30 - McNaughton rules

The first famous legal test for insanity came in 1843, in the McNaughton case. 

Englishman Daniel McNaughton shot and killed the secretary of the British Prime Minister, believing that the Prime Minister was conspiring against him. The court acquitted McNaughton "by reason of insanity," and he was placed in a mental institution for the rest of his life. 

However, the case caused a public uproar, and Queen Victoria ordered the court to develop a stricter test for insanity.

The "McNaughton rule" was a standard to be applied by the jury, after hearing medical testimony from prosecution and defense experts. 

The rule created a presumption of sanity, unless the defense proved "at the time of committing the act, the accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know what he was doing was wrong."

The McNaughton rule became the standard for insanity in the United States and the United Kingdom, and is still the standard for insanity in almost half of the states.

29 - Tache noire

*Tache noir is one of the important postmortem changes seen in the eye after death.

*If the eyes remain open after death, the areas of the sclera exposed to the air dry out, which results in a first yellowish, then brownish-blackish band like discoloration zone called TACHE NOIRE.

*It is seen mostly after 7 to 8 hours after death. (AP PG 2010 Question).

28 - Indices used for SEX identification by Sacrum

1. Sacral index: (Width x 100) / Straight Length

2. Curvature index: (Straight Length x 100) / Mid -ventral curved length

3. Index of body of Ist Sacral vertebra: (AP daimeter of body of S 1 x 100) / Transeverse dia of body of S 1

4. Corporo-basal index: (Transverse diameter of body of S1 x 100) / Width of sacrum

5. Alar index: (Length of ala x 100) / Transverse diameter of body of S1

6. Auricular index: (Length of auricular surface x 100) / Width of sacrum

--------

1. Maximum length of sacrum (Wilder's mid- ventral Straight length) -measured along the mid-line of sacrum with the sliding caliper from middle of antero-superior margin of promontory to middle of antero-inferior margin of the last sacral vertebra.

2. Maximum breadth of sacrum -measured with the sliding caliper by taking two points at the upper part of auricular surface anteriorly (or lateral most part of alae of sacrum), thus maximum breadth is measured on anterior aspect of sacrum.

3. Curved length of sacrum (Mid-ventral curved length)- measured along the mid line of the anterior surface of the sacrum (from middle of antero-superior margin of promontory to middle of antero-inferior margin of the last sacral vertebra) by the flexible steel tape.

4. Antero-posterior diameter of the body of Ist sacral vertebra - It is the maximum possible diameter of Ist sacral vertebra measured with the sliding caliper by taking one point on antero-superior border and another point on the postero-superior border of Ist sacral vertebral body.

5. Transverse diameter of the body of Ist sacral vertebra- It is the maximum transverse diameter of Ist sacral vertebra measured with the sliding caliper by taking one point on each side of the lateral most point on the superior surface of body of Ist sacral vertebra.

6. Length of alae -It is measured on both sides with the sliding caliper by taking one point on lateral most point of superior surface of body of Ist sacral vertebra and another point on lateral most part of alae. The mean of the length of the two sides is taken as length of alae.

7. Maximum length of auricular surface-It is the straight auricular length measured on lateral aspect of sacrum by means of a sliding caliper by taking one point on the upper most part of auricular surface and another point on the lower most part of auricular surface of sacrum.

27 - Differences between Antemortem and postmortem wounds

FEATURES	ANTEMORTEM WOUND	POST MORTEM WOUND
Haemorrhage	-Arterial -Blood clotted and the clot is    ~laminated    ~firmly adherent to      the lining of endothelium    ~firm, rubbery and      variegated -Copious amount -Deep staining of edges   which can't be    washed away	-Venous -Blood usually not clotted  and if clots it is    ~Non laminated    ~Weakly adherent to the       lining of endothelium    ~Soft,friable chicken       fat(yellow) or current       jelly(red) appearance    ~Homogenous -Slight amount -Staining is superficial  and can be washed away
Wound edges	Gaping,everted,swollen	Apposed,not swollen
Vital reaction	Signs of inflammation, infection(pus,slough) and healing (granulation tissue) present	Not present
Enzyme histo chemistry	Negative and positive vital reactions	Vital reaction absent
Wound serotonin and histamine content	Increased	No increase
Microscopy	-Clot has platelets -Leucocyte and  RBC infiltration in between muscle fibers	-Clot lacks platelets -No infiltration

26 - Clinical features of Organophosphorous poisoning

*Since organophosphorous compounds are powerful inhibitors of cholinesterase, their poisoning manifests as cholinergic symptoms.

