more respectable persons and drafts a report of the apparent cause of death. In practice, however, the police officer usually would have suggested his own views on the matter and this in very many cases is accepted without any dissent by the witnesses. In a case of suspected foul play or doubt regarding the cause of death, the police forwards the body for post-mortem examination to the nearest state medical officer.

It is also seen from the survey as detailed below that the autopsy rates on reported police inquests vary from State to State.

Autopsy rates on reported inquests, 1959.

State

No. of Inquest

No. of Autopsies

Post-mortem index (Autopsy rate on inquest cases per cent)

Madras

Delhi

Kerala

Punjab

West Bengal

Maharashtra

Assam

Uttar Pradesh

Madhya Pradesh

Jammu & Kashmir

Andhra Pradesh

Orissa

7,047

830

3,817

4,276

7,629

15,900

2,756

16,918

11,533

286

11,084

4,798

3427

586

2645

2092

3310

6623

896

5379

3402

83

3065

889

77.0

70.6

69.0

47.9

43.5

41.7

32.5

31.7

29.4

29.8

27.6

18.5

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The danger of disposing of dead bodies without recourse to autopsy is well known to medical jurists. The above data gives an idea of the proportion of medico-legal autopsies to the number of inquests in the 12 States. It is clear that the post-mortem index in Madras State is highest, and in Orissa State the lowest. The post-mortem index speaks of the efficiency of the medico-legal investigation system in any State of Country.

The system is obviously defective as murder cases are sometimes disposed off as cases of accidents or suicides after police inquest without sending the body for medico-legal investigation at all. The police officer and the respectable witnesses on whose opinion the body is disposed off do not possess any medical qualifications nor have they any knowledge to ascertain the cause of death to give a true verdict in such cases.

Examination of Scene of Crime.- In India the participation of medical officer in the investigation of crime is often restricted only to the performance of a post-mortem examination. Inspection of the body at the scene of crime is most essential to a proper medico-legal autopsy. It is regretted that the present system is defective in this respect as it is not practicable for the medical officer to visit the scene of crime and has to depend on the police requisition or inquest report.

Further, excellent team work is the essence of successful homicide investigation. This is of great value in determining the circumstances of death, i.e. reconstruction of crime, and, at times no less important, in excluding theories or explanations the medical officer might otherwise tend to offer, or which might be raised by the defense during the trial.

OUR RECOMMENDATIONS

The Committee fully endorsed the recommendations made by the Central Medico-legal Advisory Committee at their sixth session, that wherever possible the Medical Officer should visit the scene of Crime. However, the Committee feels that at present stage, this is possible only at the Medical College Centers. This practice may be extended to other centers when facilities are made available.

Secondly, it should be made compulsory for the police officer to send bodies for post-mortem examination after every inquest. To implement this, it may be necessary to amend paragraph (3) of Section 174 Cr. P.C.

Thirdly, the police officers should be properly trained in the conduct of inquest and the type of information required by the medical officer with a view to improve the usefulness of their requisitions or inquest reports.

Coroners Inquest.- This system has its origin in the early period of Anglo-Saxon civilisation and introduced into India after he advent of the British rule. The Coroners Act enacted in 1871 was made applicable to the old presidency towns of Madras, Bombay and Calcutta. The capital city of former Hyderabad State also followed a modified system of coroners inquest. In Madras, the office of the Coroner was abolished in 1889 and Calcutta are full-time appointments held by lawyers. According to the Coroners Act, the Coroner with the help of a jury holds an inquest in cases of unnatural or suspicious, deaths or in cases of deaths occurring in a jail within the jurisdiction of his court. The Coroner is authorised by law to order a post-mortem examination of

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body to be made by any medical man, usually the police surgeon, who is summoned to give evidence on oath. He then records evidence and gives a verdict as to the cause of death.

The Committee feels that the Coroners inquest as practiced in this country is antiquated with many defects and needs revision. However, this system though defective is still better in practice than the police system, and the Committee is strongly of the opinion that the Coroners Act be revised and be made applicable to all jurisdictions having a population of more than two lacs.

Other Systems.- The Committee is aware of the Medical examiners system prevalent in some places in the United States, the Procuratory. Fiscal system in Scotland, and the systems in European countries. While there are certain advantages in each of these systems, in view of the present conditions in India. It is not practicable to introduce them.

 

B. MEDICO-LEGAL EXAMINATIONS

The important application of the science of forensic medicine to the needs of the community is the proper conduct of an autopsy and a careful examination in clinical cases. The improper performance of an autopsy, and failure to understand the normal from pathological findings and their misinterpretation, have frequently resulted in miscarriage of justice. Further, scrutiny of medico-legal certificates at random in several States has revealed very poor quality of medico-legal work resulting mostly from ignorance and occasionally from indifference. The medical evidence presented at various stages of a case is most unsatisfactory. There is utter lack of co-ordination between medical and other agencies concerned in the conduct of a case.

Forensic Pathology (Medico-legal Post-mortem Examination)- It is the firm opinion of all medical jurists of the world that this specialised procedure of post-mortem examination, should be undertaken only by an experienced forensic (medico-legal) pathologist. Yet as realists, we are aware, that most of the medico-legal post-mortem examinations outside the medical college centers in our country is undertaken by untrained and inexperienced medical officers.

Our survey has shown that there are hardly ten forensic pathologists throughout the country including those in medical colleges. In most places medico-legal post-mortem examination are performed by state medical officers with the result that many mistakes are committed. The medical officers also regard post-mortem examinations as a nuisance particularly as they are required to give evidence in court in all cases where a prosecution is initiated. It is also observed that in most cases and particularly in putrified bodies post-mortem are not conducted by the medical officers but are entrusted to a sweeper or a ward boy.

The fallacious idea that any medical officer or even a pathologist without any medico-legal training is qualified to undertake medico-legal post-mortem examinations needs correction in the first instance. The pathologist or medical officer may interest himself only in determining a mortal lesion as the direct cause of death, but a forensic pathologist has to solve many other questions. The latter has to operate not only with actual findings in the case, but with an adjudication of further possibilities has to reconstruct the case, based on facts and findings. An almost mathematical precision is demanded of a forensic pathologist to determine

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facts which are of no interest to a pathologist. This explains the surprising nature of conclusions drawn from special investigations made by forensic pathologists.

From a survey of post-mortem certificates from certain States in India. It is seen that 60% of the dead bodies were submitted for post-mortem examination after 24 to 48 hours and in 17% of cases after 72 hours and above. This delay militates against an expert assessment or the probable cause and manner or death.

However, in India circumstances have so contrived that any Medical Officer irrespective of his knowledge or ignorance, experience or inexperience of forensic pathology might be called upon to conduct medico-legal autopsies. This is an unfair burden even to an experienced general pathologist when it comes to a question of pronouncing opinion on the full nature of implications of, for instance, criminal violence on normal subjects, or what is more complicated, the effect of such violence on previously operant pathology. If it is realised that the life and liberty of a person might be dependant on such an opinion the responsibility becomes all the heavier. The fact that all medical jurists in the United Kingdom are experienced forensic pathologists should be a sufficient incentive to be followed in India. This very justifiable emphasis on experience in pathology is enhanced by the fact that in the United Kingdom the purpose of the majority of autopsies is legally negative, to establish that death was due to natural causes, and thereby to exclude criminality.

1. Training & Qualifications of Medical Officers- In European Countries like Denmark, Rumania etc., State Medical Officers, even as early as 1914, had to undergo a course of one year in Forensic Medicine in a Medico-legal Institute and obtain a diploma before they were entertained into service. According to Prof. Minovici (1928) "in this way the creation of a select body will be attained to which justice will have to address itself exclusively for the opinions in legal medicine". The Mudaliar Committee (1961) and the Central Medico-legal Advisory Committee have also recommended the creation of a separate cadre of Medical Jurists from specially trained persons and the matter is receiving attention at State Level.

