Modern Textbook of Forensic Medicine & Toxicology Putul Mahanta
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1FORENSIC MEDICINE
Section Outline
  • ◆ Introduction and History of Forensic Medicine
  • ◆ Legal Procedures
  • ◆ Medical Law and Ethics
  • ◆ Euthanasia (Mercy Killing)
  • ◆ Identification
  • ◆ Forensic Osteology
  • ◆ Forensic Odontology
  • ◆ Forensic DNA Typing
  • ◆ Thanatology
  • ◆ Autopsy
  • ◆ Mechanical Injury
  • ◆ Firearm Injuries
  • ◆ Regional Injuries
  • ◆ Road Traffic Injuries
  • ◆ Thermal Injuries
  • ◆ Medicolegal Aspects of Injuries
  • ◆ Asphyxial Deaths
  • ◆ Anesthetic Procedures and Death
  • ◆ Starvation Death
  • ◆ Impotence, Frigidity and Sterility
  • ◆ Pregnancy, Delivery, Legitimacy and Paternity
  • ◆ Abortion and MTP Act
  • ◆ Infanticide
  • ◆ Virginity, Sexual Offences and Perversions
  • ◆ Forensic Psychiatry
  • ◆ Postmortem Artefacts
  • ◆ Forensic Serology
  • ◆ Crime Scene Investigation
  • ◆ Medicolegal Importance of People Living with HIV/AIDS
  • ◆ Human Rights, Custodial Torture and Deaths
  • ◆ Techniques in Museum
  • ◆ Forensic Science Laboratory2

Introduction and History of Forensic MedicineCHAPTER 1

Putul Mahanta
LEARNING PLAN
  • ◆ Learn what forensic medicine is
  • ◆ Understand about religious and public attitudes towards autopsy
  • ◆ Know the phylogenesis of forensic medicine in india
  • ◆ Future of forensic medicine
 
WHAT IS FORENSIC MEDICINE?
Forensic or Legal Medicine (Forensic: of or used in Courts of Law) deals with the application of medical knowledge to aid in the administration of justice. Earlier Medical Jurisprudence (Juris means law and Prudentia means knowledge) was used for this discipline, but now Forensic/Legal Medicine has become more common usable (except, perhaps in Scotland!).
Forensic Medicine denotes the branch of medicine that deals with the application of the principles and knowledge of medicine for the purpose of law, both civil and criminal.1
The purpose of this introduction and history on Forensic Medicine and Toxicology is to introduce the fundamental concepts in these disciplines to police officers, lawyers, medical students, pathologist, residents and physicians. The history of this specialty will give some insight into how they evolved.
This is an attempt to discuss Forensic Medicine and Toxicology solely pertaining to the medicolegal investigation of the cases. The contents are intended to lead the medical students, doctors, lawyers and the police officers through the basic knowledge of the subject and the procedures that are needed in the examination of the dead body found under obscure, suspicious or in criminal circumstances. The concise but informative nature of the book is to provide maximum information in simple language, which can be easily referred to and understood.
The subject matter is chosen to cover all of the basic facts of deaths and related issues commonly witnessed during the medicolegal work. An expert of Forensic Medicine is the one who has amassed his knowledge through experience, common sense and scientific interpretation. The secrets of disease or crime are always hidden in the silent soul: “The Dead Body”.4
 
AUTOPSY
Antiststius, the physician, examined the body of Julius Caesar (100–44 BC) and opined that out of 23 injuries; only one injury in the chest was fatal. In 1374 AD, right of holding medicolegal autopsy was given by Pope. But perhaps, the first systemic autopsy was held by Dr Ambroise Pare on the body of King Henry II in 1589.
 