*The clinical features of Organophosphorous poisoning are :

A. MUSCARINIC ACTIONS :
1. Bronchoconstriction and increased bronchial secretion - simulates bronchial asthma. Other symptoms are dyspnea, cough, pulmonary edema and cyanosis.
2. Increased sweating
3. Increased salivation
4. Increased lacrimation - tears may be red
5. Slightly bradycardia
6. Miosis, Blurring/Dimness of vision
7. Increased frequency of micturition and involuntary micturition.
8. Abdominal cramps, diarrhea, epigastric/substernal tightness

B.NICOTINIC ACTIONS :
1. On striated muscles - easy fatigue, fasciculations, cramps, dyspnea (weakness of respiratory muscles and cyanosis)
2. On sympathetic ganglia - Pallor, Occasional elevation of B.P

C. CNS ACTIONS :
1. Restlessness, irritability, apprehension
2. Fine fibrillary tremors of hands, eye lids, tongue
3. Mental confusion, convulsions
4. Coma with absence of reflexes and depression of respiratory and circulatory centres. Death usually occurs due to paralysis of respiratory muscles.

Parikh' Textbook of Medical Jurisprudence Forensic Medicine and Toxicology

25 - Signs and Symptoms of chronic LEAD poisoning

1. Facial pallor : This is the earliest symptom.
2. Colic and Constipation : This is the first symptom that armbouses suspicion of plumbism
3. Anemia : This is associated with punctate basophilia
4. Lead line (BURTONIAN LINE) : A bluish-black line due to epithelial deposition of lead sulphide granules on the gums at the junction with the teeth. (not on teeth). Similar line may also be seen with Mercury, Copper, Bismuth, Iron and Silver poisoning.
5. Paralysis : Usually a late manifestation. Commonly causes wrist drop (extensor muscles of wrist) but may cause foot drop (peroneal muscles).
6. Lead encephalopathy : Frequently seen in children (not so common in adults).
7. Reproductive system : Menstrual disorders, abortion/still births, degenerate offsprings and sterility.

24 - Differences between Male and Female pelvis

BONY FRAME WORK	Massive and heart shaped	Less massive, rounded
PELVIC INLET	Deep and narrow	Shallow and wide
ILIUM	Less expanded, hence walls are not splayed	More expanded, hence walls are splayed
ILIAC FOSSA	Shallow	Deep
ASIS	Not widely separated	Widely separated
PUBIC ARCH	Narrow, V shaped, angle less than 70,less distance between ischia	Wide, U shaped, angle greater than 90, more distance ischia
ISCHIAL TUBEROSITY	Inverted	Everted
OBTURATOR FORAMEN	Ovoid with base upward	Triangular with apex forward
GREATER SCIATIC NOTCH	Narrow, deep, angle less than 90	Wide,shallow, angle greater than 90
PREAURICULAR SULCUS	Narrow,shallow, without marked edges	Broad,deep, in parous women
SACRUM	Long,narrow,has greater than 5 segments,well marked promontory	Wide,short,has 5 segments,promontory less marked
CURVE OF SACRUM	Equal over entire length, S-index less than 112	Straight in first 3 segments, the curve being confined to a point below the centre of 3rd sacral vertebra (J-shape)
ISCHIOPUBIC INDEX	73-94	91-150
ARTICULAR SURFACE OF SACRUM EXTENDS TO	2.5-3 Vertebral bodies	2-2.5 vertebral bodies
ACETABULUM	Wider and deeper	Narrow and shallow

