A Brief Historical Overview of the Past of Forensic Medicine

Abstract

Forensic medicine is a large and multifaceted science that blends legal concerns with medical knowledge. It has a long history that has evolved alongside advances in the legal and medical professions. By combining medical and legal sciences, forensic medicine provides critical insights into various criminal investigative duties, such as victim identification, determining the cause of death, and examining injuries. This subject has its origins in ancient societies. Establishing systematic guidelines and training programmes for medical examiners in the 19th century marked a significant advance in forensic medicine. The development of scientific techniques such as toxicology and pathology greatly increased the precision and dependability of forensic operations, allowing for more useful contributions to the court system. Throughout its long history, forensic medicine has evolved in line with scientific and legal advances. It began with simple facts and common sense before evolving into a complicated field that combines methodologies from other academic disciplines, including pathology, chemistry and biology. Because of its interdisciplinary nature, forensic medicine acquires depth and complexity, cementing its place as a critical link between health and the law and providing insights that significantly impact court judgements.

Introduction

Forensic or legal medicine is the application of medical knowledge in the pursuit of justice. It refers to the field of applying medical ideas and knowledge to civil and criminal law. ¹ Discussion in this discipline mostly centres on the medico-legal assessment of cases. ²

Historically, it was frequently used synonymously with ‘forensic pathology’, the medical discipline that examines mortality. The subject is further confused by words such as ‘forensic and legal medicine’ or ‘legal and forensic medicine’, which are acknowledged as separate fields of medical specialisation. These phrases typically encompass all facets of medicine related to justice systems and may differ from one nation to another. The phrase ‘forensic medicine’ currently encompasses all facets of forensic activities in medicine. ³ The speciality was chosen to cover the essential mortality characteristics and related issues commonly faced in medico-legal practice. The mysteries of disease and criminality are forever veiled within the silent psyche. A forensic medicine specialist learns through experience, practical reasoning, and scientific analysis. As this speciality deals with poisoning cases, it is also called forensic medicine and toxicology. Combined, they offer scientific proof that courts and law enforcement employ to solve crimes and carry out justice.

The history of this speciality will shed light on how the subject evolved. The fields have developed over time, including developments in chemistry, medicine and judiciary enforcement tactics. This review article explores the field’s ancient beginnings and early practices, focusing on the foundations of forensic medicine and toxicology and the contributions of Greek and Roman civilisations.

Brief Review

Branches

Clinical forensic medicine is an important division of this subject that evaluates, analyses, interprets, and reports on living people for medico-legal purposes, including victims and accused perpetrators of sexual assault, child abuse, and domestic violence. There are also activities such as evaluating intoxication cases, assessing age, resolving identity disputes, traffic medicine (mainly examining injured pedestrians), determining driver vs passenger status, and assessing driving fitness. ² Analysing the medical requirements for establishing criminal culpability and assessing competency for detention and questioning within the context of justice administration.

Forensic pathology studies the various signs of violence on the human body and investigates unnatural fatalities such as car accidents, hanging, drowning, and both suspected and spontaneous mortality. It establishes the cause of death through scientific study of autopsy results on cadavers. The investigation and interpretation of histological tissues retrieved during the autopsy are also discussed.

Previously, medical jurisprudence referred to the application of law in the realm of medicine and its legal consequences. It covers the physician’s responsibilities in the doctor-patient connection, doctor-doctor relationship, doctor-state interaction, medical negligence, licensed medical practitioner rights and privileges, professional misconduct, inquests, consent concerns, and ethics. The state regulates contemporary medicine, requiring medical personnel to submit evidence and testify as expert witnesses in medico-legal cases involving death, sexual assault, and other related issues. As a result, the two disciplines have historically been linked. ⁴ However, forensic or legal medicine has become increasingly relevant. It is known as forensic medicine and toxicology because it also deals with cases of poisoning. It was also referred to as ‘state medicine’.

Historical Event

Documents about the medico-legal quandary can be found in Egypt, Samaria, Babylon, China, and India. The Egyptians mastered mummification and developed their legal system circa 3000 bc, whereas Chinese law emerged around 4000 bc.^{2, 5} In ancient Egypt, detailed records of injury and cause of death were kept on papyrus, illustrating early forensic documentation.

