History of Forensic Autopsy

The term Forensics comes from what?

The Latin term forum and was used by Antistius to describe the medical examination of the dead in legal contexts.

The autopsy of Julius Caesar is history’s earliest recorded Autopsy

Conducted by Antistius, a Roman physician, who performed it to determine the cause of death following Caesar's assassination in 44 BC, and revealed 23 stab wounds. The cause of death was determined to be the wound to the chest.

Historical Origins - Roman Justinian Enactments (529-564)

Provided for the regulation of what?

The practice of medicine.

Historical Origins - Roman Justinian Enactments (529-564)

The Characterized function of a medical expert is what?

Assisting the judiciary by impartial interpretation of medical evidence. This is regarded as the highest point of achievement in forensic medicine in the ancient world.

Middle Ages And Renaissance: East Asia (1247)

In the Sixth Century, Chinese physician Chich-ts’si wrote the first known what?

treatise on forensic medicine

The Middle Ages And the Renaissance- Europe

Reports from the fourth and 10th centuries indicate that autopsies was being performed on whom?

Corpses of criminals

Middle Ages and Renaissance- Europe

In the late Middle Ages, the first recorded autopsies were performed chiefly to do what?

Identify causes of suspicious deaths.

Middle Ages and Renaissance- Europe

During the Renaissance the predominant purpose of an autopsy was for what purpose?

Anatomic dissection and academic purposes.

Middle Ages and Renaissance- Italy (1209)

Pope Innocent the Third provided for the appointment of doctors to courts to do what?

Determine the cause of wounds.

Middle Ages and Renaissance- Italy

In 1231, Holy Roman Emperor Frederick the Second issued a decree mandating what in regard to human bodies?

One human body should be dissected at least once every five years for anatomic studies at Salerno; Human Dissections between 1266 and 1275 were of a probable medical-legal nature.

Ancient Greece

Herophilus is known as what?

The father of anatomy

Ancient Greece

Herophilus was believed to have performed the first known what?

The first known autopsies to characterize the course of diseases, and subsequently wrote treaties on human anatomy.

Ancient Greece

Galen (130-210 AD)

What is he best known for?

His systemization and innovation of the Hippocratic medical tradition. He studied anatomy through the dissection of animals, typically pigs and apes.

Ancient Greece

Galen (130-210 AD)

He was the first to do what in correlation to the patient’s affected area of the deceased?

He was the first to correlate patient complaints and symptoms with what was found upon examination of the affected area of the deceased, clinical pathologic correlation.

Historical Origins

Pliny was a Roman author, recorded that the bodies of those who died were examined for what purpose?

Determine Cause of Death

Historical Origins

Who were most likely to determine both the cause and manner of death in Ancient Egypt?

Priests- who were also very well versed in toxicology as well

Historical Origins

Ancient Egyptian texts demonstrate detailed knowledge of what topic?

Anatomy, but it is unclear whether this knowledge of anatomy came from the dissection of human or animal remains.

Historical Origins

Ancient Egypt

The removal of organs provided whom the opportunity to observe the natural and diseased working states?

Embalmers, but because they were considered lower social class, they may not have communicated their findings to the upper-class priests.

Historical Origins

King Ptolemy (367-282 BC)

Established a university and a Library here, where he authorized medical officials to dissect and examine bodies

Alexandria

Historical Origins- Ancient Greece

The ancient Greek system of Medicine was based on the balance of what?

The balance of the four humors- blood, phlegm, yellow, and black bile. The function of internal organs was thought to be limited to the production and circulation of these various humors.

Historical Origins- Ancient Greece

If there was an imbalance in black bile, it was thought that a person had what?

Melancholy

Middle Ages And Renaissance- Italy

Fortunato Fedele, a physician, made a career doing what?

Performing autopsies and testifying in court and published a book in forensic medicine (De Relationes Medicorum) in 1602

The Middle Ages And the Renaissance- Italy

Pablo Zacchias is considered what? and published how many books?

The father of forensic medicine.

Three volumes on forensic medicine. He published three volumes on forensic medicine, published between 1621 and 1651

Middle-Age and Renaissance- Germany

The Bamberg Code (1507), this code authorized the opening of bodies to examine what two things?

Theft and damage caused by wounds.

Middle-Age and Renaissance- Germany

Caroline Code (1553). This code required expert medical testimony to guide judges in cases involving what?

