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DEPARTMENT OF FORENSIC MEDICINE - KATURI MEDICAL COLLEGE, GUNTUR

Exam Paper Answers (15.07.2026)

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LONG ANSWER QUESTION (15 Marks)

Q1. A 14-yr girl brought for medical examination with allegation of sexual assault

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(a) Applicable Sections of BNS, BNSS and BSA

• Section 63, BNS (=S. 375, IPC): Definition of Rape
• Section 64, BNS (=S. 376, IPC): Punishment for rape - rigorous imprisonment not less than 10 years, extendable to life
• Section 65, BNS (=S. 376AB): Rape on woman under 12 years - punishment up to death
• Section 66, BNS (=S. 376A): If rape causes death or persistent vegetative state - RI not less than 20 years to life or death
• Since the victim is 14 years (under 16): Punishment = RI not less than 20 years, which may extend to life
• Section 67, BNS: Gang rape

• BSA S. 108 (=S. 105, IEA): Burden of proof lies on the defense to prove mental illness (relevant to any mental illness plea)

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(b) Classification of Sexual Offences / Definition of Rape

1. Rape (S. 63, BNS)
2. Gang Rape (S. 67, BNS)
3. Sexual harassment
4. Unnatural offences - Sodomy, Bestiality
5. Incest
6. Sexual paraphilias (voyeurism, exhibitionism, etc.)
7. POCSO offences (for children)

• (a) Penetrates his penis, to any extent, into the vagina, mouth, urethra or anus of a woman or makes her to do so
• (b) Inserts any object or part of body (not being penis) into the vagina, urethra or anus
• (c) Manipulates any part of the body so as to cause penetration into vagina, urethra, anus
• (d) Applies his mouth to the vagina, anus, urethra

1. Against her will
2. Without her consent
3. Consent obtained by putting her in fear of death or hurt
4. Consent given under mistaken identity of husband
5. Consent given when unable to understand due to unsoundness of mind, intoxication, or stupefying substance
6. With or without consent, when she is under 18 years of age
7. When she is unable to communicate consent

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(c) Medical Examination Procedure

• With full consent (guardian/parent for a minor)
• By a female doctor, if available
• In a proper examination room, in presence of a female nurse/attendant

1. History: Obtain detailed history from accompanying person or police (if victim unable to speak). Note time, date and nature of assault. Note if she has washed, changed clothes or urinated since the assault.
2. General Examination: Note age (ossification charts, secondary sexual characters), height, weight, built, general condition, emotional state.
3. Signs of struggle/violence: Examine for bruises, abrasions, lacerations on the body, face, neck, breasts, inner thighs, wrists. Examine fingernails (broken/bent due to scratching).
4. Genital Examination:
   • Examine the vulva, labia, hymen (tears, bruising), vaginal introitus
   • Look for fresh lacerations of the hymen - typically at 6 o'clock and 3 & 9 o'clock positions
   • Note any bruising of the labia, perineum, posterior fourchette
   • Examine the vagina for lacerations, injuries
   • Per rectal examination if sodomy is alleged

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(d) Findings of Recent Forceful Penetrative Sexual Intercourse

• Torn/disheveled clothes
• Scratches, bruises, bite marks on the body
• Sand/grass stains on the back

• Hymen: Fresh lacerations, tears (most commonly at 6 o'clock position), bleeding, bruising of the hymenal margin - tears extend to the base
• Labia majora and minora: Bruising, abrasions, lacerations
• Posterior fourchette: Most common site of lacerations
• Vaginal wall: Bruising, lacerations; vagina may be distended; can examine with speculum
• Perineum: Bruising, lacerations
• Pubic hair: Matted with blood or seminal fluid

1. Seminal fluid - presence of spermatozoa in vagina = proof of sexual connection (but not of rape)
2. Vaginal discharges - if assailant has STI (gonorrhea - mucopurulent discharge in 2-4 days; syphilis - indurated ulcer in ~3 weeks)
3. Signs of struggle - broken/bent fingernails, bruises
4. Seminal stains on clothes

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(e) Samples to be Collected for Medico-Legal Purpose

1. Vaginal swab - for spermatozoa, DNA analysis
2. Vaginal wash - for acid phosphatase, sperm, DNA
3. High vaginal swab - for gonococci
4. Cervical swab - for gonococci (Gram-negative intracellular diplococci)
5. Fingernail scrapings - from under nails of the victim (and possibly assailant's DNA)
6. Pubic hair combings - for foreign pubic hair (for comparison)
7. Blood sample - for DNA, blood group, serological tests for syphilis, HIV
8. Urine sample - for pregnancy test (urine hCG)
9. Clothing of the victim - for seminal stains, blood stains, trace evidence
10. Swabs from other body sites (mouth, anus, neck bite marks) if indicated
11. Photographs of injuries

• Any external sanitary napkin or internal tampon is also collected

Number of semen donors can be determined by Y-chromosome STR (DNA fingerprinting) markers.

