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FORENSIC MEDICINE

INTRODUCTION

&

History

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Health & Diseases

Modern science of Medicine
AYUSH Practitioners

Ayurveda,
Yoga,
Unani,
Siddha and
Homeopathy

Other Systems of treatment

Acupuncture
Traditional Methods of Treatment
Shamanic Methods of Treatment
Quackery

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The subject

Medical Jurisprudence:- America, Earlier in India ( Juris= law, Prudentia= knowledge) Legal aspect of Medicine- State laws, medical ethics etc
Legal Medicine:- France, Germany, America
Forensic Medicine:-Forensis= Pertaining to Forum (Law courts)- Forensic Pathology

+ Medical aspect of law ( India, England, Scotland)

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Jurisprudence

Jurisprudence is the knowledge of things divine and human; the science of the just and the unjust.
The maxims of law are these: to live honestly, to hurt no one, to give everyone his due
Justice is the constant and perpetual wish to render every one his due.- Roman Concept

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The Definition

Brothers (1914)

Medical jurisprudence is the science, which treats of the application of medical and surgical knowledge and skill to the principles and administration of law. It comprises all legal subjects, which have medical aspects.

Buchanan (1925)

Application of Medical Knowledge to the administration of justice.

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Defi… Continued

Modi's definition

That branch of medicine, which treats of the application of the principles and knowledge of medicine to the purposes of law both civil and criminal.

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Introduction

Forensic Medicine

Application of medical knowledge in civil, and criminal cases to decide legal issues in courts

Medical Jurisprudence

Is the legal aspect of practice of medicine
Medical Ethics

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Branches of forensic Medicine

Forensic Pathology

Autopsy and related pathological investigations

Clinical Forensic Medicine

Examination of the injured
Examination of Sexual Assault Victims and Accused & other Forensic Aspects of Human Sexuality Cases
Determination of Identity / Age
Forensic Psychiatry

Medical Ethics & Laws applicable to doctors
Toxicology

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From 4000-3000 BC

Records are available which reveal Awareness of law medicine problems in Babylon, India, Egypt, Sumer and China.

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Apollo

A god in Greek Mythology, was son of Zeus and Leto, twin of Artemis and father of Asclepius “The Physician” He is associated with music, Poetic inspiration, archery, prophecy, pastoral life, sun, and medicine. In ‘The Iliad’ he is depicted as the bringer and reliever of plagues.

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Chiron

In Greek mythology, the centaur, Chiron, was wounded by Hercules. Though he was immortal, it is said that he invented medicine in order to heal himself. He taught Asclepius the art of healing, which became the source of all divine medical knowledge among the Greeks. Chiron was also the teacher of the Achilles, who was thought to have had some special medical knowledge.

Achilles�Many depictions of Greek medicine involve battle injuries, especially of the Heroes. In this noted vase painting, Achilles tends to the wounds of Patroclus.

"...But save me. Take me to the ship, cut this arrow out of my leg, wash the blood from it with warm water and put the right things on it - the plants they say you have learned about from Achilles who learned them from Chiron, the best of the Centaurs."-The Iliad of Homer, Book XI

KHEIRON (or Chiron) was the eldest and wisest of the Centaurs, a tribe of half-horse men. But unlike the rest of this tribe he was an immortal god, a son of the Titan Kronos and half-brother of Zeus. Kheiron's mother was the nymph Philyra who was coupling with Kronos when his wife suddenly appeared on the scene. To escape notice he transformed himself into a horse, and in this way sired a half-equine son. Some time later when a tribe of Kentauroi (or Centaurs) were spawned on Mount Pelion by the cloud nymph Nephele, Kheiron and his daughters took them into their care and raised them as their own.

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Asclepius

Images of Asclepius are generally recognizable by his beard and staff with a single snake. In this image, he is accompanied by his small, mysterious attendant, Telesphoros. One of the earliest Greek gods of healing. Healers and those in need of healing invoked his name in prayers and healing ceremonies in temples as well as at home.

Marble statue in the Louvre. Engraving by Jenkins (London, 1860).

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Hygieia

The goddess Hygieia (‘Health’), the daughter of Asclepius, was considered a guardian and personification of health. The word “ Hygiene” is derived from her name.

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Statuette of Imhotep in the Louvre

Imhotep was the physician to Egyptian King Djoser and lived in about 2600 BC. He was worshipped as a god of healing after his death, and temples were built during Greco-Roman times. He was also the chief Justice, Chief magician, Chief Minister and grand vizier.

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Code of Hammurabi between 1500 BC to 2500 BC

Depicts a regular, recognized medical profession existing 4,000 years ago that attempted at least minor surgery, observed its legal responsibility, and operated on a government controlled sliding fee schedule, all based on the social status of the patient.