Religious and Social Attitudes of Autopsy6
At that time of Tertullian and Augustine, there were strong religious and social objections to the autopsy. Although in the early years of Christianity, there was no formal church prohibition, the general attitude of church leaders was still unfavorable. Both Tertullian (160–230) and Augustine (354–430) wrote strongly against dissection, apparently more on humanitarian and aesthetic grounds than on any theological basis. Vindician, a physician and friend of Augustine, is quoted in a 10th century manuscript from Monte Cassino as saying, “It pleased the ancient anatomists to examine the viscera of the dead to learn in what way they died, but for us humanities prohibits this”. 2 Wolf-Heidegger and Cetto Singer have concluded that dissections were being done in Italy between 1266 and 1275, and that the earliest dissections were medicolegal in nature.
There were no official church decrees on the subject, but at the Council of Tours in 1163, it was affirmed that “the church abhors blood”. This was interpreted to mean that the clergy could not perform surgery on the living or the dead. Since most physicians did belong to the clergy, this effectively prevented autopsies, but did not absolutely forbid them. In 1299, Boniface VIII forbade the cooking of bodies to separate the flesh from the bones. This had been done to bring home the bones of people who died on crusades. Although the ruling specifically referred to cooking the body, many people interpreted it to forbid any dissection.3
Nevertheless, it was about this time that a few physicians began to dissect and eventually the church's attitude was modified. In 1410, Pope Alexander died suddenly and was autopsied by Pietro D'Argelata. Pope Sixtus IV (1471–1484) issued a bill permitting studies on human bodies by students at Bologna and Padua, and Clement VII (1523–1534) confirmed this. In 1556, Ignatius Loyola was autopsied and stones were found in the kidneys, bladder and gallbladder.4
It, therefore, appears by that time autopsy was fully accepted by the Catholic Church. In fact, one autopsy had been performed in 1533 specifically for a religious reason. According to the New World History, compiled by Oviedo Y Valdes, in 1533 in Espafiola (now the Dominican Republic), a double monster, female twins joined from the region of the umbilicus to a point in the thorax just below the breast, were born. The infants were to be baptized, but the priest was uncertain as to whether one soul or two souls required baptism. The father reported that one would cry while the other was quiet, one might sleep while the other was awake. And so, two baptisms were performed, but the priest was still uneasy. When the infants died at the age of 8 days, an autopsy was done to settle the question. Since two complete sets of internal organs were found, it was decided that there probably were two souls. Chavarria and Shipley, who located and translated this fascinating story, commented that this was perhaps the only postmortem examination ever conducted to study the soul of the deceased.5
Respect for the body was an important part of the Jewish tradition, as the Bible taught that God created man in his image. Handling a dead body made a man unclean for several days. It was emphasized that the body must be treated respectfully and buried promptly. Even for a criminal hanged till death on a tree, “his body shall not remain all night upon the tree, but thou shall in any wise bury him that day”. These laws were interpreted by the rabbis to forbid postmortem dissection, which would be a disgrace to the body. However, it is recorded that about 100 AD, the students of the Rabbi Ismael obtained the body of a young harlot who had been executed and boiled it in order to count the number of bones. They found 252.65
There is one passage in the Talmud stating that if an autopsy would save the life of an accused murderer, it would be permitted. Autopsies were otherwise not approved by Jewish authority until the 18th century, when Rabbi Landau was asked if it were permissible to make an incision in the body of a patient who died of cancer, in order to learn the proper therapy in future cases. He replied that autopsy is a desecration of the dead and is only permissible to save the life of another patient immediately at hand, not some problematic future patient.7 This ruling was apparently maintained by orthodox Jews until the 20th century, when the Knesset, the Israeli parliament, passed a law permitting autopsies under strictly limited conditions.8
Some indications of the popular objections to autopsies may be noted here. In 1538, Guillaume Rondelet (1507–1566), a scientist in Montpellier, autopsied his own infant son and later requested that autopsies be performed on his sister-in-law and his first wife. This is included in a biography, dated 1578, by his pupil Joubert, who comments, “a cette Epoque le public avait 1'anatomie en horreur”.9
Vesalius, who practiced medicine and performed many autopsies, died in 1564 during the return from a pilgrimage to Jerusalem. Many years later, a biographer, Melchior Adam, published a letter allegedly written by Hubert Languet in 1565, stating that Vesalius had been forced to make this pilgrimage as expiation for the sins of murder and impiety. O'Malley is convinced that there is no foundation of fact for this story.10 However, he points out that it may be based on the same rumor referred to by Ambroise Pare, who, writing in 1573, warned against opening a body too soon and noted that “in this century, it happened that a great anatomist … I say great and famous … then a resident in Spain was ordered to open the body of a woman believed to be dead of suffocation of the womb. At the second cut of the razor the woman began to move and show other signs that she still lived … the good master had to leave the country and being exiled, soon after died of grief, which was certainly a great loss for the Republic”.11
Jarcho has called attention to the problems of performing autopsies in Germany in 1670. In a medical periodical of that year, there is an autopsy report with a comment, “the other structures could not be examined because a female relative changed her mind. Our people have a great horror of autopsies and very rarely allow them unless special persuasion has been used.” The editor of the journal added a discussion of the difficulties of obtaining permission and some possible answers to the objections of relatives.12
Popular reluctance for autopsies at a slightly later period is also evident by the fact that, the 1699 ruling of the Republic of Lucca designed to limit the spread of consumption, which included the recommendation of autopsies, had to be revoked because of the citizens’ objections.13 Even today, these attitudes are encountered and further consideration would carry us too far afield.
 