Murder, wounding, poisoning, hanging, drowning, infanticide, abortion, and other circumstances involving injury to a person.

Middle Ages and Renaissance- France

Ambroise Pare (1510-1590) is considered to be the first what?

The first forensic pathologist.

Modern History of Forensic Medicine- East Asia

During Japan’s Edo Period (1603-1868) Coroner Investigations were

Mandatory for cases involving death and unusual incidents

Modern History of Forensic Medicine-

In East Asia, officials who investigated scenes were known as?

Kenshi, who were equivalent to the European coroners.

Modern History of Forensic Medicine- Europe/England/Germany/Italy

In 1788, Samuel Farr wrote a book containing descriptions of findings required for judgment by coroners and courts of law in cases including SA and manslaughter.

Elements of Medical Jurisprudence.

Modern History of Forensic Medicine- Europe/England/Germany/Italy

In 1789, Andrew Duncan began

lecturing on legal and public health

Modern History of Forensic Medicine- Europe/England/Germany/Italy

The Chair of Forensic Medicine was established where?

The University of Edinburgh in 1803.

Modern History of Forensic Medicine-Europe/Italy

In 1761, Anatomist Giovanni Morgagni published De Sedibus (based on hundreds of autopsy dissections) and is credited with establishing the concept of?

Clinical pathologic correlation.

Modern History of Forensic Medicine- Europe/Germany And Austria

The first known medical legal clinic was established where in 1830?

In Vienna, Austria.

Modern History of Forensic Medicine- Europe/Germany And Austria

Carl von Rokitansky performed 30,000 autopsies at which medical school?

The second Vienna Medical School

Modern History of Forensic Medicine- Europe/Germany And Austria

The basics of modern autopsy techniques were developed by which two people?

Frederick Zenker (1825-1898) and Rudolph Virchow (1821-1902) pathologists who contributed significantly to forensic science.

Modern History of Forensic Medicine- Europe/France

The first professional chair in legal medicine was established where and when?

In France in 1794

Modern History of Forensic Medicine in Europe/France

In 1803, a judge required this provision in relation to death investigation.

Judges required the appointment of medical experts who were graduates of medicine and had passed examinations in legal medicine. The first medical-legal clinic was est. in 1840.

Modern History of Forensic Medicine- America

The first recorded Coroner’s Inquest in America occurred in?

Plymouth Colony in 1635

Modern History of Forensic Medicine- America

As early as 1636, The role of coroner transitioned from this to this?

An appointed role to an elected role.

Modern History of Forensic Medicine- America

Dr. J.S. Stringham, began lecturing on legal medicine in New York around what year?

1804.

Modern History of Forensic Medicine- America

In 1813, New York City saw its first chair for what?

Medical Jurisprudence.

Modern History of Forensic Medicine- America

In 1860, Maryland Law enabled the coroner to require this?

The presence of a physician at the inquests.

Modern History of Forensic Medicine- America

In 1868, Baltimore saw the first appointed this?

A physician was appointed to the position of Coroner.

Modern History of Forensic Medicine- America

In 1877, In Massachusetts the first known use of this term was used.

Medical Examiner.

Modern History of Forensic Medicine- America

In 1890, Physicians performing autopsies in Baltimore were referred to this?

Medical Examiners.

Modern History of Forensic Medicine- America

In 1918, New York City established the first true this that replaced this office.

Medical Examiner system, replacing the coroner’s office.

Modern History of Forensic Medicine- America

In 1939, Maryland established the states first office of this?

Medical Examiner’s office

Modern History of Forensic Medicine- America

In 1959, The American Board of Pathology began to offer certification for this

Forensic pathology.

Modern History of Forensic Medicine- America

In 1966, This Association was established

The National Association of Medical Examiners (NAME).

Hospital VS Forensic Autopsy

Hospital Autopsies are also known as what?

Clinical Autopsies

Hospital VS Forensic Autopsy

Forensic Autopsies are also known as this?

Medico-legal Autopsies

Autopsy is derived from the Greek term meaning what?

To see for oneself.

The type of autopsy is determined by these two things?

The circumstances of death, and the setting of death.

Both Hospital and Forensic Autopsies include these four things:

external examination of the body, internal examination of the body, consideration of ancillary procedures (x-rays, toxicology), and generation of an autopsy report.

Hospital VS Forensic Autopsy- Personnel And Setting

What do Hospital Pathologists do?