23 - Causes of Post mortem caloricity

*Post mortem Caloricity is a condition where the temperature of the body remains raised for the first two or so hours after death. In certain conditions, instead of promoting the process of cooling of the body, act in a way, so that, the body temperature is either high at the time of death or is increased for sometime after death, so that, at a particular time after death the body may appear disproportionately warmer than what it should have been. This is termed as Post Mortem Caloricity and the conditions are

1.      Post mortem Glycogenolysis

a.       This is a normal phenomenon and the rise is 3.6^oF or 2^oC

2.      Various Causes of Death such as

a.       Septicaemia,

                                                              i.      Infectious diseases,

                                                            ii.      Bacteremia

                                                          iii.      Tetanus, Rabies, yellow fever

b.      Asphyxial Conditions

c.       Severe convulsions

                                                              i.      Tetanus

                                                            ii.      Strychnine

d.      Hyperpyrexia at death

                                                              i.      Heat Stroke (sun stroke)

                                                            ii.      Pontine Haemorrhage

e.       High Atmospheric Temperature

f.        Peritonitis, Meningitis, Nephritis

g.       Alcohol poisoning

22 - Cognizable and Non-Cognizable offences

A cognizable offence in the criminal justice system of India is one in which the police is empowered to register a FIR, investigate and arrest an accused involved in cognizable crime without a court warrant. As defined in Cr.PC, a non-cognizable offence is one in which police can neither register a First Information Report (FIR) nor can investigate or effect arrest without the express permission or directions from the court.

 A cognizable offence is a case where the Police can arrest without a warrant. All cognizable cases involve criminal offences. Murder, Robbery, Theft, Rioting, Counterfeiting etc. are some examples of cognizable offences. Non-cognizable offences are those criminal infractions, which are relatively less serious. Examples of non-cognizable offences include Public Nuisance, Causing Simple Hurt, Assault, Mischief etc. The Police cannot register criminal cases or cause arrests with regard to non-cognizable offences. In all such cases, the Police have to take permission from a magistrate for registration of a criminal case.

21 - IPC sections related to forensic medicine

Sec 118 IPC—Concealing design to commit offence punishable with death or improsonment for life.


Sec 176, IPC—Omission to give notice or information to public servant by person legally bound to give it.


Sec 177 IPC—Furnishing false information.


Sec 182 IPC—False information with intent to cause public servant to use lawful power to the injury of another person. .


Sec 191 IPC—Giving false evidence


Sec 192 IPC—Fabricating false evidence.


Sec 193 IPC—Punishment for false evidence.


Sec 194 IPC—Giving or fabricating false evidence with intent to procure conviction of capital offence.


Sec 195 IPC — Giving or fabricating false evidence with intent to procure conviction of offence punishable with imprisonment for life or imprisonment.


Sec 197 IPC—Issuing or signing false certificates.


Sec 201 IPC—Causing disappearance of evidence of offence, or giving false information to screen offenders .
Sec 203 IPC—Giving false information respecting an offence committed.


Sec 204 IPC—Destruction of document to prevent its production as evidence.


Sec 284 IPC —Negligent conduct with respect to poisonous substances.


Sec 304 IPC—Causing death by negligence.


Sec 309 IPC—Attempt to commit suicide


Sec 313 IPC—Causing miscarriage without woman's consent


Sec 318 IPC—Concealment of birth by secret disposal of dead body.


Sec 319 IPC—Hurt.


Sec 320 IPC—Grievous hurt.


Sec 351 IPC—Assault.


Sec 362 IPC—Abduction.


Sec 375 IPC —Rape.


Sec 376 IPC—Punishment for rape.


Sec 377 IPC—Unnatural offences.


Sec 497 IPC—Adultery.


Sec 39 Cr. P.C—Every person, aware of the commission of or of the intention of any other person to commit any offence is punishable under I.P.C. shall forthwith give information to the nearest magistrate of police officer of such commission or intention.


Sec 84 IPC—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 what he is doing is either wrong or contrary to law.