2. Clinical Forensic Medicine Practice- In cases of assault or offences against morality victims and accused persons can only be medically examined with their consent or, in the case of children below 12 years of age or persons of unsound mind, with the consent of a parent or guardian. There is no provision analogous to the laws in France, West Germany, Japan, South Africa, etc., whereby an accused person can be examined without his or her consent. This question was discussed at the fourth session of the Central Medico-legal Advisory Committee, and it was felt that the time was not ripe to bring any legislation. The Committee was of the opinion, that the situation would be clarified if a study is undertaken by, say, the Indian Law Institute of Officers of the Law Commission or a University Faculty of Law to ascertain in what types of criminal cases, if any, medical examination of the accused is so essential that a successful investigation or prosecution would be stultified by the refusal of the accused to submit to medical examination. As a result of such study, it would be known in what types of cases and what kind of medical examination may justifiably be made compulsory by legislation.

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A large number of cases of assault are reported daily to the police throughout the country,-survey in some selected centers in India has shown that only 7 per cent of cases examined by Medical Officers had sustained grievous injuries, and the rest of the 93 per cent of cases were simple injuries and, therefore, non-cognizable offences. In these 93 per cent of cases, prosecutions are not instituted by the police and this shows the wastage of valuable time and unproductive work of the Medical Officers. During the recent year, even in obvious cases of simple injury or even when there are no injuries, the police are obliged to have the complainant medically examined. These cases come mostly during the odd hours of the night. In those States where prohibition is in force, cases are sent for examination at all odd hours and the Medical Officers are frequently disturbed during the night, with the result that some of them have resigned from Government service. The number of cases where persons have to be examined for other offences is relatively small.

The view is also held that clinical forensic examinations require no special training. This attitude is basically wrong as few realise the difference between clinical forensic medicine examinations and other clinical examinations. The unfortunate result of this state of affairs is that the police are often unable to present their cases satisfactorily to the court because essential elements in the medico-legal examinations are wanting.

The successful practice of clinical forensic medicine will depend upon a re-orientation in the approach to the work on the part of the Medical Officers concerned. The re-orientation can be brought about by giving training as recommended by the Central Medico-legal Advisory Committee (Chapter V). The special features of such examinations can be emphasised and Medical Officers can be taught to appreciate the importance of such examinations.

The introduction of standard Report forms for medico-legal examinations would facilitate the recording of clinical findings. The advantage of such a method is discussed in detail in Chapter VIII.

3. Procedure in the Examination of Biological Materials.- Existing procedure for sending biological materials for expert opinion varies from State to State. In some States, Skeletal remains, tissues for histological examination, smears for microscopic examination etc., are sent to the respective Chemical Examiners who after securing opinion from the concerned expert transmit the report under their signature. In certain other States, some of these materials like bones are sent directly to Professors of Forensic Medicine, while in others they are sent to Professors of Anatomy. The Committee feels that all these materials should be examined in the Department of Forensic Medicine of the nearest State Medical College where a qualified full-time professor is available.

4. Procedure in the examination of cases of sexual assault on girls.- The number of victims of sexual assault is considerable especially if one adds, that much larger number which must exist but remain unknown to the police, largely because the parents fear of publicity and the rise of increasing psychological trauma in an already disturbed girls. The omission to report is a pity, as reporting might lead to the tracking down of a man who has been assaulting other little girls.

A Child's reaction to assault varies a great deal, being partly influenced by age, intelligence, general temperament, and home condition. The children below 7 years are usually frightened and still show this fear

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when examined. They are mainly cases with only slight damage and signs that quickly disappear. In such cases, if parents reassure and love their children, and carry on a normal existence, the children forget about the incident. In cases of children between 8-12 years old there is much physical pain, with tearing of hymen, bleeding, and also from fright. The victims in this group are afraid to report to their parents and suffer from some feeling of shame and grief as well. It is necessary to gain their confidence otherwise their fear may prevent them telling the truth. An unsympathetic approach will only lead to a poor statement and also the likelihood of deepening the trauma in the child's mind. The same attitude is also seen in adolescent girls.

In the above cases the statement should as far as possible be recorded by a police woman of experience at the home of the child or wherever the child can be most relaxed, but not at the police station. It is better if the police officer goes in plain clothes with as little fuss become the center of unhealthy interest. The mother (or confidant of the victim) should be present in order to give her more feeling of security. It is ideal if the recording is postponed and done in the presence of the doctor, who is asked to examine her.

If it is decided to take the case to court then it should be done with the minimum of delay. Many of the victims, feel anxiety about going to courts, often made worse by parents attitude, so the sooner the ordeal finishes the better it is. The evidence of the girl may be recorded in camera.

C. CHEMICAL EXAMINERS LABORATORIES

With the exception of the States of Assam, Madras, Maharashtra, Madhya Pradesh and West Bengal all the other States have separate Chemical Examiners Laboratories. In the States of Madras, Maharashtra and West Bengal the former Chemical Examiners Laboratories have been integrated into the Forensic Science Laboratories.

The work of Assam State and those Centrally Administered regions is being carried at the Central Forensic Science Laboratory, Calcutta and of Madhya Pradesh at the Uttar Pradesh Chemical Examiners Laboratories, Agra.

The set up of the laboratories in different State varies, depending upon the nature and type of work. Each State has prescribed rules for sending articles for examination to the Chemical Examiner. Nature of work undertaken is more or less common to all States, whereas in certain States, the articles for prohibition offences constitute a great load of work. In almost all States, Chemical Analysis in cases other than in murder cases constitute 50% of work and in 8 out of 16 States this constitute more than 70%.

It is noticed that many specimens for toxicological analysis are being sent by medical officers without any scientific indication or necessity for such an examination; this is largely due to their lack of knowledge of pathology. Similarly the investigating police officers also are observed to collect far too many specimens of bloodstains, etc., in some cases which do not warrant such a procedure. The volume of work in some laboratories is so great in relation to the staff available, that there is considerable delay in all-toxicological examinations. These delays are partly due to examination of stomach wash or viscera in cases of accidents, suicides, natural deaths, cases for exclusion, and also due to

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inadequacy of staff. The practice of examining articles in criminal cases in which prosecutions are likely, as is the practice in England be adopted, if unnecessary work is to be avoided.

Toxicological Boxes.- Except in a few States, the Medical Departments have not adopted the procedure of supplying toxicological boxes containing chemically clean glass jars to dispensaries and hospitals by the Chemical Examiner Laboratories for use in connection with the submission of viscera for analysis. As a consequence, viscera are often submitted to the Laboratories in bottles or jars, which have been cleaned by compounders or ward boys. The unsatisfactory nature of these arrangements is obvious and should be rectified immediately.

Immediate steps should be taken for the preparation of specifications for toxicological boxes and glass jars. Sufficient number of these boxes as per requirements of each State should be manufactured for distribution to all post-mortem centers of the State. The responsibility for cleaning toxicological jars and bottles should be taken by the Chemical Examiner to Government. After chemical cleansing, the glass jars or bottles should be sealed and should be placed in a sealed toxicological box hearing the seal of the Chemical Examiner to Government. When a medical officer has to submit viscera for toxicological analysis he should personally break the seal of the Chemical Examiner, open the box, place the viscera in the jars, add a suitable preservative (four ounces of preservative in the bottle), and then personally re-seal the jars and bottles and the toxicological box. The provision of such a system for the submission of viscera for toxicological analysis is absolutely essential in the interest of justice.

D. FORENSIC SEROLOGY

With the exception of the State of Maharashtra who have decided to set up their own laboratory, serological work in medico-legal cases throughout the country is at present being done in the department of Serologist and Chemical Examiner to the Government of India, Calcutta. The question whether it should be decentralised, was considered by the Central medico-legal Advisory Committee at length in the first, third, fifth and sixth sessions of the Committee and it was decided that the serological work should continue to be carried out in the laboratory of the Serologist, Government of India. The Committee at its fifth session, considered the decentralisation of serological work and felt "that time had become opportune for the establishment of a regional laboratory at Hyderabad which will reduce the work load of the Central Laboratory and at the same time provide facilities for training in forensic serology to the students in the upgraded department of Forensic Medicine of Osmania Medical College". As the Department of Forensic Medicine, Osmania Medical College has not yet been upgraded, perhaps the question of starting a regional laboratory at Hyderabad has been only postponed. The Survey Committee recommends decentralisation of serological work by the States, provided qualified persons are available.

