Forensic Medicine

FORENSIC MEDICINE, a medical discipline aimed at the study and resolution of various questions arising in legal practice, questions which can be resolved with the help of medical and, in general, natural-scientific knowledge. The necessity of clarifying such questions in legal practice is apparently as old as law itself, and with the emergence of legal relations, there also appeared a need for "knowledgeable" persons who could resolve the questions that arose with their knowledge in the field of medicine. The ever-increasing need to involve physicians for the resolution of special questions in criminal and civil cases also significantly contributed to the development of forensic medicine, especially from the beginning of the 16th century. Individual indications of the invitation of knowledgeable persons for the resolution of doubtful questions can be met even in deep antiquity. Thus, in the books of Moses, there are indications about the examination of lepers by priests, who were at that time among the Israelites, and by physicians. In later periods, there are no definite indications of the invitation of physicians to assist justice, although some branches of medicine were already sufficiently extensive. Here we encounter the influence of legal norms on the development of forensic medicine. Among ancient peoples—Jews, Greeks, Romans, almost until the time of the emperors, and among the Germans—infanticide and the expulsion of the fetus were not considered crimes. Murder and various bodily injuries were not prosecuted by state authority, but prosecution was left to the interested party. From the times of the Roman Republic, there is already more detailed information about the invitation of physicians to establish, for example, the immediate cause of death. According to the testimony of Suetonius, the physician Antistius was invited privately to the body of the murdered Julius Caesar, who, having examined Caesar's corpse, stated that of the 23 wounds discovered by him on the body, the second, which penetrated the chest cavity, was fatal. Later, Galen already pointed out the difference between the lungs of those who had breathed and stillborn infants. To him also belongs the first work on feigned diseases and their recognition. The requirement of medical information in judicial cases is established for the first time by the Code of Justinian regarding the examination of pregnant women who had committed crimes. The examination was entrusted by the court to midwives, who were the first forensic physicians. The determination of age, mental illness, dementia, unconsciousness, etc., was left to the judges. Among the Germanic tribes in the 6th century, one can find mention of specific punishments for murder and bodily injuries. But physicians were not yet involved for conclusions in such cases, and all questions were resolved by judges, and then, on a par with them, by clergy, although later laws (the Law of the Alamanni) definitely state that when judging injuries, the opinion of a physician should be required. The development of canon law, the spread of views on crime as a sin, and the prosecution of crime by the state also cause a greater need for legal and medical information for the determination of the corpus delicti and the measure of punishment. From the times of canon law, information has also reached us about the invitation of physicians to judicial proceedings. In 1209, a thief who had stolen valuables in a church was killed by a crowd. By the order of Pope Innocent III, a physician was invited to resolve the question of whether a certain person could have caused the thief's rapid death with a blow from a spade. In 1311, Philip the Fair in France introduced the institution of surgeons—chirurgiens jurés du roi—who were required to provide conclusions on special questions arising in court. In obstetric cases, this duty was performed by midwives—matronnes jurées. In Italy, somewhat earlier, physicians began to be accepted into city service, obligated to monitor the sanitary condition of the city and provide conclusions on medical questions in court.

From the 14th century, the development of natural science and medicine proceeded with faster steps. In 1315, Mondino de Luzzi performed the first public dissection of two female corpses at the University of Bologna. The 15th and 16th centuries already produced a number of brilliant anatomists—Vesalius, Sylvius, and others. By this time, the development of various branches of medicine, including forensic medicine, sometimes allowed physicians to substantiate their conclusions in judicial cases with considerable confidence. The development of forensic medicine was also facilitated by the development of new forms of legal relations. At the beginning of the 16th century (1507), the criminal code of the Bishop of Bamberg appeared—Constitutio criminalis Bambergensis—and in 1532, the code of Charles V—Constitutio criminalis Carolina. In the code of Charles V, it was proposed for the first time that the court mandatorily summon physicians to resolve various questions in cases of abortion, secret births, murder, suicide, infanticide, poisoning, medical errors, and legal capacity. Detailed instructions were also given on the performance of the examination of dead bodies. The code of Charles V recognized witchcraft and sorcery, for which burning at the stake was prescribed. The requirements imposed by the code on physicians naturally caused the latter to pay corresponding attention to forensic medical questions, which was reflected in the appearance of works devoted to forensic medical research. In 1550, the treatise of the physician Weyer (De praestigiis Daemonum) was published, in which he argued that sorcerers and witches were simply mentally ill people and rebelled against their executions. The Chinese have the collection Xi Yuan Lu (1248), written by the chairman of the criminal court, which sets out information about violent death, the examination of corpses, the differences between antemortem and postmortem injuries, etc. At the end of the 16th century, 50 years after the publication of Constitutio Carolina, Ambroise Paré released the first forensic medical treatise—Tractatus de renunciationibus et cadaverum enbammatibus—where forensic medical questions were also analyzed: signs of virginity, various types of death of newborns, fatal wounds. A more substantial development of forensic medical questions belongs to the Italians. In 1601, the Palermo professor Fortunato Fedele released the first chronological manual on forensic medicine, De relationibus medicorum, in quibus ea omnia, quae in forensibus ac publicis causis Medici referre solent, plenissime traduntur, and 20 years later, the personal physician of Pope Innocent IX, Paolo Zacchias, published his manual Quaestiones medico-legales. In particular, Zacchias, when examining disputed mental states, often surprises with the accuracy.