THE rich lands between the Euphrates and Tigris rivers, Mesopotamia, now a part of Iraq, frequently have been called “the cradle of civilization”. Contemporary with Egypt, , there were organized communities in the twin valleys as early as 6,000 years ago, with evidence of the existence of physicians as early as 3,000 B.C. When Mesopotamian peoples began to record the happenings of their day on clay tablets or stone. Medicine was a well-recognized profession.

Unlike the case in Egypt, the peoples, languages and governments of Mesopotamia underwent many changes throughout the years during which ancient civilization flourished there. Although various groups such as the Sumerians, Akkadians, Amorites, Assyrians Elamites, and Chaldeans, Paraded across the historico-political stage of this ancient land, the ancient indigenous culture prevailed and absorbed each group of newcomers. In spite of political vagaries, there was basically one Mesopotamian civilization, which is often loosely called Babylonian, Social, religious, and way-of-life patterns varied title, and the practice of the healing arts seems not to have changed considerably throughout the millennia. In ancient Mesopotamia, the basic concepts concerning disease and its treatment were apparently religious. Seals of Sumerian physicians, at least 5,000 years old and ancient Sumerian prescriptions are known. Also, there is a rather extensive documentation on Mesopotamian medicine written in cuneiform script on clay tablets. However, one of the oldest documents, and one of significance to medicine, is the Code of Hammurabi. This is one of the oldest known law collections, promulgated by the Babylonian King Hammurabi, toward the end of his reign. There is no agreement among authorities as to the time of Hammurabi’s reign. Dates as early as 2123 B.C. and as late as 1686 B.C. are given. Therefore, the origin of the Code can be placed only in the general area of 2000 B.C. obviously it is a codification of much older laws and customs. This extremely interesting document, preserved on a pillar of black diorite standing now in the Louvre, in Paris, France deals with all phases of economic and family life in ancient Mesopotamia. Of its 282 paragraphs, 11 refer to the practices of physicians and veterinarians. Several substantially similar translations are available. Excerpts of one by Charles Edwards, of London, paragraphs 215-224, follow;

�“If a doctor has treated a Freeman with a metal knife for a severe wound, and has cured the Freeman, or has opened a Freeman’s tumour with a metal knife, and cured a Freeman’s eye, then he shall receive ten shekels of silver.�“If the son of a plebeian, he shall receive five shekels of silver.�“If a man’s slave, the owner of the slave shall give two shekels of silver to the doctor.�“If a doctor has treated a man with a metal knife for a severe wound, and has caused the man to die, or has opened a man’s tumour with a metal knife and destroyed the man’s eye, his hands shall be cut off.�“If a doctor has treated a slave of a plebeian with a metal knife for a severe wound and caused him to die, he shall render slave for slave�“If he has opened his tumor with a metal knife and destroyed his eye he shall pay half his price in silver.�“If a doctor has healed a Freeman’s broken bone or has restored diseased flesh, the patient shall give the doctor five shekels of silver.�“If he be the son of a plebeian, he shall give three shekels of silver.�“If a man’s slave, the owner of the slave shall give two shekels of silver to the doctor.�“If a doctor of oxen or asses has treated either ox or ass for a severe wound, and cured it, the owner of the ox or ass shall give to the doctor one sixth of a shekel of silver as his fee.”

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1850 BC- The earliest record of the first murder Trial that occurred in Sumer was discovered through a clay tablet found recently.

NEW YORK. March 14 (Special) 1950 . — American archaeologists have dug up in Nippur (Iraq) a

clay tablet which gives an account of a murder trial 3800 years ago. ' Legal' experts in New York said yesterday the trial, which was the oldest on record, was remarkable because this ancient civilisation used a modern democratic process of law similar to that used to-day. All evidence The tablet, written In cuneiform script, gave all the evidence of a case, ap parently in 1830 B.C. Three men murdered a high Temple official. The case was tried before a Citizens' Assembly'. where attorneys prosecuted for Fix this text the crown and conducted defence. The three defendants were sentenced to death, and the wife of the murdered man, who had been named as an accomplice was acquitted on the grounds of lack of motive and not having been at the scene of the crime. The three men were symbolically executed in front of the dead man's chair.

1850 BC: The Earliest Known Legal Decision

A clay tablet reveals the case, in 1850BC, of the murder of a temple employee by three men. The victim's wife knew of the murder but remained silent. Eventually, the crime came to light and the men and woman were charged with murder. Nine witnesses testified against the men and woman and asked for the death penalty for all four. But the wife had two witnesses which told the court that she had been abused by her husband, that she was not part of the murder and that she was even worse off after her husband's death. The men were executed in front of the victim's house but the woman was spared.

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Manu Smriti / Samhita�(Laws of Manu) (circa 500 BC)

Various eugenic and public health provisions are laid down.