FORENSIC SCIENCE LABORATORIES

The Government of India in the year 1960 had stressed the need for setting up of forensic science laboratories in the States as the facilities available for forensic examinations were very few. They recommended that these laboratories should be in addition to and not in place of the existing Chemical Examiners laboratories in the States.

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A forensic science laboratory as per their recommendations should ordinarily consist of (a) Biological (b) Chemical (c) Physical and (d) Ballistics sections. Forensic science laboratories have been established in some States, while in others there are still in the process of formation. The Committee observes that all the medico-legal work relating to the Chemical Examiners laboratory is being done at the State Forensic Science Laboratories in the States of Madras, Maharashtra and West Bengal.

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CHAPTER IV - Teaching of Forensic Medicine

The report thus far has dealt almost exclusively with the 'practical application of medicine to the needs of justice. Forensic Medicine, looked on as an important branch of medical science, cannot attain its fullest development unless it is made a field for teaching and research and chairs are created in every Medical College. The two aspects of forensic medicine, the practice and academic, are dependent on each other. Neither of them can progress without the other.

A. UNDER-GRADUATES OF MEDICINE

Instruction in forensic medicine provided to under-graduate medical students as part of the curriculum of studies for a degree in medicine is very unsatisfactory Opportunities for practical training in clinical forensic medicine (e.g. examination of injured sexual offences, etc.) and specially medico-legal post-mortem examinations are almost non-existent in most Universities and very restricted in others. In a vast majority of the medical colleges this subject is taught by teachers not having the qualifications prescribed by the Medical Council of India.

A course of lectures, consisting of 40 to 50 in number, is delivered during the second year of the clinical course in most of the Universities. Only in a very few, it is compulsory for every fourth year medical student to attend 10 to 12 medico-legal post-mortem examinations during the course, and to present a record of 6 post-mortem examinations witnessed by the candidate at the time of the University Examination. Therefore, it is clear that in most of the Medical Colleges in the country, students qualify without witnessing even a single medico-legal post-mortem examination. All Universities have a theory and oral examination in Forensic Medicine and in only three Universities is there a practical examination.

It is very essential to continue under-graduate instruction in Forensic Medicine even after the formation of the special cadre of medical jurists; as even the private medical practitioners, let alone the State Medical Officers at the periphery have to possess some knowledge of the subject for the correct discharge of their various duties to the State and to the patients.

Malpractice is a medical problem, the gravity of which has not been realised by the medical profession. As the people are becoming educated and politically conscious, suits relating to malpractice will increase in the future. The Survey Committee hopes that in the teaching of this subject to under-graduates in medicine and those practicing the profession more stress should be laid on the law relating to the liability of the medical practitioners and medical institutions for professional negligence.

There are about 80 Medical Colleges in the country and will reach 100 in a few years as per the recommendations of Mudaliar Committee (1962), and yet only in about 13 Medical Colleges, is there a separate department of forensic medicine, and only in about 10 Medical Colleges is there a separate chair with Professors possessing the requisite qualifications prescribed by the Medical Council of India. In the majority of the Medical

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College a Civil Surgeon, with or without any post-graduate training or degree in forensic medicine is posted as a part-time Professor or Lecturer.

At present the Professors of Forensic Medicine in most of the Medical Colleges do not get an opportunity to examine and treat or reporting on cases of injury, poisoning, sexual offences, etc., requiring medico-legal investigations. In such cases the Professor has to depend on his theoretical knowledge or on his previous experience, if any, for his teaching these subjects. This is most unsatisfactory and has been adversely commented upon by the Indian Medical Council. To remedy the above defect, the Committee feels that the Department of Forensic Medicine should have access or be given a share in part of the work of the Casualty Department of a teaching Hospital and the Professor of Forensic Medicine be designated as Consultant in Clinical Forensic Medicine.

Comparative Evaluation of teaching in other countries and India.- The number of hours allotted to forensic medicine varies in different Universities of different countries - Poland, 105; France, 70. In Universities of Denmark, West Germany, U.A.R. the examination in forensic medicine is held in the final year, whereas in U.S.S.R. it is held after the examination in Medicine, Surgery, etc. The information from other countries is not available. In America and England (in contrast to Scotland) limited attention is paid to the teaching of forensic medicine. In most of the Indian Universities when the course was of five years duration, the examination in Forensic Medicine, was held prior to final examination in medicine, surgery and obstetrics and gynecology, and subsequent to the examination in pathology. With the reduction of the course to 4 years, the examination is held after 3 years along with pathology, pharmacology, and social and preventive medicine. The subject of forensic medicine is concerned with "the application of knowledge. This subject should be taught during the last term of the 2nd M.B.B.S. and the first term of final M.B.B.S. course, and the examination held six months prior to the final examination.

As can be seen from above, there is a wide variation in the attention paid to the teaching of forensic medicine in Poland, U.S.S.R. etc. on the one side and in England (in contrast to Scotland) on the other. In England, being a small country with good communications, the whole of the medico-legal work including teaching is entrusted to few experienced senior forensic pathologists. In India, the largeness of the area, the extremely small number of forensic pathologists and as the local medical officers in remote parts of the country have to undertake medico-legal work, provision for teaching of forensic medicine at University level is an imperative necessity.

B. POST-GRADUATE EDUCATION IN FORENSIC MEDICINE

The facilities for post-graduate education in Forensic Medicine in the different Medical Colleges are absent or very inadequate. Nevertheless,

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there is provision for the award of M.D. degree in Bihar, Lucknow and Osmania Universities and for post-graduate diploma in Bombay and Osmania Universities. The absence of qualified teachers and lack of adequate facilities for training in advanced forensic medicine have been the subject of comment in forensic medicine are not trained in morbid anatomy and morbid histology, and without such training it is obvious that the so-called specialists cannot be called "forensic (medico-legal) pathologists" and much less are they qualified to do a medico-legal autopsy. As a result, post-graduates in forensic medicine without the basic training in pathology are being produced; this presents a grave situation for forensic pathology in particular and for justice in general.

Award of such degree and diplomas, while laudable in itself, does not solve the basic problem of post-graduate training and should be discouraged. There should be a clear understanding by the State, by the University, by the Profession, and also by the Public, that for recognition as a fully qualified specialist, a minimum period of three years of whole time study in the Department of Pathology, Forensic Medicine, etc., in a large teaching center, where qualified and training teachers plus adequate facilities are available, not only for instruction and acquisition of knowledge, but also for the conduct of research, are required.

Post-graduate education in forensic medicine should be devised to meet two different needs, each important in itself but not connected with each other.

They are:

  1. the training of teachers and specialists in Medical Colleges or Medico-legal Institutes,

  2. the training of practitioners desirous of joining the future Medico-legal Service of a State.

In the case of (a) such training will naturally involve years of work in various departments including forensic medicine under the guidance of a Professor of Forensic Medicine. The training may extend up to 3 years and lead to a higher qualification such as M.D. degree.

In the case of (b) the training will be in the specialty for a period of one year under suitable guidance leading to a diploma in forensic medicine (D.F.M.).

The Survey Committee examined the existing regulations and syllabi, scheme of examination for the post-graduate degree and diplomas in forensic medicine of various Universities and other bodies. The regulations are very variable and deficient in some Universities. The Survey Committee recommends the model scheme drawn by them which they hope will be adopted throughout the country (Appendix I).

Except in the Osmania University in none of the Universities in India is forensic medicine a compulsory subject for the student of law. A suggestion has been made in the UNESCO "report on the teaching of criminology" that forensic medicine should become part of the law teaching. In Turkish and Yugoslav law courses, the subject is compulsory. It is also compulsory to entrants to the Faculty of Advocates in Edinburgh University since the year 1856. It is also taught in the University of Glasgow, Sheffield and others in United Kingdom. In Italy it is optional, and forensic medicine is likewise an alternate subject in Austria.

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The object of these courses for law students is to enable them to understand so much of the subject as to fit them to comprehend medico-legal reports, and to indicate the lines of defense and how best to cross-examine a witness in various circumstances. The advantage of teaching of forensic medicine to law students is inestimable. This can be seen by the standard of presentation of medico-legal aspects of a case, and thereby the administration of justice in these countries. Therefore, the Survey Committee recommends the teaching of forensic medicine to under-graduates in law as in Scottish, continental and Osmania Universities, may with advantage be introduced in all other Universities of India.