PHYLOGENESIS OF FORENSIC MEDICINE IN INDIA
Many a genius from the pages of ancient Indian history had influenced the Rule of Law. Their word remained an integral part of the Government's functioning.
One such person was Kautilya, who wrote the Arthashastra—the most comprehensive treatise of statecraft of classical times. The book covered numerous topics, e.g. the king, code of law, foreign policy, secret and occult practices and so on. Even after a lapse of more than 2000 years, the master strategist, widely known as India's Machiavelli, continues to rake up the minds of the country's modern day spiritual gurus.14
The first recorded medicolegal autopsy was performed in India by Dr Edward Bulkley on the afternoon of 28 August 1693, when Mr Wheeler, a member of council, See a Customer and Chief Justice of Choultry in Chennai, died on 28 August, 1693.
India's first medical school was established in Kolkata in 1822 and was converted into a 6Medical College in 1835. In the same year, Madras Medical College was also established. In 1857, the first chair of professor of medical jurisprudence was established at Madras Medical College.
The most prominent contribution of India to legal medicine during British period is modern dactylography. It was Sir William Herschel of the Indian Civil Services, who first used this method of identification in 1858. Based on Herschel's theory, Sir Francis Galton of England devised the systemic study and methods of using fingerprints for personal identification in 1892.1
The British government altered method from time to time till 1862, when the Indian Penal Code came into existence. In fact, the foundation of our criminal laws is still Mohammedan law, but it is so altered and added to by our regulations that it ceases reflect its originality.15
The police system of crime investigation was introduced in India in 1861 and the coroners systems in 1871 in the presidency towns of Bombay and Calcutta.1 The Indian Medical Council established in 1933.
The subject of Forensic Medicine has grown from the days when it was taught as part of pathology, to being a complete specialty in itself. However, Forensic Medicine has to advance many miles to keep pace with new developments, and we need the committed efforts of all doctors in this profession to meet the expectations of society.
Presently, the teaching of Forensic Medicine has improved with the establishment and expansion of the academic departments of Forensic Medicine and Toxicology in most of the medical colleges. Postgraduate courses in Forensic Medicine and Toxicology are available in most of the universities. It is hoped that trained medicolegists will be available in India in sufficient large numbers in the districts, around the country very soon.
 
FUTURE OF FORENSIC MEDICINE
As history has shown, Forensic Medicine and Toxicology have made substantial contributions to society across the centuries. We have been, and will continue to be, servants to the continued development of the discipline in our pursuance to give society the very best that they have to offer. We must continue to strive for the highest standards in the practice of Forensic Medicine and Toxicology and in the application of their various subspecialties in the search for the cause and manner of death. The same principle must be applied to our participation in the Clinical Forensic Medicine. It is only through striving to attain these goals that we can best serve society.
Some Forensic Medicine and Toxicology experts argue that more autopsies are performed than necessary. However, recent studies show that autopsies can detect a person's condition that were not suspected when the person was alive, and the growing awareness of the influence of genetic factors in disease has also emphasized its importance. It is important to note that autopsies can also provide peace of mind for the bereaved family in certain cases. Therefore, an autopsy should be encouraged regardless of caste, community and religion upon all unnatural deaths. The key lies in a renewed understanding of Forensic Pathologists, clinicians and hospital administrators about the role of autopsy in health care. The autopsy room should not be seen as the place where sorrow and the specter of death come alive; rather it should be where death rejoices to aid the living.16
REFERENCES
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  1. Wolfe-Heidegger, Cetto p. 367
  1. Proskauer C. The significance to medical history of the newly discovered fourth century Roman fresco. Bull NY Acad Med.1938;34:672–88.
  1. Ullman W.H. Obduziert wurde Ignatius von Loyola. Med Welt.1963;35:1758–63.
  1. Chavarrla AP, Shipley PG. The Siamese twins of Espafiola. Ann Med Hist.1924;6:297–302.
  1. Gordon BL. Medicine among the ancient Hebrews. Ann Med Hist (Series 3).1942;4:219–325.
  1. Rosner F. Studies in Torah Judaism, Modern Medicine and Jewish Law. Department of Special Publications of Yeshiva University;  New York,  1972. p. 136.
  1. Kottler A. The Jewish attitude on autopsy. NY State J Med. 1957;57:1649–50.
  1. Pags A. Petite histoire de l'autopsie anatomo-pathoiogique. Monspeliensis Hippocrates. 1960;3(10):16–24.
  1. Mahanta Putul. The medico-legal autopsy—Its religious and social attitudes. Journal of Indian Academy of Forensic Medicine. 2010;32(2):183–8.
  1. Pare A. Oeuvres completes, Vol 2. Edited by JS Malgaigne, Ailliere;  Paris,  1840. p. 755.
  1. Jarcho S. Problems of the autopsy in 1670. Bull NY Acad Med. 1971;47:792–6.
  1. Castiglioni A. A History of Medicine, 2nd ed. Translated and edited by EB Krumbhaar. Alfred A. Knopf, Inc;  New York,  1947. p. 56.
  1. Kautilya's Arthashastra comes alive for world corporate giants. [cited 2007 Jan 17]; 1(1): (2 screens). Available from: URL:http//www.c2b2bnews.com/kautilya.asp
  1. Tandon MP, Tandon R. The Indian Penal Code. General Principles of Criminal Law. Allahabad Law Agency;  Allahabad:  1989. p. 1–2.
  1. Mahanta P. The medico-legal autopsy its religious and social attitudes. J Indian Acad Forensic Med. 2010;32(2):183–7.