20 - Arsenic Poisoning

MAIN SOURCES :

Smelting and microelectronics industries; wood preservatives, pesticides, herbicides, fungicides; contaminant of deep-water wells; folk remedies; and coal; incineration of these products

METABOLISM :

Organic arsenic (arsenobentaine, arsenocholine) is ingested in seafood and fish, but is nontoxic; inorganic arsenic is readily absorbed (lung and GI); sequesters in liver, spleen, kidneys, lungs, and GI tract; residues persist in skin, hair, and nails; biomethylation results in detoxification, but this process saturates.

TOXICITY :

Acute arsenic poisoning results in necrosis of intestinal mucosa with hemorrhagic gastroenteritis, fluid loss, hypotension, delayed cardiomyopathy, acute tubular necrosis, and hemolysis.

Chronic arsenic exposure causes diabetes, vasospasm, peripheral vascular insufficiency and gangrene, peripheral neuropathy, and cancer of skin, lung, liver (angiosarcoma), bladder, kidney.

Lethal dose: 120–200 mg (adults); 2 mg/kg (children).

DIAGNOSIS :

Nausea, vomiting, diarrhea, abdominal pain, delirium, coma, seizures; garlicky odor on breath; hyperkeratosis, hyperpigmentation, exfoliative dermatitis, and Mees' lines (transverse white striae of the fingernails); sensory and motor polyneuritis, distal weakness. Radiopaque sign on abdominal x-ray; ECG–QRS broadening, QT prolongation, ST depression, T-wave flattening; 24-h urinary arsenic >67 micromoles/day; (no seafood x 24 h); if recent exposure, serum arsenic >0.9 micromoles/L ( 7 micrograms/dL) . High arsenic in hair or nails .

TREATMENT :

If acute ingestion, ipecac to induce vomiting, gastric lavage, activated charcoal with a cathartic. Supportive care in ICU.

Dimercaprol 3–5 mg/kg IM q4h x 2 days; q6h x 1 day, then q12h x 10 days; alternative: oral succimer.

19 - organophosphorous poisoning mcqs

1q: a 5 year old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia and hypertension. Which of the following poisons can cause these manifestations ?

a. opium
b. organophosphorous insecticide
c. dhatura
d. organochlorine pesticide

answer b. organophosphorous insecticide

explanation : only opium and organophosphorous insecticides out of the above 4 options cause miosis . it is to be noted that dhatura ( atropine ) and organochlorine cause mydriasis .

organsophosphate poisoning : organophosphate poisons irreversibly inhibit acetylcholinesterase and cause accumulation of acetylcholine at muscarinic and nicotinic receptors .

Muscarinic effects of organosphosphorous poisons are :

1. miosis and blurred vision
2. increased sweating, salivation, lacrimation
3. increased bronchial secretions, bronchoconstriction
4. abdominal cramps, diarrhea, nausea, vomiting
5. urinary frequency and incontinence

Nicotinic effects of organophosphorous poisons are :

1. on striated muscles – twitching, fasciculations, cramps and muscle paralysis
2. on sympathetic ganglia – hypertension and tachycardia

CNS effects of organophosphorous poisons are :

1. anxiety , restlessness and confusion
2. seizures and coma

- this child presents with tachycardia and hypertension which are nicotinic manifestations. Sometimes the presentation can vary due to the muscarinic effect on cardiovascular system which causes bradycardia and hypotension , but this occurs due to severe organosphosphorous poisoning .

This question was asked in the november 2002 AIIMS question paper . 

18 - NIMS FEBRUARY 2009 forensic mcqs

1q: honey comb appearance of the liver is observed in ?

a. putrefaction
b. mummification
c. adipocere
d. autolysis

answer: a . putrefaction .

putrefaction begins internally with the stomach and intestine . the liver develops a honey comb pattern with gas formation and similar changes may be seen in the brain ,most readily if it is fixed in formalin prior to wetting .

check out this link from google books .

click here for other questions with answers from the NIMS february 2009 paper .

