The history of legal medicine.

Before discussing legal medicine and forensic science, it would be helpful to have a general definition of terms. Forensic science is a broader term than legal medicine. The former actually encompasses the latter. The term “forensic” is used as an adjective to identify a growing group of subspecialties in science and medicine, all of which convey the fundamental concepts of methods, hopefully both scientifically valid and legally admissible, for the presentation of evidence in courts of law. Legal medicine is considered to be the field of study and accumulation of materials that deals with the application of medical knowledge to the administration of justice. For the purposes of this article, forensic medicine should be considered synonymous with legal medicine. Medicine and law have been related from the earliest times. The bonds that first united them were religion, superstition, and magic. The functions of the physician and the jurist were united in the priest, the intermediary between God and man. In early civilizations, primitive legal codes, religious doctrines, and social precepts were often ill distinguished, and laws with a medical content were often found within their context. Ecclesiastical courts and canon law were concerned with much that related not only to religious matters but also to medicine— for example, impotence, divorce, sterility, pregnancy, abortion, period of gestation, and sexual deviations. The oldest of these written records, the Code of Hammurabi, includes legislation pertaining to the practice of medicine, dating back to the year 2200 B.C. It covered the topic of medical malpractice and set out for the first time the concept of civil and criminal liability for improper and negligent medical care. Penalties ranged from monetary compensation to cutting off the surgeon’s hand. Fees also were fixed. The Code discussed various diseases of a slave that would invalidate a contract. Also included were references to incest, adultery, and rape. In ancient Egypt, the acts of the medical man were circumscribed by law. Stab wounds were differentiated in the 17th century B.C. The Egyptians had a thorough knowledge of poisons. There is evidence that priests made determinations regarding the cause of death and whether it was natural or not. The Chinese published information about poisons, including arsenic and opium 3000 years B.C. In ancient Persia, wounds were put into one of seven classes, ranging from simple to mortal. In ancient Greece, there was a knowledge of poisons and laws against abortions. However, autopsies were not performed, since a dead body was regarded as sacred. In Rome 600 years B.C., a law was passed requiring that a woman who died in confinement should be immediately “opened” to save the child. The investigators of murder were selected from the citizenry. When Julius Caesar was assassinated in 44 B.C. (March 15), the physician Antistius examined his body and concluded that only one of the 23 stab wounds was mortal. The legal code in ancient Greece (about 460 B.C.) was very elaborate. In addition, it was a time of great advances in medicine. Though there is no clear evidence that medical knowledge was officially made use of in establishing proof in courts of law, it is known that Hippocrates and others discussed many genuine medicolegal questions. These questions included the relative fatality of wounds in different parts of the body, the average duration of pregnancy, the viability of children born before full term, and other matters. Moving across the Mediterranean, there is in existence a papyrus, found in Egypt and dated from pre-Christian times, in which a medical officer in Alexandria submitted a report on a suicide Dr. Wecht is Coroner of Allegheny County, Pittsburgh, PA, and is in private practice at Cyril H. Wecht and Pathology Associates, Pittsburgh, PA. Address correspondence to: Cyril H. Wecht, MD, JD, Office of the Coroner, Allegheny County, 542 Fourth Avenue, Pittsburgh, PA 15219. E-mail: [email protected]