What is Forensic Pathology?

Forensic Pathology is that discipline of medicine, which determines through gross external and internal examination, as well as microscopic examination of the tissues of the organs of the body, how diseases and injuries affected the deceased. The process through which such an examination is accomplished is referred to as an autopsy.  During the course of the autopsy tissue samples are taken for toxicoloical analysis the results of which are correlated with the gross and microscopic findings to aid in the determination of the cause of death.  In Forensic Pathology you are not only concerned with the physiologic process by which someone died, but also how the physiologic process was placed in motion.  The process by which how this physiologic process was placed in motion is referred to as the manner of death.  There are five manner's of death: Natural, Accidental, Suicide, Homicide, and Undetermined. Those who die during the course of medical treatment either due to omission or comission are classified as Accidental Death or Therapeutic Misadventure.  Manner of death is determined through the examination of the circumstances leading to the persons death.  Such analysis is accomplished through examination of physical evidence at the crime scene, as well as, police and medicolegal investigative reports, and the medical record.

Forensic Pathology is a part of Forensic Medicine, however, these two terms are not synonymous.  Whereas Forensic Pathology primarily involves the interpretation of autopsy and toxicological findings, Forensic Medicine includes not only these interpretations, but also the collation of these interpretations into the descipline of medical jurisprudence, the legal aspects of medical practice, as well as the ethical, cultural, and moral principles of right and wrong.  In is indeed the integration of ethical, cultural, and moral principles of right and wrong into the discipline of Forensic Medicine that has proven to be foundational to the contentious environment, which on occasion defines the relationship between  coroner's and medical examiner's and attorney generals, prosecutors and law enforcement personnel.  It appears some attorney generals, prosecutors and law enforcement personnel believe coroner's, medical examiners and forensic pathologist are their property, they are to follow their dictates and in the process  have forgotten the role of the coroner and medical examiner is not to provide testimony, which supports the case for the State unless that opinion is objectively reached and has a scientific foundation.  Bernard Knight, noted Forensic Pathologist, Emeratus Professor of Forensic Pathology, University of Wales College of Medicine, UK and former Consultant Forensic Pathologist to the Home Office, UK stated it best when he said, "Perhaps, in the interest of justice, an additional new forensic aphorism should be on the frontispiece: 'If you can't prove it, don't claim it!'"

Some historians have regarded Imhotep (2650-2600 BC) as the first medicolegal expert because he was both chief justice and personal physician to pharaoh Zoser.  He is also regarded as the founder of Egyptian Medicine, as well as author of a medical treatise.  Other historians regard him as the "God of Medicine," the inventor of the healing arts, more than that attributed to Hippocrates.

 

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Imhotep (2650-2600 BC)

Hippocrates (460-377 BC), the ancient Greek physician, is regarded by most as the 'Father of Medicine.'  He allegedly wrote a collection of treatises, which probably consisted of 70 works that were organized into a single work the Corpus Hippocraticum, the first edition of which was published during the reign of emperor Hadrian (117-138) AD.  In his attempt to describe the human body, Hippocrates made use of external observation only.  Autopsies at this time were not permitted as the body of the deceased was regarded as sacred.

Hippocrates the First Physician

Hippocrates (460-377 BC)

Herophilus of Chalcedon (335-280 BC), a Greek physician, is regarded as the first physician to do autopsies on a regular basis, performing some of them in public; hence, he is also thought of as the first anatomist.

Galen of Pergamum (129-200/217 AD) was a prominent Roman physician and philosopher of Greek origin.  Galen developed an interest in anatomy from his studies of the works of Herophilus and Erasistratus and performing anatomical dissections on monkeys, as human dissection was not permitted in Pergamum.  His descriptions of human anatomy endured until Vesalius's printed descriptions and illustrations of human dissections in 1543.  Galen produced an enormous amount of written works, amounting to at least twenty-two volumes in which he summed up more than six hundred years of Greek and Roman Medicine.

Galen of Pergamum

Galen of Pergamum (129-200/217 AD)

It was the Muslim physicians who were responsible for the discovery of infectious diseases and the immune system, advances in pathology, and early hypotheses related to bacteriology and microbiology.  Ibn Zuhr, whose latinized  name was  Avenzoar (1091-1161) was one of the earliest physicians known to perform not only human anatomical dissections but also postmortem autopsies.  He was the first to demonstrate the disease scabies was caused by a parasite, a discovery, which challenged the theory of humorism supported by Hippocrates and Galen.

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Ibn Zuhr, Muslim Persian Physician and Surgeon (1091-1161)

In China, the book entitled His Yuan (Record of the Washing Away of Wrongs) written by Song Ci in 1247 (Song Dynasty, 960-1279) addressed methods to be utilized in the investigation of suspicious deaths.

Song Ci Forensic Medical Expert

Song Ci, China's first Forensic Medical Expert (1186-1249)

Historically, the Coroner's System was established in England in September of 1194.  The first recorded use of the term 'Coroner's Office' was in 925 in which King Athelstane established a 'grant of the coroner's office' to St. John of Beverly.  A description of the Coroner's duties at the time Edward I became King in 1272 as it appears in Blackstone is as follows: "The office and power of a Coroner are also like those of a Sheriff, either judicial or ministerial, but principally judicial....And consist, first, in inquiring, when a person is slain or dies suddenly, or in prison, concerning the manner of his death.  And this must be upon sight of the body; for if the body be not found, the coroner cannot sit.  He must also sit at the very place where death happened and the inquiry must be made by a jury from 4. 5. or 6 of the neighboring towns over which he is to preside.  If any be found guilty by this inquest of murder or other homicide, the coroner is to commit them to prison for further trial and must certify the  whole of his inquisition, together with the evidence thereon, to the Court of King's Bench, or the next assizes.  Assizes refers to an obsolete circuit criminal court, which held periodic sessions, never being held in a fixed location as opposed to the King's Court.