17 - AIIMS november 2008 forensic mcqs with answers

1q: What is falanga?

answer beating on the soles of foot with a blunt object

2q:. hydrocution refers to?

a. Drowning in cold water
b. Electrocution in water
c. Post mortem immersion
d. Immersion in boiling water

answer a . drowning in cold water

3q: which of the following is not a constituent of embalming fluid?

a. Phenol
b. Ethanaol
c. formalin
d. Glycerine

answer b. ethanol

4q: Thanatology is study of?

answer death in all its aspects

5q: a man working as a pest killer comes to opd with pain abdomen and garlic odour in breath with transverse lines on nails. posoning is due to?

a. Lead
b. arsenic
c. mercury
d. Cadmium

answer b . arsenic. Garlic odour and aldrich mees lines typically point to the diagnosis of arsenic poisoining .

To view all the 200 mcqs of aiims november 2008 click here

16 - paraphilias - part 7

• Other paraphilias

·

• Autogynephilia describes a man's propensity to be sexually aroused by thoughts or images of himself as a woman (with female attributes).
• 
  
• Asphyxiophilia or hypoxyphilia is when a patient uses hypoxia to achieve sexual excitement; this can be complicated by autoerotic asphyxiation.
• 
  
• Video voyeurs derive sexual gratification from videos, usually of women doing natural acts or women involved in sexual activity.
• 
  
• Infantophilia is a new subcategory of pedophilia in which the victims are younger than 5 years.

15 - paraphilias - part 6

• The Marquis de Sade's life was not an ordinary one. From early on, he was rejected by his parents and moved from one place to another. The Marquis would never gain his father's approval, no matter how hard he worked. His life lacked structure, appropriate discipline, balance, and unconditional love/approval. The young Marquis was exposed to complete self-indulgent behavior lacking any form of discipline while raised by his grandmother, aunts, and uncle. Then he was exposed to extreme corporal punishment while attending prep school with the Jesuits. He was also exposed to deviant sexual behavior in both of these very different settings.
• In theory, one might postulate that exposure to these extreme polarities of behavior, especially during the very crucial formative years, might cause the underdeveloped psyche to integrate the 2. Therefore associating pleasure with pain, hence the deviant masochistic behavior.
• Transvestic fetishism

·

• Over a period of 6 months, heterosexual male patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Typically, patients derive sexual gratification from wearing clothes usually worn by the opposite sex, and patients typically are heterosexual married males (not a DSM-IV-TR criterion).
• Voyeurism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Patients derive sexual gratification from seeing sex organs and sexual acts; scopophilia is a synonym for voyeurism (not a DSM-IV-TR criterion).
• Paraphilia not otherwise specified: This category is included so physicians can code paraphilias that do not meet the criteria for any of the other specific categories.

·

• Scatologia involves making obscene phone calls.
• Necrophilia involves an erotic attraction or sexual interest in corpses. This paraphilia is rare and seldom reported to the police. Patients typically work in mortuaries and funeral parlors. This also involves dangerous situations where the individual could actually acquire infections from the corpse.
• Partialism is sexual interest exclusively focused on a particular body part.
• Zoophilia involves sexual activity with animals (ie, both actual sexual contact and sexual fantasies, higher in psychiatric patients).
• Coprophilia is sexual activity involving feces.
• Klismaphilia is sexual activity involving enemas.
• Urophilia is sexual activity involving urine.
• Masturbation is sexual self-gratification.