With the soundness of his judgments. He knew that mental disorder is revealed not so much by speech as by the actions of the patient. In the works of these authors, scientifically grounded data are intertwined with fantastic or superstition-based assertions. They, for example, believed that monsters are born from intercourse between humans and animals or between humans and devils. At the end of the 18th century, Morgagni's work 'De sedibus et causis morborum' is known, as well as other works on the mechanism of death from drowning and hanging, partly already with experimental data. The further development of Forensic Medicine was facilitated by the works of German scientists. In 1779, Eschenbach proposed separating Forensic Medicine from hygiene. In the second half of the 17th century, Rayer and Schreyer proposed the lung test for establishing the live birth of an infant, which had significant consequences in cases of infanticide. Welsch and Bonn, with their indications of the necessity in some cases for complete forensic medical autopsies, contributed to the fact that in the 18th century, in individual German states, forensic medical autopsies became mandatory. The end of the 17th century also marks the first public reading of forensic medical lectures by Prof. Michaelis in Leipzig. In the 18th century, forensic medical studies by Valentin, Alberti, Zittmann, Richter, and others provided much new information about skull injuries in newborns during difficult births, defects in skull ossification and skull fractures, the spontaneous cessation of bleeding from an untied umbilical cord, births involving falls, etc. The doctrine of fatal injuries was reworked again by Bonn, Teichmeyer, and others. But even this time was not yet free from various superstitious influences. Teichmeyer, for example, admitted that sexual impotence could be caused by spells, and Hoffmann in 1716 had to prove in court that the death of three people was caused by coal fumes, and not by evil spirits. The 19th century was marked by progress in various fields of knowledge, and Forensic Medicine began to be based on strictly scientific data. The introduction of public legal proceedings had a great influence on the development of this discipline. In connection with this reform, which constituted an entire epoch for Forensic Medicine, the accumulation of knowledge and observations in the field of Forensic Medicine proceeded rapidly. In France, where public legal proceedings were introduced earlier than in other countries, Forensic Medicine brought forward a number of major representatives, such as Orfila and Devergie, who redeveloped the doctrine of violent death, cadaveric changes, and poisoning. In other countries, with the reform of legal proceedings, the necessity and importance of a physician in the judicial process also became clear, and in various countries, such authorities in the field of Forensic Medicine as Casper, Taylor, Maschka, Tardieu, Simon, and others emerged, whose works and manuals on Forensic Medicine have not lost their value to this day. Various names were proposed for forensic medical science; Bonn (1690) was the first to call it forensic medicine. Later, Daniel proposed the name 'state medical science'. Especially among the English, one can still encounter the name 'medical jurisprudence'. The expansion of the field of activity of Forensic Medicine in the second half of the 19th century and the significant expansion of the discipline itself is associated with the names of such scientists as Hofmann, Strassmann, and Kratter in Austria and Germany; in France — Brouardel, Lacassagne, and Coutagne, who produced a whole series of classic monographs on forensic medicine; in England — Taylor; in Italy — Lombroso and Tamassia. In Russia, from pre-Petrine times, there are known individual examples of involving physicians in the examination of injuries and diseases. By order of Ivan the Terrible, Prince Andrei Ivanovich, suspected of feigning illness, was examined. Under Mikhail Fyodorovich, Maria Khlopova, who was intended to be his bride, was examined by a physician. The reason for the examination was a statement by the Saltykovs that Khlopova was suffering from an incurable disease. The court physicians Valentin and Balsyr, having examined her, found no disease, and the Saltykovs were severely punished. The official appearance of forensic medical regulations dates back to 1716, when the Military Articles of Peter I appeared, Article 154 of which states: 'it is necessary that as soon as someone dies who was in a fight and was beaten, stabbed, or slashed, physicians should be appointed to dissect the dead body and truly investigate what the cause of his death was, and they must submit a certificate about this to the court in writing'. Forensic medical examinations, as we can see, appeared in Russia significantly later than in the West, and at first were limited only to corpses, but soon were extended to living people as well. Somewhat later (1737), an order followed 'on the maintenance of physicians in prominent cities', who were also obliged to perform forensic medical examinations. In 1797, medical boards were established in provincial cities, which were also entrusted with forensic medical duties. In 1803, the Medical Council was established, which also served as the highest forensic medical authority. In 1864, public legal proceedings were introduced in Russia. The Judicial Statutes prescribed that courts involve physicians in legal proceedings. The teaching of Forensic Medicine in Russia can be considered to date from the time of the opening of the first Russian university in Moscow (1755), where Dr. Erasmus lectured on the foundations of 'medical-judicial science'. The absence of public legal proceedings, for quite understandable reasons, had a retarding influence on the development of Forensic Medicine, but nevertheless, the appearance of universities with the teaching of legal sciences in them, the transformation of medical schools where the corpses of those who died suddenly were dissected, and especially the reading of public lectures on Forensic Medicine starting in 1799 at the Moscow and St. Petersburg medico-surgical schools, moved the