D. LAW ENFORCING AGENCIES AND OTHERS

Forensic Medicine is taught regularly in various police training schools in our country, in some, by lay persons, in others by inexperienced Medical Officers. Forensic Medicine is generally found in the curricula of continental institutes of criminology. It is also taught in the Criminology course for the award of a diploma of the Madras University. This is also taught as one of the subjects in University course for police training in the United States. It is also included among the subjects of the medical group at the School of Criminology and Police Science in Brussels for training magistrates, lawyers, police officers and others in the applied criminological sciences.

E. TRAINING OF OFFICERS ABROAD AND ATTENDANCE AT INTERNATIONAL CONFERENCES

The Central Medico-legal Advisory Committee has repeatedly considered this question at its various sessions and impressed on the Government of India the need to provide facilities for training abroad to selected persons in this specialty. The Survey Committee strongly reiterates the urgency of the need for such training in view of the fact that this subject has been neglected all these years.

The Committee also emphasizes the usefulness of deputing medico-legal experts to attend International Conferences as mutual discussion of matters of common interest with experts in the same field in one of the well recognised methods for advancement of knowledge. In spite of Government of India's approval of this principle it is regretted that hardly any expert has benefited so far by this scheme.

F. ACADEMY OF FORENSIC SCIENCES

It is gratifying to note that due to the initiative of some forensic scientists an Academy of Forensic Sciences in India has been formed in the year 1961. This augurs well for the development of this specialty in our country. To carry out the various objectives of the Academy it is essential that the Government of India give substantial financial aid in the initial years of its development and may also advise the States to do the same for the development of its branches in the States. This would not only bring together persons who are actively concerned with the various disciplines of forensic sciences but also improve the standard of medico-legal work and for better understanding of the law enforcing agencies.

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CHAPTER V

Mudaliar Committee's Recommendation on the creation of a Separate Cadre of Medical Jurists.

Prof. Kayssi of Iraq at the symposium of " The teaching of Forensic Medicine" held under the auspices of the British Association of Forensic Pathologists, London in 1954, said "that the State has a duty to make experts available in all districts in much the same way as the Medical Officer of Health is now available. Those appointed should be adequately compensated financially in a manner suited to their great responsibilities. The forensic expert is no less essential in the cause of justice than is the M.O.H. in the maintenance of Public Health". The creation of a cadre of medical jurists in all the States of India has been also under consideration of the Government for some time.

RECOMMENDATION OF CENTRAL MEDICO-LEGAL ADVISORY COMMITTEE

The Central Medico-legal Advisory Committee during its first session in 1956, considered the suggestion of the Ministry of Home Affairs, Government of India, to create a special cadre of medico-legal officers. The Committee then felt that the question of creating a special cadre of medico-legal officers whose exclusive field would be to undertake all medico-legal examinations was not practicable at that time. However, the Committee recommended that each State should give advance medico-legal training to at least one officer in each district and in important cities and towns and such an officer should undertake the specialised medico-legal work himself and also co-ordinate all general medico-legal work by other Government Medical Officers in his jurisdiction.

In discussing this important question and also that of the training of Medical Officers during the sixth session, the Committee recommended that every medical officer on his first appointment to Government service should receive three months training in medico-legal work under a professor of Forensic Medicine. Officers engaged in medico-legal work at the district level should receive further advanced training for six months under a Professor of Forensic Medicine. The specialised training of selected medical officers should be in Medico-legal Institutes.

The Ministry of Health, Government of India, emphasised on the State Governments the need for training of medical officers in medico-legal work. The recommendations of the Committee regarding the establishment of Medico-legal Institutes and the grant of special pay to officers engaged in medico-legal work were brought to the notice of the State Government.

PRACTICE IN OTHER COUNTRIES

In United Kingdom, the teaching and practice of forensic medicine is entrusted to experienced forensic pathologists designated as Home Office Pathologists. In continental countries like Denmark, Rumania, etc., ordinary State Medical Officers who have to do medico-legal work as part of their duties, even as early as 1914, had to undergo a course of training for one year in forensic medicine in a medico-legal institute and also obtain a diploma before they were entertained into service. According to Prof. Minovici (1928), "in this way the creation of a select body will be attained to which justice will have to address itself exclusively for the opinions in legal medicine".

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MUDALIAR COMMITTEE'S RECOMMENDATIONS

The Mudaliar Committee has recommended the creation of a separate cadre of specially trained medical jurists to look after the medico-legal work of the State. It has been accepted that it is the duty of the State to make full-time experts available to look after medico-legal work of the district in the cause of justice, in much the same way as Health Officers are available in the maintenance of Public Health.

The advantage of the recommendation of Mudaliar Committee in creating a special cadre of medical jurists is two fold; firstly, it improves the standard of medico-legal work and secondly, it relieves the medical officer of all medico-legal responsibilities. As it is, a considerable proportion of their work in the Casualty Departments of General Hospitals, District and Taluqa Hospitals is medico-legal in nature, and to that extent the Medical Officer attention is diverted from the discharge of their curative work which is their primary responsibility. In short it raises the standard of the practice of not only forensic medicine but also curative medicine as well.

OUR RECOMMENDATIONS

It is imperative to create a cadre of medical jurists; but as long as there exists a lack of trained personnel, it is not an immediate practical proposition. We require at least about 50 trained teachers and about 500 medical jurists for the 338 District Hospitals and in other important cities and towns. Therefore, as a first step, it is absolutely essential to start the Central Legal Institute as already recommended by the Bhore Committee (1946) and the Central Medico-legal Advisory Committee at its various meetings. The primary object of this institute will be the training of teachers and specialists in forensic medicine. Each State should also start a State Medico-legal Institute at its capital city attached to a Medical College for the training of the existing and future entrants into the medico-legal service of each State. It is only by taking such steps, that we can attain a satisfactory means of training a body of medical jurists in a short time to create the cadre of medical jurists.

The nucleus of a cadre of medical jurists has to be formed immediately in each State by direct recruitment from among Senior Asst. Surgeons and after preliminary training in the Department of Forensic Medicine in any State Medical College they may be posted with the stature of a Civil Surgeon to the Headquarters of every District. They may be given the special pay of not less than Rs. 200 p.m. and be debarred from any sort of private practice.

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CHAPTER VI - Medico-legal Institutes

Medico-legal Institutes have been in existence for centuries in several European countries. The first medico-legal institute was started in Austria in 1804. There are medico-legal institutes in Italy, France, Austria, Rumania, Egypt, Japan and other countries.

The importance of setting up of medico-legal institutes in every state of a country, closely associated with medial colleges, for the systematic teaching of forensic medicine, training of specialists, for the investigation of medico-legal problems, etc., has been stressed by all the leading medical jurists of the world.

RECOMMENDATION OF THE BHORE COMMITTEE

The Health Survey and Development Committee, Government of India, 1946, in their report had recommended the starting of a Central Medico-legal Institute which will serve "the triple purpose of - (a) training specialists and teachers in Forensic Medicine; (b) carrying on research with particular reference to conditions in the Tropics and India; (c) to be a center for expert advice".

RECOMMENDATIONS OF THE CENTRAL MEDICO-LEGAL ADVISORY COMMITTEE

The Central Medico-legal Advisory Committee, at its sixth session held in Calcutta, in March 1961, have considered the inadequacy of trained Medical Officers undertaking Medico-legal work and recommended that they should be properly trained before they were entrusted with such work. With a view to end this unsatisfactory state of affairs, and realising the difficulty of imparting specialised training to selected medical officers who will be required to shoulder greater responsibility, the Committee recommended the establishment in India of one or two Medico-legal Institutes for such higher specialised training. Considering the administrative difficulty likely to be encountered specially in obtaining material necessary for teaching, the Committee felt that it may not be practicable for the Union Government to establish and maintain such an institute. This difficulty was not likely to be faced by the State Governments and Universities whose forensic pathologists, police surgeons and chemical examiners would have jurisdiction over the area where the institute would be located and the Committee therefore recommended that the State Governments and Universities would take early action to establish such institutes. They further strongly recommended that the Union Government should give substantial aid in the form of grants, equipment for the Institute, fellowship for the scholars, etc., to the State Governments and Universities agreeing to establish Medico-legal Institute on the lines mentioned above.