14 - paraphilias - part 5

• Donatein was quite young to have been uprooted so many times. He was 10 years old when he was enrolled at the prep school. Although the Jesuits had a remarkable reputation as educators, they were infamous for their practices involving sodomy and corporal punishment. The Jesuits would beat, whip, or flog the young boys in front of an assembled student body to humiliate them. The humility of the beatings, oddly enough, could also be sexually arousing. This practice came to be known as sado-masochistic behavior. As an adult, the Marquis de Sade was unable to be aroused by normal sex, so it appeared that his sexuality was arrested at the infantile anal stage.
• After 4 years with the Jesuits, Donatein was transferred to a military academy upon this father's request. In 1755, shortly following his arrival, Donatein served in the King's light cavalry regiment as a sub leutenant. He was only 15 years old at the time. The young Marquis served in the war and was considered a brave and decisive leader. Unsatisfied with Donatein's success in the cavalry, his father had him placed with a cavalry company commanded by one of the members of the royal family. Donatein's bravery, good looks, and social charm made him a very successful soldier. His superiors were quite impressed by the Marquis; therefore, he was promoted to captain at the young age of 18. Donatein seemed able to impress everyone but his own father. His father never praised his son for his many accomplishments, yet had no difficulty pointing out his shortcomings.
• When the Marquis de Sade returned from the war in 1763, he had his sights set on a particular lady whom he wished to marry. However, his father was opposed to the union. Instead, he arranged for the Marquis to marry her elder sister, Renee-Pelagie de Montrieul. The couple had 3 children, 2 boys and a girl.
• The same year the couple was married, the Marquis de Sade frequently traveled away from home for "business" reasons. While away on his travels, he rented several different maisons around Paris where orgies were held. One particularly disturbing encounter took place between the Marquis and a young prostitute. After he was alone with her, he quizzed the young prostitute about her religious convictions regarding the Roman Catholic Church. When he discovered that she was a faithful Roman Catholic, he began degrading her with inconceivable vile insults.
  
  To the young woman's horror, he proceeded to perform sexually explicit acts on her with the aid of religious objects that were extremely blasphemous and sacrilegious in nature. When the young prostitute refused his request to beat each other with a hot whip, he pleasured himself sexually with a pair of crucifixes. Then he held her at knife point, forcing her to repeat vulgarities in the most blasphemous manner. This resulted in the Marquis de Sade's first imprisonment; however, his lewd and debaucherous behavior would result in numerous other imprisonments during his lifetime. He died in 1814 and was buried in Charenton. Later his skull was removed from the grave for phrenological examination.

13 - paraphilias - part 4

• Donatein's mother was a distant cousin to the Prince de Conde, a junior branch of the royal Bourbon family. She served as a lady in waiting to the Princess de Conde and was a governess to her son, the young Prince de Conde. An early account of Donatein's violent nature involved an altercation between he and his young cousin over a toy. When the young Prince tried to retrieve one of his favorite toys from the grasp of his 4-year-old cousin, Donatein pummeled his cousin with increasing blows of violence. Soon after this incident, the young Marquis was sent to live with his paternal grandmother in Avignon.
• The troubled young boy spent his formative years in Avignon surrounded by female relatives who indulged his every need and enveloped him with sensual affection. Donatein's grandmother and aunts continually doted on the child and indulged every one of his selfish demands. There was no mention of discipline in the boy's upbringing. These actions were only detrimental to the child's development; consequently, his behavior became increasingly unruly. When the Comte de Sade (Donatein's father) received report of his son's unconventional upbringing, the young Marquis was sent to live with his father's brother. The Comte hoped that his brother, Abbe de Sade, would be able to provide a masculine presence and influence that was obviously lacking in Donatein's life.
• Abbe de Sade was a noted author, clergyman, and scholar of his time. He was also very much like his sisters in the sense that he enjoyed the sensual side of life and indulged himself with many pleasures. He was referred to as "sybarite of Saumane" meaning one inordinately attached to pleasure and luxury. Once again the young boy was in an atmosphere that encouraged sexuality and sensual indulgence as an expectation rather that an exception to the rule. During Donatein's stay at his uncle's home, the abbe housed many female companions which included a local prostitute.
• Throughout this period of time in Europe, men and women of the cloth, indulged themselves in various sexual escapades with little remorse. There was rumor of orgies taking place in abbeys and convents, where priests, nuns, prostitutes, and nobles all engaged in debaucherous behavior. Abbe de Sade had a library filled with a genre of literature, and some were pornographic in nature. Donatein was free to read all of the literature in the library at his leisure. After becoming abreast of the ever present debauchery in Donatein's life, his father moved him to Paris where he was enrolled in a Jesuit prep school for young men of nobility.