The drunk, insane, hungry, thirsty, fatigued and those with defective sense organs were not permitted to be witness in the court, Statements of children, old men, diseased persons and the weak minded were not to be relied on since they often speak falsely when giving testimony, use of damaging medical plant was a punishable offence. Many sexual matters were brought under the law. At this time Indian hemp was used for drugging.

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SHUSRUTA – SURGEON OF ANCIENT INDIA SUSHRUTA -700-400 BC

His book Shusruta- samhita, or, “The Collection of Shusruta.” is mainly devoted to surgery, but deals with all aspects of medical practice including ethics. His reputation as a surgeon is recognised all over the world

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Hippocrates 540-460 BC

Was born in the Island of Cos in Aegean sea. He is called the father of modern science of medicine, who founded the first medical academy and is credited with code of medical ethics- “The Hippocratic Oath” He described many aspects of health care including relative seriousness of wounds on different part of body, average period of pregnancy, malingering, lead poisoning etc.

Relative seriousness of wounds on different part of body, average period of pregnancy , malingering , code of medical ethics, lead poisoning. Etc are described by him.
His founded the first medical academy
Hippocratic Oath

Soranus of Ephesus, a 2nd-century Greek gynecologist,^[9] was Hippocrates' first biographer and is the source of most personal information about him. Information about Hippocrates can also be found in the writings of Aristotle, which date from the 4th century BC, in the Suda of the 10th century AD, and in the works of John Tzetzes, which date from the 12th century AD.^[5][10]

Soranus wrote that Hippocrates' father was Heraclides, a physician, and his mother was Praxitela, daughter of Tizane. The two sons of Hippocrates, Thessalus and Draco, and his son-in-law, Polybus, were his students. According to Galen, a later physician, Polybus was Hippocrates' true successor

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Hippocratic Oath (Ορκος) is perhaps the most widely known of Greek medical texts.

Little is known about who wrote it or first used it, it is estimated to have been written in the 4^th century BC. Medical profession throughout the world now attribute it to Hippocrates.

12^th Century Byzantine

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Greek physicians are said to have performed autopsies 2,500 years ago.

Roman physician called Antistius, examined the body of Julius Caesar in 44 BC.

Julius Caesar July 13, 100BC to March 15, 44BC

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Dioscorides

Was a Greek physician born in first half of first century. He traveled extensively seeking medicinal substances and wrote five books known in Latin as De materia medica, dealing with the preparations, properties and testing of drugs and poisons. These books formed principal source of medical knowledge for next 1600 years

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Galen 131-201 A.D Was born in Pergamos in Asia Minor(Turkey). After receiving medical training in Smyrna and Alexandria, he gained fame as a surgeon to the gladiators of Pergamos. He was eventually summoned to Rome to be the physician of the Emperor Marcus Aurelius. Galen spent the rest of his life at the Court writing an enormous corpus of medical works. His books were used by medical students till middle ages

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AD 117-138- During rule of Hadrian, the medico legal issue of Prolonged pregnancy and legitimacy was resolved by physicians and philosophers, maximum period of pregnancy – 300 days.

Hadrian -14^th Emperor of Rome

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529- 564 AD Emperor Justinian in his codes and instructions regulated the practice of medicine and surgery and established the function of medical expert witness for legal procedures

Justinian the Great, was Byzantine Emperor from 527 to 565 AD.

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Caduceus With its two intertwined snakes grasping a staff was adopted by Indian Medical Association and many other medical bodies as the "ancient" symbol of their profession. But in the ancient world, the caduceus was a symbol of Hermes, the Roman Mercury, who was primarily a messenger god linked with commerce.

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1200-1250- In China a manual was prepared to aid in the investigation of deaths.

he Chinese developed the first known nonmedical system of death investigation about 221 B.C. These were civil servants sent to investigate a corpse found under suspicious circumstances. Though it is not proven, this might be a link to the beginning of the English coroner system that is still in place today. The Chinese were very adamant and careful regarding attempts to establish time of death. However, even they refrained from attempting to pinpoint time of death to any window narrower than a day or two. Much of this process was more about tracking down roving bands of bandits who committed murder. The Chinese did not use physicians often in their ancient homicide investigations, but it appears they developed a fairly good system by using human decay factors combined with seasonal changes in temperature. These ancient Chinese homicide investigators apparently had a fairly accurate system and they understood the importance of including environmental changes in the process.

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Paracelsus -Phillipus Aureolus Theophrastus Bombastus von Hohenheim 1493 to 24/9/1541

“All substances are poisonous. The right dose differentiates a poison from a remedy” Paracelsus German born Swiss physician & alchemist also laid the concept of modern toxicology.