The Committee further discussed this problem at its seventh session at Bangalore and nothing the lack of response in the above matter from the State Governments and Universities, felt that as the matter was linked with the training of Forensic Medical Officers, it was important and urgent, and therefore the Union Government should initiate the move for establishing a Central Medico-legal Institute. The Committee also

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reconsidered the question of impediments likely to be experienced by the Union Government in establishing a Central Medico-legal Institute and felt that they are mainly administrative and the difficulties of jurisdiction could be overcome by assigning to the various departments of the institute, all work relating to medico-legal investigation of the area, where the institute would be located. For these reasons and considering the urgency of the matter the Central Medico-legal Advisory Committee agreed to revise their earlier decision, and strongly recommended to Government of India that they should give a lead and establish a Central Medico-legal Institute functioning directly under their administrative control.

Zonal Medico-legal Institute.- The Ministry of Health, Government of India in their note o.F. 23-7/62/M3, has suggested to the Ministry of Home Affairs the desirability of establishing four such Institutes in four Zones of the country. The Government of India called for proposals from the various States and we understand that some States have sent in their proposals.

Central Medico-legal Institute.- The proposal for the establishment of a Central Medico-legal Institute along with Central Forensic Science Laboratories etc., at Hyderabad on the site of the University Campus offered by the Osmanian University to the Home Ministry, Government of India has been deferred, due to national emergency.

OUR RECOMMENDATIONS

The Survey Committee believes that the essential mission of a medico-legal institute should be to train medical jurists, because for lack of competent men in India, the application of forensic medicine has become illusory. The Mudaliar Committee (1962) has recommended the creation of a separate cadre of specially trained medical jurists to look after the medico-legal work of the State. It is the duty of the State to make full-time experts available to look after medico-legal work of the district in the cause of justice, in much the same way as Health Officers are available in the maintenance of Public Health. An important step in the development of medico-legal Institute and State Medico-legal Institutes functioning as Departments of Forensic Medicine in Medical Colleges located in the capital city of the States.

Central Medico-legal Institute.- We require several trained teachers and at least 500 medical jurists to man the future cadre of medico-legal service in India. Therefore, the Survey Committee recommends as a first step, the starting of one Central Medico-legal Institute as recommended by the Bhore Committee (1946) and the Central Medico-legal Advisory Committee at its various meetings- the primary object of the Institute being the training of teachers and specialists in forensic medicine. The Institute may preferably be located at Hyderabad along with the proposed Central Forensic Science Laboratories in the University Campus on the site offered by the Osmania University.

Zonal Medico-legal Institute.- The committee considered the proposal of starting four Central Medico-legal Institutes in the four zones of the country and feels that it is neither feasible nor practicable, due to lack of trained personnel, finance, etc.

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State Medico-legal Institute.- Each State should also start a State Medico-legal Institute at its capital city attached to a Medical College. The following functions should be carried out by the State Medico-legal Institute:

  1. to cater to needs of under-graduate and post-graduate education in forensic medicine and to provide appropriate courses of instruction to other law enforcing agencies.

  2. be responsible for conduct of all medico-legal necropsies of the city.

  3. undertake medico-legal examination of skeletal remains.

  4. be responsible for all forensic serological investigations of the State.

  5. should provide consultative service to Medical Officer and assist those engaged in clinical forensic medicine practice.

  6. it should be required to work in close collaboration with the Departments of Police and Justice to whom it should provide consultative and advisory services on all relevant technical problems concerning the investigation of crime. It should also advise the Government on all medico-legal matters.

  7. To conduct research.

In carrying out these objectives the Institute should establish close liaison with other University or Government Departments such as Departments of Botany, Anatomy, Pathology, Pharmacology, Anesthesiology, Serology, Chemical Examiners Laboratories, etc.

The Central Medico-legal Advisory Committee during its sixth session recommended that the Union Government should sanction substantial aid in the form of grants, equipment for the institute, fellowships, etc. The attention of the State Governments was specially drawn to this recommendation of the Committee by the Ministry of Health, Government of India. The State Governments should be urged to start State Medico-legal Institute on the pattern suggested.

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CHAPTER VII - Medico-legal Adviser to Government

During the Eighth session of the Central Medico-legal Advisory Committee several members drew pointed attention to the lack of progress in medico-legal practice in India. It was noted that the majority of State Governments have not shared the anxiety expressed by the Committee and the Ministry of Health, Government of India. This problem has not received the importance and attention it deserved. The Chairman suggested that each State should have a Medico-legal Adviser to look after the medico-legal problems of the State. Such posts have been in existence in Israel, Iraq and other countries.

The Survey Committee considered this question and recommends that each State shall have a Medico-legal Adviser to advise Government on matters pertaining to medico-legal services and problems. This may be a collateral duty of the Director of the Medico-legal Institute.

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CHAPTER VIII - Standardization of Official Medico-legal Report Forms

The Medico-legal report forms used in India vary from State to State and after the reorganisation of States even in the same State. Post-mortem forms in some shape or other are used in most of the States, while in some State no official forms are used in cases of clinical forensic medicine examinations viz., sexual offences, age determination, etc. The letters of transmittal, requisitions for medico-legal analysis, reports of examination and analysis used in different states are also not uniform. The Central Medico-legal Advisory Committee at its fourth session considered this problem and decided that it is desirable to standardize the forms used throughout the country, both as regards the contents and the format. The Committee referred this to the Survey Sub-Committee and to make recommendations thereon.

In India in 1897, Col Carruthers, I.M.S., drew up for the first time a form and published a "Scheme for a post-mortem examination" with a view to obviate as far as possible omissions due to over sight in medico-legal post-mortem examinations. This form and its modifications have been used in different states all these years. These forms have not been revised for several decades.

OUR RECOMMENDATIONS

The Survey Committee felt as medico-legal work will continue to be handled by other than specialists for some more years, it is essential to revise the forms which are out of date. After going through the various forms used in India and other countries the Survey Committee recommends the use of the revised standard report forms as this will facilitate the recording of post-mortem or clinical findings without any omissions and will be useful to medical officers conducting post-mortem and other medico-legal investigations.

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CHAPTER IX - Planning of Mortuaries and Post-mortem Accommodation

Public in general are very averse to post-mortem being done on the bodies of their dear ones. This is particularly so in some States. They believe that a post-mortem examination resembles an uncontrolled orgy of butchery, a belief which may be sustained by the appalling conditions of the post-mortem rooms or sheds in our country.

There are hardly and properly equipped mortuaries anywhere in our country. Except for a few Medical Colleges, which have fairly good mortuaries with refrigeration facilities, most of the other places have plan is provided when "fifty-two or more post-mortems examinations have to be carried out in a year", otherwise only "temporary post-mortem sheds" are built. While in other states even these minimum facilities are not provided and the examinations have to be carried out in dis-used garages, isolation sheds or under trees. The condition of these post-mortem rooms or sheds remain most unsatisfactory, as, they have no lighting, ventilation or running water facilities. In some states, there are rules for the location of these so-called "mortuaries", that they should not be located 'in close proximity to the Civil Hospital or Dispensary' but near a police hospital. As there are only a few police hospitals in our country, the mortuaries are usually located at the outskirts of the town, have a peculiar predilection for municipal dumping grounds or abattoirs. Yet in some places sheds are provided with doors but without a latch or broken doors, where pigs and other animals have nosed their way and made their habitation.

The State Medical Officers have to work under such horrible and primitive conditions, and therefore, they loathe to conduct post-mortem examination. It is no wonder that they make most unsatisfactory examinations, and in almost all cases, entrust the opening of body, removal of organs, etc. to sweepers or ward boys. Instances are not wanting where without opening of skull, opinions have been given as to the cause of death in murder cases. If performing of medico-legal autopsies by the Medical Officers were not made part of their duties by the State, and if it were a part-time assignment on payment as in other countries, most of the medical officers would have refused to work under such deplorable conditions long ago.