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(f) POCSO Act, 2012 with Recent Amendments

• Sec. 19: Mandatory Reporting - any person aware must report to police/SJPU; failure punishable under Sec. 21
• Sec. 24: Child-friendly investigation - police record statement in non-threatening environment; trials in camera
• Sec. 29 & 30: Presumption of guilt - accused presumed guilty unless proven innocent (reverse burden of proof)
• Sec. 35: Compensation for medical treatment and rehabilitation

1. Gender-neutral law - protects both boys and girls
2. Child-friendly procedures - special courts, in-camera trials, video-recorded statements
3. Mandatory reporting - doctors and teachers must report; failure is punishable
4. Age of child = below 18 years

• Death penalty introduced for aggravated penetrative sexual assault (Sec. 6)
• Increased minimum punishments
• Stricter penalties for child pornography (storage also punishable)

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(g) Medical Findings in a Victim of Sodomy

• Fissures and lacerations of the anal margin and anal canal
• Bruising of the perianal skin and anal margin
• Bleeding from anal/rectal injuries
• Erythema (redness) around the anus
• Seminal fluid around the anus and in the rectum
• Spermatozoa in rectal swabs

• Funnel-shaped anus (infundibular anus)
• Dilatation of the anal sphincter - the anus is patulous (widely open) and does not contract
• Smooth, rounded, everted anal margins - loss of anal rugae
• Thickening and folding of perianal skin (due to repeated stretching)
• Absence of normal reflex contraction of the sphincter ani
• Hemorrhoids (piles) may be present

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SHORT ESSAYS (5 Marks each)

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Q2. Causes of Impotency in Males and Medicolegal Importance

Causes of Impotence in Males:

• Poor physical development of the penis is a common cause
• In advanced age, power of erection and ability to sustain erection diminishes
• In cases of precocious development (gonadal/adrenal tumors, McCune-Albright syndrome), sexual organs may show advanced development

• Congenital absence of penis, micropenis, hypospadias, epispadias
• Phimosis (tight foreskin), paraphimosis
• Peyronie's disease (fibrous induration)

• Orchitis (inflammation of testes)
• Hydrocoele, varicocoele
• Injury to the penis

• Vasculogenic impotence (~40%) - most frequent; due to poor arterial inflow (arteriosclerotic narrowing). Diabetes, hypertension, pelvic and genital injuries reduce blood flow (arteriogenic), or excessive venous leakage (venogenic)
• Diabetes mellitus (15-20%)
• Neurogenic (7%) - injuries to spine, pelvic/perirenal injuries, pelvic surgeries injuring nerves of penis
• Endocrinologic - testosterone deficiency, LH and prolactin disorders, hypothyroidism, Cushing's syndrome
• Antihypertensives, opiates, psychotropics, tranquillizers affect neurotransmitters and cause impotence
• Occupational exposure to lead causes sterility
• Orchitis following mumps (especially in adolescence) may cause testicular atrophy

• Fear of impotence ("first night impotence" / "honeymoon impotence")
• Anxiety, guilt sense, depression, timidity
• Quoad hoc - impotent with one particular woman but not others
• Aversion to females (sexual aversion disorder)

• Psychogenic (12%), vasculogenic (40%), neurogenic (7%), diabetes (15-20%), endocrinologic

Medicolegal Importance:

• Impotence is grounds for nullity of marriage (divorce proceedings)
• Relevant in cases of rape accusation against an impotent man
• Relevant in paternity disputes
• Can be used in civil suits related to marital disputes
• In cases of suspected impotence, the medical examiner can only give an opinion in the negative form unless there is a marked anatomical deviation from normal

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Q3a. Artificial Insemination - Legal Problems / Medicolegal Aspects

• AIH (Artificial Insemination by Husband): Using husband's semen - used when husband is impotent or infertile
• AID (Artificial Insemination by Donor): Using donor semen

1. Legitimacy of the child:
   • Child born by AIH = legitimate
   • Child born by AID (without husband's consent) = illegitimate
   • If husband consented to AID = child treated as legitimate
2. Adultery: AID without husband's consent may constitute adultery
3. Identity of donor: The donor's identity is kept secret to protect the donor and child
4. Delhi Artificial Insemination (Human) Act, 1995 - main purposes:
   • (1) Allow issueless couples to have a child through AI and give it legal status
   • (2) Control spread of HIV through AI
   • (3) Regulate the donation, storage, sale or supply of human semen/ovum
   • (4) Makes it obligatory on medical practitioners:
     • Not to segregate XX or XY chromosomes (no sex selection)
     • Not to disclose the identity of donor/recipient
     • Prohibit carrying on semen bank without registration