development of this discipline forward in Russia as well. With the founding of other universities, forensic medical departments began to open there as well. The newly opened departments were initially staffed by scientists invited from abroad, familiar with the latest achievements of science in the West, but little familiar with practical work in Russia and, consequently, detached from it, which also affected the training of qualified forensic medical personnel. At the beginning of the 19th century, individual manuals on Forensic Medicine by Russian authors already appeared: Thiele (1826), Gromov (1832), and Yanikovsky (1845). The 'Forensic Gynecology' by Merzheevsky, published in 1878, was a solid manual for that time with rich casuistry. From 1865, the journal 'Archive of Forensic Medicine and Public Hygiene' (St. Petersburg) began to be published. Practical work in Forensic Medicine was carried out by forensic physicians who were under the jurisdiction of the Ministry of Internal Affairs, whose rights and duties were determined by the Code of Criminal Procedure. In addition, many administrative duties were imposed on district and city forensic physicians. At the end of the 19th and the beginning of the 20th centuries, a whole series of major scientists and practitioners emerged in Russia who contributed to the development of this discipline in our country — Pelikan, Neiding, Gvozdev, Chistovich, Ergard, Grigoryev, Obolonsky, Ignatovsky, Minakov, and Bokarius. Developing in parallel with the growth of various branches of medicine, the achievements of which were immediately reflected in forensic medical practice, forensic medicine emerged as an independent, separate medical discipline. Questions arising in legal practice can concern the most diverse branches of medicine, which in turn places high demands on Forensic Medicine workers in terms of their general medical and natural-scientific training. Using the achievements of various medical disciplines to solve a number of questions, Forensic Medicine includes a number of branches that do not belong to any other specialties and have been scientifically developed by prominent forensic physicians. These include: the study of cadaveric phenomena, putrefactive changes, the examination of material evidence, violent death (murder, infanticide, suicide), the determination of identity, rape and molestation, etc. Those branches of Forensic Medicine that touch upon clinical disciplines: surgery (injuries), gynecology, obstetrics, urology (sexual expertise), etc., receive a completely different treatment depending on the demands placed by legal practice. If injuries interest a clinical surgeon from the point of view of diagnosis and treatment, then for a forensic physician, for example, the determination of the instrument with which the injury was inflicted, the severity, and the age of the injury received are of greater importance; in the case of gunshot wounds — the determination of the direction of the bullet track and the distance from which the shot was fired. The loss of working capacity caused by an injury, and a whole series of other features that have almost no significance for a clinician, are of great value to a forensic physician. Over time, some branches of forensic medicine have separated into independent disciplines: forensic psychopathology, toxicology, etc.

At present, Forensic Medicine includes the following sections: 1) general, including the formal legal norms of this discipline (rights and duties of experts, legislative provisions in the field of Forensic Medicine, preparation of forensic medical documents, etc.); 2) death and cadaveric phenomena; 3) death from strangulation (asphyxia—its various types); 4) bodily injuries (antemortem and postmortem from various instruments, classification of injuries, determination of loss of working capacity, etc.); 5) death from extreme temperatures, electricity, starvation; 6) poisoning (action of poisons); 7) sexual functions in a forensic medical context (pregnancy, childbirth, rape, abortion, sexual examination, etc.); 8) suicide, infanticide; 9) determination of personal identity; 10) examination of material evidence; 11) study and resolution of issues related to medical errors and crimes. The above convincingly proves that only a person who has undergone special training can be a forensic physician. The Code of Criminal Procedure of the RSFSR indicates that any physician may be invited as an expert. The teaching of Forensic Medicine in the past was limited to lectures and a small number of hours for practical exercises on the examination of material evidence and cadavers. At present, the program is designed for 80 hours per year for 4th-year students. Practical exercises have been expanded and supplemented with the examination of living persons. From 1924 to 1929, courses for the advanced training of forensic medical experts existed at the Leningrad Institute for the Advanced Training of Physicians. In 1933, the People's Commissariat of Health in Moscow organized the Scientific Research Institute of Forensic Medicine from the institutes of forensic medicine of the 1st and 2nd Moscow Medical Institutes and the Central Forensic Medical Laboratory of the People's Commissariat of Health, at which courses for the improvement of forensic medical experts were organized again. In addition to medical institutes, the teaching of Forensic Medicine takes place in institutes of Soviet law and legal courses for law workers, as well as in schools for the command staff of the militia and criminal investigation workers. Practical work on the forensic medical examination of dead bodies and living persons is carried out by the apparatus of forensic medical expertise, which is in the system of the People's Commissariat of Health. The examination of material evidence is carried out in special forensic medical laboratories with chemical and biological departments. The regulation on special laboratories was approved by the People's Commissariat of Health in 1924. At present, there is a central laboratory in Moscow at the Scientific Research Institute of Forensic Medicine, and regional forensic medical laboratories have been organized in the largest centers.