The Jewish and Greek legal systems were important, dating back to 1200 bc. The Materia Medica of China, written around 3000 bc, includes information on drugs and poisons. The King of Babylon developed the Code of Hammurabi, a Babylonian law text created in 1755 bc. It is the oldest, longest, and best-preserved medico-legal text, with a considerable impact on the evolution of medico-legal practices.^{2, 5}

Hippocrates (460–377 bc) was a Greek physician from the ancient period who is regarded as one of the most famous figures in medical history. His impact on medico-legal practices is considerable, as he is credited with inventing the Hippocratic Oath, a key ethical code for physicians, and his contributions to the study of ethics have affected the growth of medico-legal practices.^{2, 5}

Socrates (470–300 bc), an Athens-based philosopher and reformer, was poisoned with hemlock for corrupting Greece’s youth. Antistius, the Roman physician, performed Julius Caesar’s first autopsy in 44 bc without dissection and decided that only one of the 23 stab wounds, located in the chest between the first and second ribs, was fatal. This is the oldest documented autopsy.^{2, 5}

The first medico-legal autopsy was performed in Bologna in 1302 bc by Bartolomeo da Varignana, an Italian physician and pioneer in forensic pathology. His pioneering work laid the groundwork for future growth in the discipline. Dr Ambroise Paré performed the first systematic autopsy on the remains of King Henry II in 1589.^{2, 5}

The Constitutio Criminalis Carolina, which outlined procedures for capital punishment, was published in Germany in 1532 and approved by King Charles V. This document was a watershed moment in the formation of legal medicine.^{2, 5}

Paulus Zacchias, the founder of forensic medicine and psychiatry, wrote and published Questiones Medicolegalis in 1657. His work was critical in defining the concepts and methods for both fields, and his contributions continue to influence medical-legal research and practice today.^{2, 5}

Mathieu Joseph Bonaventure Orfila (1787–1853), a Spanish academic in chemistry and toxicology in Paris, pioneered chemical procedures for toxin extraction, earning the title of creator of modern toxicology. His efforts significantly advanced the field of toxicology. Johann Ludwig Casper (1796–1864), a German forensic scientist, criminologist, pathologist, paediatrician, pharmacologist, professor, and author of forensic medicine, released the ninth edition in the 17th century.^{2, 5}

Alfred Swaine Taylor’s The Principles and Practice of Medical Jurisprudence was published in 1865. Sidney Smith defined forensic medicine as we know it today in 1951. Professor Alec Jeffreys invented DNA fingerprinting for identity verification in 1984.^{2, 5}

Phylogeny of Forensic Medicine in India

The thoughts of numerous philosophers from ancient Indian history had a tremendous impact on India’s legal framework. Their significant ideas have been critical to the government’s operations, shaping the course of justice and legal practice.

The oldest legal treatise is Manava-dharma-sastra, or Manusmriti, which predates the Hammurabi Code of 2600 bc. It discusses the legal marriage age, sexual offences, punishments, and how sickness and intoxication affect court attendance and contract creation. It was intended to be written in 1200 bc. Manu may have been recognised as the originator of legal medicine in ancient India.^{2, 5}

The Rig Veda, written during the Vedic period (2000–1000 bc), mentions various transgressions, including abortion, incest, adultery, and murder, as well as their respective consequences. The Atharva Veda (1500 bc) describes snake bites, piercing wounds, arrow injuries, and their treatment. In Vedic law, illegal abortion is known as brunahatya, while suicide is known as Atmahatya.^{2, 5}

The Arthashastra, the most comprehensive work on statecraft from classical India, was written by Kautilya (Chanakya) in the 4th and 3rd centuries during the Mauryan Empire. The book covered various topics, including the monarchy, legal codes, medico-legal criminal investigation, law administration, foreign policy, and covert and esoteric procedures. Despite the passage of more than 2000 years, the brilliant strategist, often known as India’s Machiavelli, continues to inspire modern spiritual leaders in the country. He advocated medical inspections in cases of fatalities caused by assault, poisoning, or asphyxiation, like the autopsy performed today.^{2, 5} Medical practice was strictly regulated, and the King’s authorisation was required. Negligence in treatment may result in harsh charges, highlighting the high standards of care expected of medical practitioners.^{2, 5}