There is also a need to educate the public that a modern post-mortem examination is a carefully conducted surgical operation in which the body is not unnecessarily mutilated. Then, if the public realise that an examination is necessary would they not desire that it should be done properly in a respectable premise? Therefore, it is high time that provision of modern mortuaries with refrigeration facilities must be considered essential in a tropical country like India.

The Union Health Minister, Dr. Sushila Nayyar has justly emphasised the need for improving the mortuaries in our country.

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RECOMMENDATIONS

The Committee therefore desires that the note on "Planning of Mortuaries and Post-mortem Accommodation" along with plans at the State, District and Taluq level recommended by them (Appendix No. III) be followed by every State, to improve the present situation.

A list of equipment required for autopsy rooms is also appended (Appendix No. IV)

The provision of mortuaries, their maintenance and equipment and the appointment of mortuary attendants at places other than Medical Colleges should be the responsibility of the District Medical Officer.

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CHAPTER X - Conclusion

1. The Survey Committee strongly emphasized the immediate necessity of setting up of medico-legal service in the country on a sound footing right now when it is still in its infancy of development. The Committee further reiterates that it could be possible only if:

  1. soundly integrated and independent medico-legal administrative system is established both at the Centre and at the State Levels.

  2. a well organised teaching system is set up both at the under graduate and at the post-graduate levels.

  3. the Union and State Governments both establish their own Medico-legal Institutes in the country.

2. Although medico-legal practice is purely a medical subject and practiced only by graduates in medicine yet it has not been adequately dealt with either in the Bhore Committee Report (1946) or the Mudaliar Committee Report (1962). Understandably both Committee Reports pertain to health survey in which medico-legal practice, in a way, has no direct bearing. Medico-legal practice is directly concerned more with the Home and Law Departments of the Government than with the Health Department except that the practitioner is invariably a qualified medical man. A doubt is some times raised as to whether the medico-legal practitioner should be under the Ministry of Law, Home or Health. The Committee is of the view that the service should continue to remain under the Ministry of Health as it feels that the incumbents should continue to remain under the Ministry of Health as it feels that the incumbents should in no sense be dependent upon departments which are concerned with the process of trial or the investigation of crime.

3. The proposed medico-legal cadre in each State should be organised on the same bases an any All-India Service. Forensic Medicine though a very important branch of medicine suffers from the same handicaps in attracting able men to this branch as any other non-clinical branch of medicine. Besides it suffers from an additional disadvantage in that the incumbents to his branch have to work in most difficult conditions and have to give evidence in courts of law in all cases they handle which is a great ordeal to any technical man. It is but essential that the profession is made amply remunerative to attract the right type of persons and completely debarred from any private practice. The Committee further a part of the All India Health Service Cadre, to be formed. This would greatly enhance the dignity of the profession which is very essential in the interest of justice and the public.

4. Whole-time professional departments should be created in all the Medical Colleges. Adequate provision should be made for the theoretical and practical teaching in forensic medicine to under-graduates in every University. In each State one of the State Medical Colleges should be upgraded to undertake post-graduate training in forensic Medicine.

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5.The Committee recommends that Medico-legal Advisers to State Governments be appointed to advise them on medico-legal matters particularly in the development of medico-legal service in the State.

6. The Professors of Forensic Medicine must be provided with enough facilities to encourage them to undertake research in their field without which it will be impossible for them to keep abreast of the latest advancements in the subject and discharge their duties efficiently. The material available to them in this country for such work is very vast but we are constrained to point out that at present it is going waste for want of even ordinary facilities to them to do research; they are overburdened with routine work in the departments. The Committee further suggests that the Indian Council of Medical Research may be approached with a request that it encourages research in forensic medicine by giving more liberal grants for the subject.

7. The Committee agrees that organisation of Summer Schools in Forensic Medicine on the lines suggested by the Ministry of Cultural Affairs and Scientific Research will go a long way in improving the quality of medico-legal practice and in developing it on a more uniform pattern throughout the country. It further suggests that all the Professors of Forensic Medicine, the Police Surgeons, the Chemical Examiners to State Governments, the Directors of Forensic Science Laboratories and the Serologists doing medico-legal work be invited to attend such Summer Schools.

8. The Committee feels that notwithstanding interest taken by the Centre and a few State Government, the present deplorable condition of the medico-legal practice in the country will take some years to improve it. It will therefore be very desirable for a co-ordinate advancement of the subject in the country that the Ministry of Health, Government of India, through the Director-General of Health Services, guide, encourage and help the uniform development of the subject in all the States.

9. The Committee is quite conscious of the existing national emergency and has therefore observed strictest economy in formulating the present recommendations. A minimum of services most essentially required for the efficient working of the system only have been suggested in order to immediately check ;the rising tide of crime in the country.

10. The Committee would like to express its grateful thanks to the State Governments, to the authorities at the Centre and others who have so kindly helped it in gathering the necessary material for the survey. It was not possible for the Committee to visit all the States to gather first hand information; it however, utilised the information from those States who made it available for assessing the total requirements of the country. The Committee is pleased to record and thank Dr. K.N. Rao, Addl. Director General Health Services, Government of India and Dr. A.T.M.A. Khader, Director of Medical Services, Government of Andhra Pradesh, for the keen interest they have shown by their presence at times and rendering valuable suggestions and advice to the Committee while this report was being drafted.

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CHAPTER XI - Summary of Report

1. A Medical Officer in India is hardly, if ever, called upon to participate in the investigation of a murder case by visiting a crime scheme. A visit to such scene by him is absolutely essential to determine the circumstances, for the reconstruction of the crime. The Government of India have already recommended this procedure to the State Governments; it is desirable that this is implemented by the State in all their Medical College Centers where a qualified and trained professor is available.

2. Post-mortem index is highest for Madras State and lowest for Orissa State. The index indicates the efficiency of the Medico-legal investigation system of the State. The low values that are obtained at present clearly shows how a large number of dead bodies are disposed off after inquest without recourse to post-mortem examinations. It is therefore recommended that post-mortem should be made compulsory after all inquests. The Criminal Procedure Code in this connection accordingly needs to be amended.

3. As long as sufficient number of medical officers are not available to make a preliminary examination of all bodies at the crime scene, police officers should be properly trained to better understand the procedure and the type of information required by the medical officers who shall be called upon later to do the post-mortem on the same body. This will enhance the usefulness of the police requisition or the inquest report. The Inspectors General of Police of the State may be requested in this connection to lay more stress to this subject in their police training colleges.

4. The Coroner system of inquest is no doubt better than the police inquest system. It is therefore strongly recommended that the old Coroners Act may be suitably amended to bring it up-to-date and in line with such Acts as are in vogue in other parts of the world and it be made applicable throughout the country to all jurisdictions having a population of more than two lacs.

5. The creation of a separate cadre of Medical Jurists in the States is absolutely essential. The Government of India have already recommended it to all States for its implementation. The State Medico-legal personnel should be from the All-India Medical and Health Services cadre to be formed.

6. Senior Asst. Surgeons may be given special training immediately in forensic medicine and posted at district levels with special allowance. This will be the nucleus for the special cadre of medical jurists.

7. The Standard Report Forms may be adopted in every State for clinical Forensic Medicine Examinations and Post-mortem Examinations. This is necessary not only for statistical purpose but for avoiding any omissions by the Medical Officers in recording any particular observation.

8. A standard pattern for mortuaries and post-mortem accommodation as recommended may be provided at centers doing post-mortem work.

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9. It is essential in the interest of justice that standard toxicological boxes and glass jars are used in all the States for the dispatch of viscera by the Medical Officers to the Chemical Examiners.

10. State Laboratories may carry out their Medico-legal Serological work in their own laboratory provided they have the required qualified trained personnel. There is a dearth of such qualified personnel, steps may therefore be taken for imparting such training to well qualified candidates such as those possessing a basic medical degree with post-graduate degree or diploma in Bacteriology, Microbiology, etc.

11. Skeletal remains, tissues for histo-pathological examination etc. should be sent for examination direct and not through the Chemical Examiners, to the Department of Forensic Medicine of the nearest State Medical College where a qualified person is available.

12. The existing procedure for examining girls in sexual assault cases is not proper, therefore, certain suggestions have been made which may be implemented.