Deals with Colon biopsies, skin biopsies, and examines other gross surgical specimens, and then looks at them microscopically to determine if they are a melanoma. Mostly in a hospital setting, they can do autopsies there. (not as often).

What do Forensic Pathologists do with regard to autopsies?-

perform forensic autopsies. Some forensic autopsies are performed by hospital pathologists in hospital settings (not often anymore).

A Forensic Pathologist may perform hospital autopsies.

Autopsies can be performed in several locations including:

Hospital morgues, government morgues, funeral homes, or privately owned facilities.

Hospital VS Forensic Autopsy- Authorization for Examination

Hospital Autopsies require what from the Next of Kin

Signed consent from the next of kin

Hospital VS Forensic Autopsy- Authorization for Examination

Forensic Autopsies with regard to next of kin

Do NOT require signed consent from the next of kin. Although notification may be provided to the next of kin.

Forensic autopsies are performed based on this?

Legal jurisdiction governing the operation of medical examiner or coroner offices, as mandated by state or local statutes.

Some forensic autopsies may be subject to what type of objection?

Religious or cultural beliefs, but these objections may be subject to court review.

Hospital Autopsies are subject to limitations or restrictions by whom?

Consenting next of kin, restrictions are noted on the autopsy consent form.

Forensic Autopsies are usually complete but are sometimes limited to these two areas?

External examination, or specific areas of the body such as the head.

Hospital VS Forensic Autopsy-

Scope and Aim of Hospital Autopsies usually pertain to?

Natural deaths occurring in the hospital setting.

Hospital VS Forensic Autopsy- Scope and Aim of Hospital Autopsies

Clinicians use these autopsies to do these things:

1. Determine the COD, 2. Address clinical questions or concerns, 3. Address quality of care, 4. Provide information concerning disease progression, 5. Compare antemortem and postmortem diagnoses. 6. Evaluate the efficacy of therapies and surgical techniques, 7. Protect against false liability claims. 8. further medical knowledge. 9. Provide medical education. 10. potential information regarding inheritable conditions.

Hospital VS Forensic Autopsy- Scope and Aim of

Forensic Autopsies cover a wide spectrum of natural and non-natural deaths including:

Accidents, Slewercides, and homicides.

Forensic Autopsies commonly involve deaths that occur

outside of a hospital setting

Forensic Autopsies can be used to determine the following:

Cause of death, manner of death, document disease and injury for use in legal proceedings, determine the ID of the decedent, collect evidence (toxicology, trace evidence), produce accurate vital statistics, assist with civil and criminal proceedings, public health and safety monitoring (i.e., covid; crib malfunction).

The Components of an Autopsy Consist includes:

Medical Record Review, Identification of decedent, Photography, Radiology, External Examination- (height, weight, eye color, facial hair, tattoos, pitting edema, jaundice, trauma.) Internal examination (Y-shaped incision), toxicology, histology, DNA and evidence collection, specimen retention.

Medical Record Review:

In Hospital Autopsies, Medical Records:

Records should be easily obtained, help determine disease state with regard to the effectiveness of treatments, what clinical questions can be addressed by the autopsy

Autopsy Components:

Medical Record Review in Forensic Autopsies:

Records may or may not be a necessary component of the case, may be requested of the hospital or clinic by subpoena, and are usually not available at the time of the autopsy. Obtaining records may take weeks or longer.

Autopsy Components-

Identification of Decedent- In hospital Autopsies:

Identity is usually known. If identity is unknown, the case should be reported to the coroner/ME, verifying that the name on the autopsy consent form matches the ID tags on the body.

Autopsy Components-

Identification- In Forensic Autopsies:

Establishing or confirming identity is critical; circumstantial identification may be used in certain cases, and scientific methods are ideal.

Autopsy Components- Photography In hospital Autopsies

In Hospital Autopsies- It is often not used at all, may be used to document disease processes for medical education purposes, usually considered optional

Autopsy Components- Photography in Forensic Autopsies

A vital component: every case should include a facial photo with a unique autopsy case number that documents the condition of the body, identifying features, injuries, and the presence of disease.

Forensic Autopsy Photography should include:

The body as received (clothed, with evidence of therapeutic intervention, in a body bag), body cleaned and nude, injuries, scars and tattoos, clothing, jewelry personal effects, pertinent negative photos, select organs. ,

Autopsy Components-

Radiology- In-hospital autopsies are:

Performed during the decedents terminal hospitalization

Autopsy Components-

Radiology- In Forensic Autopsies

Very Common, critical in GSWs, stab wounds, decomposition, and extensive thermal injuries.; helpful in identification: dental comparison, non-dental comparisons such as frontal sinuses and spinal processes; locating orthopedic hardware or medical implants bearing unique serial numbers.