During the Buddha era, King Ashoka established hospitals, roadside clinics, and the Ayurvedic medical school in the 4th and 5th centuries bc. Dr Edward Bulkley conducted India’s first medico-legal autopsy in 1693, following the death of Mr Wheeler, a council member and Chief Justice of Choultry Chennai, on August 28, 1693, from suspected arsenic poisoning.^{1, 2}

The first medical school in India was established in Kolkata in 1822 and then evolved into a Medical College in 1835. Madras Medical College was founded in the same year. Madras Medical College established the first professor of medical jurisprudence position in 1857. ²

The inaugural Central Fingerprint Bureau of India was founded in Kolkata in 1897 and commenced operations in 1904. Since that time, forensic science has been systematically integrated into crime investigation practices in India.^{6, 7} Modern dactylography represents India’s most significant contribution to legal medicine during the British era. Sir William Herschel of the Indian Civil Service pioneered this identification method in 1858. Sir Francis Galton of England created a systematic study and methodology for using fingerprints in personal identification in 1892, drawing on Herschel’s idea.^{1, 2} The British authorities changed the method until 1862, when the Indian Penal Code was established. Our criminal laws are based on Mohammedan law but have been extensively modified and augmented by our rules, resulting in a deviation from their original forms. ⁸

The criminal investigation police system was formed in India in 1861, and coroners’ systems were introduced in 1871 in the presidential towns of Bombay and Calcutta. ¹ Professor JP Modi of Agra Medical College wrote the Medical Jurisprudence and Toxicology textbook in 1920. The Indian Medical Council was established in 1933. Forensic medicine has evolved significantly, moving from a subset of pathology to a unique speciality. This accomplishment illustrates the sector’s progress and advancement, necessitating all physicians’ ongoing dedication to meeting social expectations. ²

The teaching of forensic medicine has advanced due to the establishment and expansion of academic departments in forensic medicine and toxicology. Most universities provide postgraduate degrees in forensic medicine and toxicology. It is projected that many qualified medico-legal professionals will soon be available in various parts of India. Continuous efforts have been made to improve the capacity of forensic medicine in the country.

Religious and Social Perspectives on Autopsies^{2, 9}

In 1374 ad, the Pope authorised permission to perform a medico-legal autopsy. There were substantial religious and cultural objections to autopsy during the Tertullian and Augustine eras. Despite the lack of an explicit ecclesiastical prohibition in the early days of Christianity, the predominant opinion among church leaders was negative. Vindician, a physician and Augustine’s associate, is quoted in a 10th-century manuscript from Monte Cassino as saying, ‘The ancient anatomists found it agreeable to investigate the viscera of the deceased to ascertain the cause of death, but for us, humanities forbid this’.^{2, 10} Wolf-Heidegger and Cetto Singer have determined that dissections were performed in Italy between 1266 and 1275, with the earliest dissections being medico-legal. ²

No official ecclesiastical rules addressed the issue; however, at the Council of Tours in 1163, it was stated that the church despises bloodshed. This meant that clerics were not permitted to perform surgery on both the living and the dead. Because most physicians were clergy, autopsy was effectively inhibited while remaining permissible. In 1299, Boniface VIII forbade the cremation of corpses to extract flesh from bones. This was done to recover the remains of those who died during the Crusades. The edict specifically mentioned boiling the body, but many people misinterpreted it as barring dissection. ¹¹

However, during this time, some physicians began dissection, which caused the church’s viewpoint to change. Pope Alexander died abruptly in 1410, and Pietro D’Argelata performed an autopsy. Pope Sixtus IV (1471–1484) issued a decree enabling anatomical studies on human cadavers by students at Bologna and Padua, which was later approved by Clement VII (1523–1534). In 1556, an autopsy was performed on Ignatius Loyola, which revealed the presence of calculi in his kidneys, bladder and gallbladder. ¹²