• ART clinic must get approval from accreditation authority
• No commercial party in donor program or surrogacy
• No ART without spouses' informed consent
• Sperm donor and surrogate should not be a relative or friend of the couple
• Sex selection is not permitted
• Donors screened for HIV, Hepatitis B and C

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Q3b. Surrogate Motherhood and its Medicolegal Aspects

• Gestational surrogacy: Surrogate carries embryo of commissioning couple (no genetic relation to surrogate)
• Traditional surrogacy: Surrogate is also the genetic mother (her own ovum used)

1. The surrogate should not be a relative or friend of the commissioning couple (ICMR)
2. Biological parents must adopt the child born through surrogacy
3. The consent of the couples for the use of embryos is a must
4. The sale or transfer of human embryos outside the country is prohibited
5. Surrogacy (Regulation) Act, 2021 - regulates ethical surrogacy practice in India; bans commercial surrogacy; only altruistic surrogacy permitted
6. Paternity/maternity disputes - determining who is the legal parent
7. Surrogate must be screened for HIV and Hepatitis B and C

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Q4. Illusion / Impulse / Delusion / Hallucination / Voyeurism / Somnambulism / Bobbit Syndrome

Illusion:

• Example: seeing a dog and mistaking it for a lion; hearing bird notes and imagining them to be human voices; imagining a string for a snake; mistaking a tree stem for a ghost in the dark.
• A sane person may experience illusion but is capable of correcting the false impression.
• An insane person continues to believe in the illusion even though the real facts are clearly pointed out.
• Illusions are a feature of psychoses, particularly of the organic type.

Impulse:

• A sane person is capable of controlling an impulse.
• An insane person having no judgment, reasoning power or capacity to understand facts, may act on impulse.
• Usually seen in: imbecility, dementia, acute mania, and epilepsy.

1. Kleptomania - irresistible desire to steal articles of little value
2. Pyromania - irresistible desire to set fire to things
3. Mutilomania - irresistible desire to mutilate animals
4. Dipsomania - irresistible desire for alcoholic drinks at periodic intervals
5. Sexual impulses - compulsive urge to perform sexual intercourse (often in a perverted way)
6. Suicidal and homicidal impulses

Hallucination:

1. Visual - imagines being attacked by a lion when none exists
2. Auditory - hears voices of a person not present (commonest in functional disorders, e.g., schizophrenia)
3. Olfactory - smells pleasant or unpleasant odors when none present
4. Gustatory - feels sweet/sour/bitter taste when no food is present
5. Tactile (haptic) - imagines rats crawling in bed; common in alcohol withdrawal and chronic cocaine poisoning
6. Psychomotor - feeling of movement of a body part when no movement occurs
7. Command - ordered by hallucinatory voices to do dangerous acts; may incite suicide or homicide
8. Microptic/Macrotopic - objects appear smaller or bigger
9. Sexual - feels sexually satisfied from self-imaginative objects

Visual hallucinations = commonest in organic mental disorders Auditory hallucinations = commonest in functional disorders

Voyeurism:

• Voyeurism is obtaining sexual gratification by watching others (especially strangers) undress or engage in sexual activity, without their knowledge or consent.
• Onset usually before age 15; may be chronic.
• Occurs in severe sociopathic personality disorder.
• Usually such persons do not commit a major sex crime, but sometimes may assault the victim or commit murder.
• Rare in females.
• Punishable under Section 354, CIPC.

• Troilism: Sexual practice involving 3 persons (2 of one sex, 1 of opposite sex); an extreme degree of voyeurism
• Mixoscopia: Form of voyeurism - sexual gratification by sight of others engaged in sexual intercourse

Somnambulism:

• Characterized by aimless wandering with incomplete arousal from sleep, attended with acute anxiety.
• Person leaves bed and walks in/out of house without any awareness of his actions but rarely injures himself.
• He is not asleep but in a state of dissociated consciousness, in a hallucinatory state.
• Similar to automatism.
• Such persons are usually well-adjusted, socially well-behaved, not aggressive.
• May commit crimes (theft, murder) or suicide; no recollection of the event.
• In some cases, events of one fit are remembered in a subsequent fit.
• Such a person is not criminally responsible for his acts.
• Main factors producing automatism recognized by criminal courts: (1) Epilepsy, (2) Concussion/cerebral disease, (3) Hypoglycaemia, (4) Somnambulism.

Bobbit Syndrome:

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Q5a. Mentally Ill Person Killing Without Provocation - Criminal Responsibility (with Relevant Sections)

"Nothing is an offence which is done by a person who, at the time of doing it, by reason of unsoundness of mind, is incapable of knowing the nature of the act, or that he is doing what is either wrong or contrary to law."