Medicolegal autopsies were first performed in Europe in Bologna in 1302.  Some historians assert our knowledge of anatomic dissection has its origins in the publicly ordered medicolegal autopsies of homicide and suicide victims and or executed criminals in Italy.  For many years, executed criminals were the chief source of anatomical material for medical schools throughout Europe.

The first scholarly works in Forensic Medicine appeared at the end of the 16th century.  The first was written by Giovanni Filippo Ingrassies (1509-1580), a Sicilian physician called "Constitutiones of Capitula Necro Uirisdictiones Negii Promedicatus Officii," in 1564.  French surgeon, Ambroise Paré (1510-1590) wrote a treatise on fatal wounds, entitled "De rapports et des maijens d'embaumer Les corps mortis," published in Paris in 1575.  Ambroise Paré is considered one of the fathers of surgery.  Fortunato Fidele, an Italian physician published a textbook in Forensic Medicine entitled "De Relationes Medicorum" in 1602.  Paolo Zacchias (Paul Zacchia) (1584-1659) was an Italian physician, teacher of medical science, medio-legal jurist, philosopher and poet.  He is stated to have been the personal physician to Pope Innocentius X and Pope Alexander VII.  Zacchias was also legal adviser to the Rota Romana, the highest Papal Court of Appeals and the head of the medical system in the Papal States.  His most well known book  "Questiones Medicina-Legales," (1621-1651) established legal medicine as a topic of study.  Zacchias is regarded as having radically progressed the works of jurisprudence in medicine of his time.   He is also regarded as the "Father of Legal Medicine."  The works of Fidelis (1550-1630) and Zacchias were considered the most important text in legal medicine of their era.

Giovanni Filippo Ingrassia

Giovanni Fillippo Ingrassies, major figure in the history of medicine and human anatomy (1509-1580)

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Fortunato Fidele, Italian physician (1550-1630)

 

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Paolo Zacchias, Italian physician, teacher of medical science, medio-legal jurist, philosopher, and poet (1584-1659)

By the mid-seventeenth century formal lectures in Forensic Medicine were given in Germany by Johann Michaelis (1607-1667) and, thereafter by Johannes Bohn (1640-1718), both of the University of Lepzig.  The first course was believed to have been given at the university in 1642.  Andrew Duncan, Professor in Physiology at the University of Edinburgh, gave the first lectures in Forensic Medicine in Britain.  He established the chair of medicaljurisprudence at Edinburgh.

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Johnnes Bohn (1640-1718)

 

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Andrew Duncan (1744-1828)

In the North American Continent the first records of autopsies being performed were those accomplished by one of the surgeons for the French Explorer Samuel De Champlain in 1603.  The first coroner's inquest in this country was in the colony of New Plymouth, New England in 1635.  In 1637, The Governor of Maryland appointed Thomas Baldridge of St. Mary's to be sheriff and coroner (1638/1639-1641). The first medicolegal application of an autopsy occurred in Maryland on March 21, 1665. Due to the controversies surrounding the Coroner's System in Massachusetts, the Coroner's System was replaced with a Medical Examiner's System in 1877.

The first recognized textbook in Forensic Medicine in this country was by Theodoric  Beck (1791-1855) who published  "Elements of Medical Jurisprudence" in 1823.  This was considered the seminal text in American Legal Medicine for the first half of the 19th century.

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Theodoric Beck (1791-1855)

 In 1815, Dr. Walter Channing was appointed to the first chair in Midwifery and Medical Jurisprudence at Harvard University.  Dr. Frank Draper, Professor of Legal Medicine at Harvard University and Boston's first Medical Examiner, published a textbook in legal medicine in 1905.

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Dr. Frank Draper

 In 1918, Dr. Charles Norris was appointed the first Chief Medical Examiner for the City of New York (1918-1935).  Dr. Norris was a pioneer of forensic toxicology in America.

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Dr. Charles Norris (1867-1935)

 Dr. Thomas Gonzlaez succeeded Dr. Norris as Chief Medical Examiner on September 18, 1935.  He was assisted by Dr. Helpern, Dr. Vance and Dr. Dominick DiMaio all of whom were noted forensic pathologist.  Dr. Milton Helpern, who became recognized as one of the most outstanding Forensic Pathologist of the twentieth century, followed Dr. Gonzalez.  In 1937, Dr. Helpern, along with Dr. Gonzalez and Dr. Vance published "Legal Medicine and Toxicology." which was considered the most important American text in Forensic Medicine during the first half of the twentieth century.  The second edition was published in 1954.  Dr. Helpren was one of the founders of the National Association of Medical Examiners in 1966.  The American Academy of Forensic Medicine was the first recognized national academy in forensic medicine having been established in 1948.  

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Dr. Milton Helpren and Dr. Ralph Miller