13. Whole-time professional departments should be created in all Medical Colleges. Adequate provision may be made for the theoretical and practical teaching in forensic medicine in every University. The subject of forensic medicine should be taught during the last term of M.B.B.S. and the first term of final M.B.B.S. course and the examination held six months prior to the final examination.

14. In Post-graduate education in forensic medicine stress should be laid on pathology, i.e., morbody anatomy and morbid histology. Without such training the specialists cannot be called forensic or medico-legal pathologists. Post-graduate training in forensic medicine should be devised to meet two different needs - the training of teachers and specialists in Medical Colleges and Medico-legal Institutes, and the training of practitioners desirous of joining the Medico-legal Services. Model regulations and syllabi for the M.D. degree and diploma in forensic medicine are appended to this report.

15. Professors of Forensic Medicine may be designated as consultants in Clinical Forensic Medicine to the Casualty Department of teaching Hospitals.

16. The Government of India may offer facilities to Medico-legal experts to attend International Conferences in their subjects. This is most essential if the medico-legal practice in the country is to be kept abreast with the world.

17. The Government of India and State Governments may be requested to encourage the growth of forensic in the country by liberally financing:

  1. the Indian Academy of Forensic Sciences and similar bodies in fulfilling their objectives.

  2. the research schemes in the subject for which there is unlimited scope.

18. Medico-legal Service should be a district category in the contemplated All India Health Services to be created soon under the Ministry of Health, Government of India. They may, however, be allotted to different State of Ministries as other All India cadre officers are posted.

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19. Summer Schools in forensic medicine may be organised on the lines suggested by the Ministry of Scientific Research and Cultural Affairs.

 

  1. Dr. I. Bhooshana Rao Rao-Convenor.
  2. Dr. H.S. Mehta
  3. Dr. K.C. Jacob
  4. Dr. A.R. Natarajan
  5. Dr. H.S. Mahal

Hyderabad-A.P. Members of the Survey Committees.

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INSTRUCTIONS FOR THE HOLDING OF MEDICO-LEGAL AUTOPSIES & THE COMPLETING OF POST-MORTEM REPORTS

1. If a complete autopsy is not carried out by the Medical Officer evidence which later may prove of great medico-legal importance may be irretrievably lost and, as a result, the course of justice may be impeded. It is, therefore, essential that in all cases, the autopsy should be a complete one. The responsibilities of carrying out a complete autopsy must rest solely with the Medical Officer.

After full external examination, all body cavities should be opened and all the internal organs inspected in situ. All internal organs should then be removed and should be individually dissected and examined.

2. The opening of the body and the removal and examination of the organs should be personally carried out by the Medical Officer.

3. For appropriate methods of dissection standard text-books should be consulted.

4. All injuries or abnormalities found should be briefly but fully and accurately described. Abnormal collections of fluid i.e. pleural, pericardial, peritoneal exudtes, etc. should be accurately measured. The relative number, sizes, and distribution of petechial haemorrhages occuring in the substance of or on the surfaces (pericardial, pleural, etc.) of organs should be noted. When organs appear normal the appropriate line of report should be endorsed "Nothing abnormal noted". Negative findings should be stated as they may be as important as positive findings. When, for any reason, organs are not examined the appropriate line of the report should be endorsed "Not examined"; it should not be merely left blanks.

5. The schedule of observation ;should be restricted entirely to the recording of facts as found by the Medical Officer at the autopsy and should NOT include any previous clinical findings, hearsay evidence, nor inferences as to how the injuries or abnormalities may have been caused.

6. Generally, in cases of suspected, poisoning where chemical analysis is indicated, the stomach and its contents, the small intestine and its contents, one pound of liver, one kidney, Urine (Not less than 4 ounces) should be retained for such examination. In certain cases it may, however be desirable to take other specimens, e.g. blood in cases of suspected. Carbonmonoxide poisoning, brain in cases of suspected acute alcoholic poisoning, hair in cases of suspected arsenical poisoning, Uterus in cases of criminal abortion where it appears that poison was administered by this route, etc. In deciding as to what specimen to take, the Medical Officer must be guided by the special circumstances of each case.

While transmitting viscera to the Chemical Examiner for analysis, it is advisable to preserve the stomach and its contents together with a place of the upper part of small intestine in one bottle, pieces of the liver and kidney in another bottle, and Urine in the third bottle. These viscera are to be preserved in methylated spirit supplied by the Government Medical Stores. If methylated spirit is not available rectified spirit may be used. In cases of suspected poisoning by alcohol, phosphorous, paraidehyde,

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lysol, etc. a saturated solution of common salt is to be employed. A sample of preservative used- either the methylated spirit or rectified spirit or the saturated solution of common salt- should always be sent for chemical analysis. Detailed instructions contained in the Hyderabad Police Mannual should be consulted in regard to the transmission of suspected substances to the Chemical Examiner particularly in cases of death suspected to be due to poisoning.

7. The report should be completed as soon as possible after the autopsy and the original Post-mortem report sent direct to the concerned Magistrate in a sealed cover, the Police being given a copy of it immediately. The opinion as to the cause of death should be handed over to the Constable accompanying the body immediately after the post-mortem and a copy of this should be sent to the Civil Surgeon forthwith on the same day. For this purpose the last pages of the Post-mortem Forms (which are perforated) should be detached and used.

8. The Post-mortem findings, or any other evidence in the case, should not be discussed by the Medical Officer with any unauthorised person but he should provide all facilities to the Investigating Offer.

9. Interested parties requiring a copy of the post-mortem report should apply to the concerned Magistrate for such a copy which should NOT be furnished direct by the Medical Officer.

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Date and Hour of Receipt of Body

------------------------------------------

Date and Hour of Autopsy ____________________

Body identified by __________________________

SCHEDULE OF OBSERVATIONS

A-General

 

  1. Name

  2. Sex

  3. Apparent Age, (Assessed from the general appearance of the body)

  4. Height, (Measure length of body)

  5. Weight

  6. Physique, (State in appropriate terms e.g. well built, normal, weak etc.)

  7. Nutrition, (State in appropriate terms e.g. thin, normal, fat, etc.)

  8. Special Identifying Feature (If body is unidentified, describe all identifying features, e.g. color of hair and eyes, scars, tattoo marks and their pattern, deformities, dental condition, caste marks etc.)

  9. Post-mortem Changes Present (Note body Temperature and describe extent of rigor mortis, Post-mortem lividity and putrefactive signs; stained blood vessels, greenish discoloration, odor, softening of eye balls, exudation from nose and mouth, ova of flies, moving maggots, blebs over body, peeling of cuticle, loosening of hair, thorax and abdomen burst sutures of skull opened eye liquefied, , Adipocre mummification, skeletenization.)

  10. External Appearance- Condition of Limbs and Orifices, (Describe position of body, state of clothing, presence of stains, surrounding condition, temperature of surrounding air, (41)


    prevailing climatic conditions, etc. depending on the case. In new born infants note conditions of umbilical cord whether or not the body has been washed and preserve any wrapping in which it was found. In all cases examine all external orifices, eyes, ears, nostrils, mouth, anus, vagina, uretha)

  11. Injuries-Briefly but accurately describe all injuries and abnormalities found. State exact sites and natures of all wounds and give accurate measurements of all their dimensions. Cut into all suspected bruises found in wounds. State whether injuries are ante-mortem or post-mortem with reasons. Sketches, diagrams, or photo graphs of important injuries are often necessary. Where indicated, take appropriate specimens for histological or bacteriological examination.)

B.- Head & Neck

  1. Skull.

  2. Brain and meninges and cerebral vessels. (Note presence of any abnormal smell, when indicated retain brain for chemical analyses for alcoholic content. In cases of death suspected to be due to ureamic or diabetic coma, take a specimen of C.S.F. for biochemical analysis.)

  3. Orbital, nasal, ascessory nasal, and aural cavities, (Examined only if special indications present.)

  4. Mouth, tongue, and Pharynx.

  5. Neck, larynx, thyroid, and other neck structures, (A careful flap dissection of the neck should always be made and all neck structures carefully examined to investigate the possibility of death being due to acute respiratory obstruction e.g. Strangulation hanging etc.)