• The burden of proof lies on the defense under BSA S. 108 (= S. 105, IEA)
• The accused's statement that he "killed the President of India" is evidence of a delusion (belief not in accord with reality = paranoid schizophrenia) - grandiose and persecutory delusions
• Being on treatment for mental illness supports this
• Key factors the doctor/court considers (in mentally ill murder cases):
  1. No motive - absent
  2. No preplanning/preparation
  3. No accomplices
  4. Nature of crime - may kill friends/relatives indiscriminately
  5. No attempt to destroy evidence after the crime
  6. Conduct after the crime - no attempt at escape

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Q5b. Civil and Criminal Responsibility of Mentally Ill Person / Insane / Legal Tests

Criminal Responsibility:

• "Not legally responsible if, at the time of committing the crime, he was suffering from such a defect of reason from abnormality of mind, that he did not know the nature and quality of the act, or that what he was doing was wrong."

• "An accused person is not criminally responsible if his unlawful act is the product of mental disease or mental defect." Causal connection between mental abnormality and crime must be established.

• "Not responsible if, at the time of committing the act, he did not have the capacity to regulate his conduct to the requirements of the law, as a result of mental disease or defect."

• "Not responsible, even if he knows the nature and quality of his act and knows it is wrong, if he is incapable of restraining himself from committing the act because the free agency of his will has been destroyed by mental disease."

• "Not responsible if, as a result of mental disease or defect, he lacks adequate capacity either to appreciate the criminality of his conduct, or to adjust his conduct to the requirements of the law."

• Not responsible if unable to appreciate the nature, quality or wrongfulness of acts due to severe mental disease or defect.

Civil Responsibility:

• Contracts made by an insane person during lucid interval are valid
• Contracts made during insanity are voidable (not void ab initio)
• A mentally ill person can give evidence if capable of understanding questions and giving rational answers
• Testamentary capacity (see below): mentally ill person may make a valid will during a lucid interval

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Q5c. McNaughten's Rule - Definition and Differentiation from Durham's Test

McNaughten's Rule:

• Arose from the trial of Daniel McNaughten (1843) - a 29-year-old Scotsman with probable paranoid schizophrenia who shot Sir Robert Peel's secretary Edward Drummond, mistaking him for the Prime Minister.
• Found "not guilty on grounds of mental illness"; sent to Bethlem Mental Hospital for life.
• The resulting rules state: "An accused person is not legally responsible if it is clearly proved that, at the time of committing the crime, he was suffering from such a defect of reason from abnormality of mind that he did not know the nature and quality of the act, or that what he was doing was wrong."
• Accepted in India as BNS S. 22 (Sec. 84, IPC)

• Only intellectual (cognitive) factors are considered, but NOT emotional and volitional factors, delusional beliefs, hallucinations, or the individual's ability to control impulses.

Durham Rule (1954):

• "An accused person is not criminally responsible if his unlawful act is the product of mental disease or mental defect."
• Broader than McNaughten - does not require that the person did not "know" - only requires that the act was caused by mental disease.
• Term "mental disease" = mental disorder; "mental defect" = mental retardation.

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Q5d. Testamentary Capacity of an Insane Person

1. He must know the nature of the act (that he is making a will)
2. He must know the nature and extent of his property
3. He must know the natural objects of his bounty (family members, legal heirs)
4. He must understand the claims of those who may expect to benefit
5. He must be free from any insane delusion which influences the disposal of property

• A will made during a lucid interval is valid
• A will made during a period of active mental illness is invalid
• Certificate from a medical officer that the person was in a lucid interval at the time of making the will is essential

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Q6a. Difference Between Feigned Insanity and True Insanity

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Q6b. Restraint of Mentally Ill Person

1. Independent admission: Any major person who considers himself mentally ill may voluntarily request admission to a Mental Health Establishment (MHE). The MO admits if satisfied. Relative's consent not necessary. Can discharge himself without consent.
2. Admission of minor: Applied by nominated representative. Requires independent examination by two psychiatrists (or one psychiatrist + one mental health professional). Minor accommodated separately from adults.
3. Supported admission (up to 30 days): Nominated representative applies. Person independently examined on the day of admission (or within preceding 7 days) by one psychiatrist + one mental health professional, both independently concluding mental illness of severity requiring admission.
4. Supported admission beyond 30 days: Requires further independent assessment; periodic review by Mental Health Review Board.

• Right to make an advance directive
• Right to appoint nominated representative
• Right to confidentiality
• Right to access mental health care
• All admissions should, as far as possible, be independent admissions

• Violent and criminal mentally ill persons are kept in a prison (not in MHE)
• Physical restraint should be minimal and only when necessary for the safety of the patient or others

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