2.1: Origin of the Terminology — Forensic Medicine

• The study of prehistoric societies suggests a connection between the advancement of science and medicine and the magic of the sorcerer, shaman, and witch doctor.

• Legal medicine was born as a separate branch of medical discipline on its own merit and has now reached its present professional and academically respected status.

4000-3000 BC

• Existing records confirm an interaction between legal and medical matters and this is to be found in the histories of the Sumerian, Babylonian, Indian, Egyptian, and Assyrian civilizations apart from Chinese and Indian data on Materia Medica which include in them information on many poisons

• It has been accepted widely that the Indus Valley Civilization is much more ancient than written chronicles on Indian history.

3000-1000 BC

• Imhotep (2980 - 2900 BC) — the Grand Vizier is considered as the first medicolegal expert.

  • He was both Chief Justice and the Chief/Personal Physician to Pharaoh Zoster, the ruler of Egypt.

  • He was claimed to be the God of Medicine.

• Code of Hammurabi of Babylon (2000-1000 BC) — the oldest written code of law written by Hammurabi, King of Babylon at about 2200 BC.

  • It is well known for its provision of punishment of physicians found wanting and guilty of improper treatment with the potential for civil and criminal responsibility.

• Code of the Hittites (1400 BC) — which constituted a long table of legal compensation for personal injuries.

1000-50 BC

• Hippocrates (460-355 BC) — the physician of antiquity and the father of medicine, dealt in his teachings with medical ethics, the lethality of wounds, causes of sudden death, etc.

• Aristotle (384-322 BC) — Father of Modern Family Planning, as he advocated population control by inducing abortion before the animation of the fetus.

• Roman Law — most important of the Pre-Christian legal codes.

  • Lex Aquillia — dealt with the lethality of wounds.

  • Tabulae Duodecem — contained a number of provisions of medicolegal significance concerning matters such as competency of the mentally ill, gestation period for the development of the human fetus, euthanasia, eugenics, etc.

• The Amicus Curiae of Roman law — honorary advisors who paid no fees for their expert opinions or advice given.

• Caesarean section surgery — an operation that was advised to save the life of the child and also the solution to the medical problem of inheritance.

• Antistius — the physician who externally examined the body of Julius Caesar, that out of 23 injuries on the body, the one that entered the chest between the first and second rib, was the mortal one.

During the Time of Christ

• Suicide in Jewish law was regarded as abhorrent as there was the belief that the individual who took his own life was possessed by evil spirits and that by taking his life he would pass the evil spirits on to other members of the community.

• In Greece, suicide was considered an act of self-destruction and rebellion against the Gods.

• In Rome, those soldiers who committed suicide were considered deserters, and those criminals who committed suicide to escape punishment were also condemned.

1st and 5th Century AD

• Pliny the Elder — His treatise mentioned about suspended animation, sudden and natural deaths, suicide, etc.

• Justinian Code — prescribed regulation of medical practice and imposition of penalties for malpractice. It also recognized expert testimony. It has been clearly enunciated in the Digest that Physicians are not ordinary witnesses but they give judgment rather than testimony.

5th-10th Century AD

• In the fifth century, Germanic and Slavic people overthrew the Roman Empire in Western Europe.

  • These tribes, Salian Franks, the Alemanni, the Goths, the Vandals, and the Lombards were considered Barbarians and destroyers of culture and civilization, and yet these people were the first to lie down by statute that medical experts should be used to determine the cause of death.

• Wergeld — A blood price paid to the victim by the suspect criminal, or in the case of murder, to the victim’s family and relatives.

• Lex Alemannorum — Gives precise anatomical details of wounds and the reparation given with the situation and gravity of these wounds and orders that medicolegal examinations were to be made for that purpose.

• Charlemagne: In his Capitularies enjoined that the judges should seek a medicolegal opinion from competent experts in cases of wounding, suicide, infanticide, rape, divorce, impotence, bestiality, etc.

11th-12th Century AD

• Frederick II — ordained that, would-be-physicians fulfill the following requirements if they wanted to practice the art of medicine as physicians; the candidate had to be:

  • Aged 21 years.

  • Born legitimately.

  • Studied logic (philosophy) for 3 years.

  • Studied medicine for 5 years according to teaching of Hippocrates, Galen and Avicenna.

  • Served a year’s apprenticeship.

  • Had to pass an examination conducted by his teachers.

  • He would have to take oath to treat the poor for free and visit his patients as required.

12th-15th Century AD

• Hsi Yuan Lu: Contained descriptions of postmortem examinations of bodies and pointed to differences between those injuries caused by sharp and blunt instruments.

• A public inquest was made obligatory in cases of sudden death in England with crowners (now coroners) being appointed for this purpose by the monarchy and entrusted with keeping the King’s please.

• Pope Innocent III (1209) — ordained the appointment of doctors in Law Courts for examination and opinion in case of injuries.

• Hugo De Lucca (1249) — A famous surgeon, was appointed as a medicolegal expert in Bologna, Italy.

• The Pope (1374) through a Bill, allowed autopsy examinations with the penalty of ex-communication being withdrawn from those involved in such examinations.

16th-17th Century AD

• Records of forensic pathology in Europe began in 1507 when a volume known as the Bamberg Code appeared.