C.- Chest

  1. Ribs and Chest wall.

  2. Diaphragm. (Note level of diaphragm right and left.)(42)


  3. Mediastinum and Thymus. (In case of obscure sudden death where the thymus appears enlarged weight it and submit a section for histological examination.)

  4. Oesophagus.

  5. Trachea and Bronchi. (All the larger air passages should be opened and carefully examined for the presence of foreign material.)

  6. Pleural Cavities

    1. Light.

    2. Left.

    3. Right.

  7. Lungs. (In new born infants a full hydrostatic test should be carried out. Note, color, distended or collapsed; dry crepitant, soft oedematous congested, friable, inelastic, emphysematous, atelocotoid; exude frothy blood, blood stained purulent matter Adhesions, haemorrhages, infarction, scars, tubercle on surface, etc.) Left

  8. Heart and pericardial sac. (Open all chambers of the heart, dissect the coronary arteries with small probe pointed scissors, and cut into the myocardium. Examine valvular rings. In sudden obscure deaths the possibility of air or pulmonary artery embolism should not be overlooked.)

  9. Large blood vessels (Abnormalities in the large arteries and veins e.g. ancurysm formation thrombosis, etc. may be noted here.)

D.- Abdomen

 

  1. Abdominal Wall.

  2. Peritoneal Cavity.

  3. Stomach and contents. (Ligature cardiac and pyloric ends of stomach and remove en-masse. Place in clean tray, silt open the lesser curvature of stomach. Note nature of stomach contents, state of digestion, description of identifiable particles, and presence of any abnormal order. Examine mucous membrane. If indicated submit stomach and its contents for Chemical analysis.)(43)


  4. Small intestine (Remove small intestine en-masse. Place in clean tray. Slit open along anti-mesenteric border. Examine mucous membrane. If indicated contents of small intestine and a loop of upper part of small intestine may be submitted for Chemical analysis.)

  5. Large Intestine, vermiform appendix and mesentery.

  6. Liver, gall-bladed, and biliary passages. (In case of suspected poisoning where chemical analysis is indicated, remove examine, and weigh whole liver. Send one pound of liver for Chemical analysis.)

  7. Pancreas.

  8. Spleen. (Note color, size, shape, large, small, capsule, wrinkled, thick, adherent, perisplenitis ('Iced' spleen), rupture, wound etc.)

  9. Kidneys, renal, pelvis, Ureters.

    1. Right

    2. Left

  10. Adrenals. (In cases of sudden death from obscure causes, examination of the supra renal glands should not be overlooked.)

  11. Pelvic Walls.

  12. Urinary Bladder and Urethra.

  13. Genital organs.

E. Spine

  1. Spinal Column and spinal cord (Palpate and manipulate the spine after the removal of all internal organs for presence of fractures and dislocations. The Spinal Cord need only be opened and the Cord examined if special indications are present.)

F.- Additional Observations(44)


 

E- Specimen Removed for Chemical Analysis

The following numbered and sealed as under, and each labeled with a signed note of reference to his report, are together with a sample of the preservative reserved for Chemical analysis.

 

SL. No.

Nature of specimen

Nature & Quantity of preservative added.

1

2

3

4

5

6

7

Stomach and contents.

Small intestine & contents.

Sample of Liver (Not less than 1 lb.)

Kidney (One).

Sample of Urine (4 oz. at least).

Preservative used (Nature & Quantity not less than 4 oz.)

Post-mortem Concluded at A.M./P.M.

 

on --------------------------------------- 196

OPINION AS TO THE CAUSE OF DEATH

  1. The approximate Time of Death

  2. Reserved Pending Report of

  3. The cause of death, to the best of my knowledge and belief was ----------------------------------------------

------------------------------------------ Hospital

Dated --------------- 19

 

(Signature)

Civil Surgeon or Medical Officer

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OPINION AS TO THE CAUSE OF DEATH

Regarding the body of a Male/Female aged about ____________________ Years, named _________________ received from the ___________ of __________ with his letter No. ___________ dated _________19

Body in charge of Police Constable No. ______________ Named ____________

OPINION AS TO THE CASE OF DEATH

  1. Approximate Time of Death ____________________________________

  2. Reserved Pending Report of ________________

  3. Cause of Death to the best of my knowledge and belief was

__________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________ Hospitals.

Date & Time ____________________

Signature of Medical Officer.


To

The Sub-Inspector of Police _______________ Police Station, Taluq ____________ District ___________________

The Civil Surgeon, ___________________________________

Received one copy of the opinion as to Cause of Death from the Medical Officer ______________________________________

Hospital ___________________ Taluq _____________

District on _______________ at ___________________,

 

Signature of the Officer Receiving.

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No. F.23-14.61-MIII

Government of India

Ministry of Health

NEW DELHI-2, dated the 17 May 1962.

From,

Shri A.C. Ray,

Under Secretary to the Government of India.

To,

The D.G.H.S., New Delhi.

Subject: Central Medico-Legal Advisory Committee Reconstitution of-

Sir,

I am directed to refer to this Ministry Letter No. F.23-14/61-MIII, dated 23rd April, 1962 and to say that the order for the reconstituting of the Central Medico-Legal Advisory Committee contained therein take effect from the 1st April, 1962.

 

Yours faithfully,

Sd/- A.C. Ray,

Under Secretary.

No. F.23-14/61-MIII,

Copy forwarded in continuation of this Ministry's endorsement of even number dated 23rd April 1962 for information to:

  1. Ministries of Law and Home Affairs, New Delhi.

  2. All State Governments/Union Territories.

  3. Secretary, Indian Council of Medical Research, New Delhi.

  4. All other Ministries of the Government of India.

  5. The member of the Committee.

  6. Accountant General, West Bengal, Calcutta.

 

By order,

Sd/- A.C. Ray,

Under Secretary.

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ANNEXURE III

DRAFT

RULES OF BUSINESS OF THE CENTRAL

MEDICO-LEGAL ADVISORY COMMITTEE

  1. The Chairman of the Committee shall preside at all the meetings of the Committee. If the Chairman shall not be present at any meeting the members present shall elect a Chairman to preside at such meeting.

  2. The Committee shall have the power to co-opt other members whenever necessary.

  3. The Chairman shall decide the date and place of every meeting and the agenda of the business for discussion at such meeting. The Committee will ordinarily meet twice a year.

  4. Five members of the Committee present in person shall constitute a guorum.

  5. Not less than 28 clear days' notice of every meeting shall be given to each member of the Committee. The notice will be sent by registered post and the non-receipt of any such notice by any of the members shall not invalidate any resolution passed at any such meeting.

  6. No business not included in the notice convening the meeting shall be discussed at the meeting except with the approval of the Chairman who may permit discussion upon any matter brought forward by any member present and shall decide whether any resolution arising thereon shall be put to the vote at such meeting.

  7.  

    1. (a) Scientific question: Purely scientific questions shall not be submitted to vote. If the members of a Committee or Sub-Committee cannot agree, each shall be entitled to retain and express his personal opinion; this statement of opinion shall take the form of an individual or group report, which shall state the reasons why a divergent opinion is held.

    2. (b) Other questions (Administrative etc.): May be submitted to a vote and decision taken by majority of the members present and voting

    3. (c) If the votes are equally divided, the Chairman shall have a casting vote.

  8. Various Sub-Committees may be formed from time to time as and when required for special purpose. Each Sub-Committee shall have the power to co-opt additional members from outside the Committee with special knowledge of the subject or subjects with which they have to deal. The Chairman of the Committee shall be ex-officio member of every Advisory Committee and be entitled at his own discretion to attend their meetings, to join in their deliberations, and to vote upon any question which may be put to the vote.

  9. Any urgent business which it may be necessary for the Committee to discuss and decide, except such as it may direct to be placed before a meeting of the Committee, may be transmitted by circulation among

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all members of the Committee and any resolution or report so circulated and approved by a majority of the members signing shall be as effectual as if such resolution or report had been passed at a meeting of the Committee provided that at least eight members of the Committee shall have recorded their views on the resolution or report.

10. The proceedings of the Committee shall normally be confidential and cannot become public except with the approval of the Government of India.

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