External Examination in Hospital Autopsies

May not be a critical component of the exam, typically only takes minutes to perform.

External Examination In Forensic Autopsies

Often, the most important aspect of the exam may require hours to complete. (i.e., documentation of wounds).

Internal Examination in Hospital Autopsies

Internal examinations are subject to restrictions indicated in the autopsy consent form, often uses the en bloc or Rokitansky method

Internal Examination in Forensic Autopsies

Internal Examinations in Forensic Autopsies are not restricted, may use the en bloc method or the organ-by-organ method, may require special dissections, ex vertebral artery dissection, removal of spinal cord, enucleation of eye.

Autopsy Component-

Toxicology in Hospital Autopsies

Toxicology is infrequently performed in a hospital setting; results of admission urine drug testing may be found in the medical records.

Autopsy Component-

Toxicology in Forensic Autopsies

Toxicology is a critical component; blood is routinely collected, and other samples include vitreous fluid, urine, bile, and sometimes tissue. Specimens should always be retained for possible testing. If the decedent was hospitalized before death, then admission blood samples should be requested for testing.

Autopsy Component

Histology in Hospital Autopsies-

A fundamental part of the examination, includes evaluation of major organ systems

Autopsy Component

Histology in Forensic Autopsies

An optional component, documents disease, dates contusions, dates subdural hematomas, documents soot and gunpowder in and around a gunshot wound, soot in the airway following smoke inhalation.

Autopsy Component

DNA and Evidence Collection In Hospital Autopsies

DNA is NOT often retained

Autopsy Component-

DNA and Evidence Collection in Forensic Autopsies

Should be retained in all cases on collection cards for long-term storage, recovered projectiles, nooses or knives, fingernail clippings, body swabs, pubic and head hair, hair combings, trace evidence (animal hair and fibers), and fingerprints.

Autopsy Component

Specimen retention in hospital autopsies

The College of American Pathologists recommends retention of wet tissue for 3 months after the final report. Paraffin blocks (made for pathology) for 10 years, slides for 10 years and reports for 10 years

Autopsy Component

Specimen Retention In forensic Autopsies

The College of American Pathologists recommends retention of Wet stock tissue (formalin) for 1 year. Paraffin blocks indefinitely, slides indefinitely, photographs indefinitely, and representative tissue suitable for DNA analysis indefinitely.

Death Investigation Systems

Medicolegal Death Investigation

Investigation into a death that is required by law

Forensic Autopsy

Postmortem examination of the body is performed in cases of sudden, suspicious, traumatic, or violent deaths.

Medical Examiner

Usually appointed a forensic pathologist whose job is to conduct medicolegal death investigations and forensic autopsies.

Coroner

Usually elected public official (without specialized medical training) who conducts medicolegal death investigations. Most do not perform autopsies. In some states, coroners must be physicians.

Coroner who do not perform autopsies may do several of the following things:

Hire a forensic pathologist to work in the coroner’s office, and/or send the body to a medical examiner’s office for an autopsy, or send the body to a private facility for an autopsy.

Death Investigation-

Medical Examiner

They are appointed physicians, almost always a forensic pathologist.

Death Investigation- Forensic Pathology

A forensic Pathologist is

A physician trained in medical-legal death investigation and forensic autopsy performance. Either an MD or DO, board-certified and completed a residency in anatomic pathology and/or a fellowship in forensic pathology. They perform autopsies, complete autopsy reports and signs death certificates.

Death Investigation-

Death Investigator

A person responsible for overseeing medical, legal, and death investigations in a given region. They may assist with investigations, conduct scene visits, prepare investigative reports, and request supplemental records.

Report of Deaths

A subset of Deaths require this:

Mandatory reporting to a medical examiner/coroner’s office. Deaths are commonly reported by law enforcement personnel or healthcare providers. Deaths are infrequently reported by funeral homes or family members.

Report of Deaths: Jurisdiction

Upon receiving the report, the office will either assume or decline jurisdiction over the case. If jurisdiction is accepted, the death certificate will be completed by the medical examiner or coroner.

The body may or may not be brought into the office for examination.