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1507 AD- The penal code of the Bishop of Bamberg in Germany officially recognised forensic medicine as a separate entity. Medical evidence was required in all cases of violent death.

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1532 AD Carolina (The Constitutio Criminalis Carolina) enabled Europe to obtain medical testimony to guide Judges in cases of murder, wounding, poisoning , hanging, drowning, infanticide abortion and other injuries. It allowed medico legal autopsies and gave forensic medicine its first sound legal basis apart from helping to make it a separate discipline

The Constitutio Criminalis Carolina (sometimes shortened to Carolina) is recognised as the first body of German criminal law (Strafgesetzbuch). It was also known as the Halsgerichtsordnung (Procedure for the judgment of capital crimes) of Charles V.

The Carolina was agreed in 1530 at the Diet of Augsburg under Holy Roman Emperor Charles V and ratified two years later at the Diet in Regensburg (which was judicially a Hoftag, an informal meeting), at which point it became law. It predominantly covered civil law alongside criminal law. Under the terms of the Constitutio Criminalis Carolina, actions such as murder, manslaughter, robbery, arson, homosexual relations and witchcraft were henceforth defined as severe crimes. In particularly the Carolina specified that those found guilty of causing harm through witchcraft should be executed with fire, laying the foundation for the mass witch trials between 1580 and 1680. It was also the basis for the use of obtaining confessions by torture.

The aim of the Constitutio Criminalis Carolina was to unify the legal system of the Holy Roman Empire, and thereby put an end to the penal jurisdiction which had until then varied haphazardly between the Empire's states. The Carolina succeeded in this despite a severability clause under which the Carolina only had subsidiary importance to the particular laws of the Imperial Estates. This severability clause was necessary to secure the assent of the Imperial Estates, which wanted to hold on to their own legal and legislative powers. Nevertheless the severability clause did not detract from the Carolina's unification of the legal system and its reformatory effect on criminal law was indisputable.

Further historical importance of the Constitutio Criminalis Carolina arises from the fact that this was the first adoption of the canonical Italian legal institute of the inquisition. Earlier criminal law only dealt with accusations of the victim of the crime without making inquiries of its own. The inquisition gave the court the chance to examine a case on its own accord and to find a judgement basing only on facts without being restricted by the interests of the parties.

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The tradition of addressing surgeons as Mr or Miss is thoughtto have its origins in the days of the unqualified barber surgeonswhose shaving skills with the blade had naturally helped themcarve out a career in surgery. King Henry VIII granted a royalcharter to the company of barbers and surgeons in 1540.

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1602-

First great work on forensic medicine by the Italian Physician Fortunato Fedele was published. It was in 4 volumes. Though it contains a lot of superstitions of his time but the nature and range of questions that he covers is surprisingly modern.

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1621 AD- The greatest of the early works (Medico legal questions) came from Paulus Zachhias of Italy, the most famous name of legal medicine. The work was in 7 volumes & is remarkable when one remembers that the study of anatomy had just begun and when surgery and chemistry were still rudimentary.

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Giovanni Battista Morgagni-1682 to 1781- Italian Physician. First to perform systematized autopsy around 1750 but without extraction of viscera. He In 1769 published the first comprehensive pathology Tex book by the name 'The seats and causes of diseases investigated by anatomy.

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Mathieu Joseph Bonaventure Orfila�24/4/1787 – 12/3/1853

He was born in Spain. His initial medical education was in Valencia & Barcelona followed by in Madrid & Paris. In 1819 he was appointed a professor of medical jurisprudence in Paris. Apart from five major works he published many other papers and received many state awards. Orfila is rightly called father of Toxicology

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Karl Freiherr von Rokitansky�19/2/1804 – 23/7/1878

Austrian pathologist. He was the first to develop an orderly autopsy (dissection) protocol. He described many syndromes, established pathology as a separate discipline, and the New Vienna Medical School a world class centre .

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Dr. R.L.K. Virchow (Rudolf Ludwig Karl Virchow)�13/10/1821 – 5/9/1902

A German doctor, pathologist, researcher, anthropologist, public health scientist, and a politician Virchow is one of the greatest name in medical sciences of all times. In 1893 he developed and described in detail his autopsy protocol. He also coined many medical terms including hyperplasia and ischaemia.

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Hist. Continued

1650- Michaelis in Germany gave first systematic course of lectures in Forensic medicine in the University of Leipzig.
1720- Professorship of legal medicine was founded in Germany.
1788- Professorship of legal medicine was founded in France.
1807- Great Britain began to include forensic medicine in medical education with first chair in University of Edinburgh. Andrew Duncan was first incumbent

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First Chair In India

First chair of Medical Jurisprudence was created in 1845 in Calcutta medical College and Dr. CTO Woodford was the first Professor. practitioner and coroner of the city, was appointed as first professor in 1857 A.D.

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