• Emperor Charles V issued a more extensive penal code called the Constitutio Criminalis Carolina.

• Michaelis and Bohn held the first formal lectures in forensic pathology at the University of Leipzig, Germany, where students were instructed in natural and violent deaths.

• The achievement of the century is that the Bishop of Bamberg codified medical evidence in all cases of violent deaths in the penal code officially.

• Ambroise Pare: Wrote a treatise on different medicolegal problems including death from various causes, how to differentiate antemortem injuries from postmortem ones, etc. Model Case reports were also incorporated.

• Methodus Testificandi: Dealing with wounds, poisoning, and sexual matters was compiled by Codronchius, an Italian physician of Imola.

• Fortunatus Fidelis of Palermo of Sicily — published a systematic treatise on legal medicine in 4 volumes entitled De Relationibus Medicorum.

17th-18th Century

• Paulo Zacchia — a papal physician, published Quaestiones medicolegales covering not only different aspects of Forensic Medicine but also that of public health and pastoral medicine in the 17th century.

• Valentini — published Pandectae medico-legalese — a work to challenge that of Zacchia.

• The first medicolegal journal was published in Berlin under the Editorship of Uden and Pyl in the latter part of the 17th century.

• Antoine Louis, Chaussier, Mahon, Fodere, Orfila from France, Henke, Mende, and Johan Ludwig Casper from Germany were considered famous medicolegal experts.

  • The latter’s monumental work (1856), entitled Praktisches Handbuch der Gerichtlicvhen Medizin, was published through 9 editions with an English translation in 1861-65.

• Chairs of Professorship in Medical Jurisprudence were established in German, Italian and French Universities in the early part of the 18th century.

• Andrew Duncan became the first Professor in the subject at Edinburgh and gave his first set of lecturers in 1807.

• Sir Robert Christison became a Professor of Medical Jurisprudence at the age of 24 years in 1882.

  • He initially became famous as a medicolegal expert at this time in the Case of Burke and Hare and later produced the first complete British pharmacopeia.

• Trial by ordeal

  • The test of fire: The defendant was required to carry hot coal or iron bars and if his body got burnt, he was declared guilty.

  • The ordeal by water: Here the accused was held submerged in water for some time, and was disproved to be guilty if did not turn unconscious.

  • The poison test: The deadly poisons were forced upon the accused and the slightest discomfort shown by him declared his guilt.

  • Death by compurgator: Parties in both criminal and civil cases could satisfy the demands of the court by swearing to the facts under the Christian oath.

In 19th Century AD

• McNaughten Rule — One of the greatest boons implemented to the mentally unsound English law during this century.

• Alfred Swaine Taylor — The most famous name in English Legal Medicine in the 19th Century.

  • He became a Professor of Medical Jurisprudence at the Guy’s Hospital Medical School in 1834.

  • Alfred Swaine Taylor’s first edition of Principle and Practice of Medical Jurisprudence was published in the year 1865.

    • The book has been revised through several editions by reputed medicolegalists of the period and is still accepted as a classic book on the subject.

2.2: Forensic Medicine in India

• Indian Forensic medicine and its evolution can be perceived through 3250-200 BC in the Indus Valley Civilization, and other treatises on Indian history such as:

  • Manusmriti (3102 BC),

  • Vedic Literatures of Vedic age (2000-1000 BC),

  • Agnivesa Charaka Samhita (700 BC).

• The most recent well-recorded evolutions occurred during 1000-1600 AD.

  • Sushruta Samhita (200-300 AD) and

  • Kautilya’s (Chanakya’s)

  • Arthashastra (300-500 AD).

• The Hindu rulers more or less followed the laws prescribed by Manusmriti and Kautilya’s Arthashasthra, but the Muslim rulers ruled with laws based on Koran, Hadis, and Sara.

• While crimes and punishments remained the same during the Mughal era, unnatural sexual transgressions increased and execution by trampling under an elephant's feet or being thrown to wild animals was also practiced.

• Inquest by Coroner’s system was introduced in Calcutta and Bombay by Coroner’s Act, 1871 with Police systems all over the rest of the country.

• Medical College of Calcutta: The first medical college of the country, commenced in the year 1835.

• Dr. CTO Woodford: The first chair in Medical Jurisprudence was established in 1845.

  • The first Professor of Medical Jurisprudence.

• Dr. Buckley in Madras — held the first postmortem in India in 1663 in a case of suspected Arsenic poisoning.

• The Indian Penal Code — was promulgated by Act XIV of 1860 and thus codified various crimes and punishments.

• Criminal Procedure Code — enacted by the Act XXV of 1861 and Act VIII of 1869 streamlined the criminal procedures.

• Indian Evidence Act of 1872 — codified laws in respect of evidence in case of trials in the courts. After the independence in 1947, new amendments and statutes were added to these Acts.

  • The terminology Medical Jurisprudence changed to Forensic Medicine after independence.

• Dr. Jaising P Modi : The first Indian Physician who handled cases of medico-legal nature provided norms to suit the Indian atmosphere and conditions in crime investigation marking the definite role for doctors, which coined him the title of Father of Indian Forensic Medicine.

  • He also wrote the first Indian textbook Medical Jurisprudence and Toxicology.