12 - paraphilias - part 3

• Sometime after this event, he witnessed the Countess and her lover caught in the act by her husband and 2 of his friends. The Count, who was obviously stunned, paused momentarily to plot his course of revenge. In the meantime, the Countess beat all 3 men to a bloody pulp. Leopold had been hiding in the room throughout the encounter, and was discovered by the Countess after gasping in astonishment. Upon discovery, she beat him as well. He made his way out of the room, but was still right outside the door watching should anything else occur. Moments later, the boy witnessed the Count, back in the same room where he had been humiliated earlier, begging for her forgiveness. The Countess looked at her husband and with that same calculating smile, all too familiar to Leopold, gave him a big swift kick.
• Sexual sadists

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the acts in which psychological or physical suffering of the victim is sexually exciting to the patient.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• This variant is named for the activities of the Marquis de Sade (not part of the DSM-IV-TR criterion).

o

• The Marquis de Sade was born in Paris, France on June 2, 1740 and died on December 2, 1814 in Charenton, France. His full name was Donatein Alphonse Francois comte de Sade. The term sadism is a derivative of his name. The Marquis was an aristocrat and an author of violent pornography. The French author's erotic books, mainly written while imprisoned, include Justine, Juliette, and 120 Days of Sodom. The Marquis de Sade regarded criminal/sexually deviant acts as being natural, which was apparent in both his writings and actions. Consequently, his novels were banned into the 20th century.
• The Marquis de Sade's life consisted of numerous acts of cruelty, which were indicative of his total disregard for human life and the law. His acts of extremely violent physical and sexual abuse resulted in numerous imprisonments and consequent escapes. He was also declared insane and admitted to an insane asylum on 2 different occasions. The Marquis was imprisoned or committed to insane asylums for at least 32 years of his life. Most victims of Marquis were young female prostitutes, as well as both male and female employees of his chateau.

11 - paraphilias - part 2

• Sexual masochism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• This variant is named for the activities of Leopold von Sacher-Masoch (not part of the DSM-IV-TR criterion). Sacher-Masoch was born in Lemberg, Austria in 1836. As an author he is most known for his book Venus in Furs. This writing is reportedly based on true events from his life.

o

• Sacher-Masoch's novel is said to be one long masochistic fantasy in which the principle male character desires and encourages his mistress to treat him as a slave. This story appears to parallel his relationship with his wife. He used to plead with her to treat him as a slave, and his outlandish requests would progressively become more demeaning to satisfy his sexual appetite. However, she was not interested in partaking in his deviant self-deprecating fantasies. Eventually they met other partners and parted ways.
• Leopold von Sacher-Masoch was the eldest son of a couple in the town of Galacia, where his father was the Director of Police and his mother was a little Russian lady of noble birth. As an infant, Leopold was very frail and sickly, and not expected to survive. To increase the infant's chances of survival, his parents hired a robust Russian wet nurse who was able to nurse him back to health. Leopold later spoke of the strong bond between the 2 of them. The woman shared strange and melancholy legends about her people with the boy, and he formed a love of the Russians that remained constant throughout his life. He reportedly said that not only did he gain his health from her, but also his soul.
• As a child, Leopold was fascinated by various representations of cruelty. He was especially drawn to pictures of executions, and some of his favorite reading materials pertained to legends of martyrs. At the onset of puberty, he had a recurring dream that he was under the power of a cruel and torturous woman. The term dream is used in this context as opposed to nightmare.
• In the town of Galacia, where Leopold was born, women were said to either rule their husbands or vice versa. At the age of 10, the boy witnessed a sadistic scene that left a permanent impression. The scene involved a female relative from his father's side of the family. This woman was referred to as Countess X. Prior to Leopold witnessing the life-altering event, he was enamored by the Countess and was impressed by her beauty and costly furs. He used to help her with various duties, services, etc. On one occasion, as he was putting on her shoes, he bent down to kiss her feet and she smiled at him and then kicked him. Instead of being hurt, he experienced a perverse sensation of pleasure.