As a result, by that time, the Catholic Church had fully accepted the practice of autopsy. An autopsy was performed in 1533 for religious reasons. A double monster, female twins united at the umbilical area to a point in the thorax just below the breast, was born in Espafiola (present-day Dominican Republic) in 1533, according to Oviedo y Valdés’ New World History. The infants were baptised, though the priest was not sure if one or two souls required baptism. The parent reported that one of the children wailed while the other stayed silent. One may sleep while the other remains vigilant. Consequently, two baptisms were performed, yet the priest remained concerned. To address the situation, an autopsy was performed eight days after the infants died. The discovery of two complete sets of internal organs led to the conclusion that there were most certainly two souls. Chavarria and Shipley, who unearthed and translated this fascinating story, stated that it was most likely the only post-mortem examination ever conducted to probe the deceased’s soul.^{2, 13}

Reverence for the body was an important component of Jewish tradition, as the Scriptures state that God created humans in His image. Interacting with a dead body made a person impure for several days. It was emphasised that the body should be treated with care and buried immediately. Even if a criminal is punished by hanging, ‘his body shall not remain overnight on the tree but must be buried that day’. The rabbis interpreted these restrictions to ban post-mortem dissection, which would disgrace the body. It is written that around 100 ad, Rabbi Ismael’s pupils obtained the remains of a young prostitute who had been executed and boiled them to count the bones. They found 252. ⁹

According to one Talmudic scripture, an autopsy is acceptable if it saves the life of an alleged murderer. Jewish authorities did not permit autopsies until the 18th century, when Rabbi Landau was asked about the permissibility of incising a cancer patient’s body to determine suitable therapy for future cases. He claimed that an autopsy is a degradation of the departed and is only permitted to save the life of a current patient rather than a prospective future patient. ¹⁴ Orthodox Jews upheld this policy until the 20th century, when the Knesset, Israel’s parliament, passed legislation allowing autopsy under certain conditions. ¹⁵

Several indications of widespread hostility to autopsy can be found here. In 1538, Guillaume Rondelet (1507–1566), a Montpellier scientist, performed an autopsy on his infant son before ordering examinations on his sister-in-law and first wife. ¹⁶

Vesalius, a physician who performed countless autopsies, died in 1564 while returning from a trip to Jerusalem. Years later, biographer Melchior Adam published a letter reportedly written by Hubert Languet in 1565, claiming that Vesalius was forced to make this pilgrimage as atonement for the sins of murder and defilement. According to O’Malley, this tale lacks a factual basis. ¹⁷ However, he observes that it may have originated from the same myth as Ambroise Paré, who warned against early dissection in 1573 and reported an instance involving a well-known anatomist living in Spain. He was sent to perform an autopsy on a woman who was thought to have died from womb suffocation. Following the second incision, the woman demonstrated movement and other indications of life. As a result, the revered master was forced to quit the country and eventually succumbed to sadness, a significant loss for the Republic. ¹⁸

Jarcho emphasised the difficulties associated with doing an autopsy in Germany in 1670. A medical journal from that year includes an autopsy report stating, ‘The examination of other structures was not conducted due to a female relative’s change of mind. Our community harbours a profound aversion to autopsies and seldom permits them without considerable persuasion’. The journal’s editor appended a discourse on the difficulties of obtaining consent and potential counterarguments to relatives’ objections. ¹⁹

A widespread aversion to autopsy later emerged, as the Republic of Lucca’s 1699 decree, meant to reduce the spread of disease while calling for autopsies, was withdrawn due to public outrage. ²⁰ Such sentiments continue today; additional investigation would deviate from the main theme.

Legislative Stipulations

The DNA bill, which has been delayed for several years, must be enacted promptly to furnish a legal basis for forensic research in India. The passage of the Forensic Legal and Development Authority Bill is essential to establish the requisite legal frameworks for forensics in India.

Although the Government of India has implemented the Information Technology Statute of 2008, ²¹ which encompasses standards for the practice of digital forensics, specialists must be informed of the statute’s requirements. Nevertheless, the existing system is deficient, necessitating the rapid implementation of the DNA and Forensic Regulatory and Development Authority laws. The reports continue to be provided by the document specialists following Section 45 of the Indian Evidence Act [Bharatiya Sakshya Adhiniyam (BSA) 39(1)]. ²² In 2023, the new criminal laws (Bharatiya Nyaya Sanhita, BSA, and BNSS) replace IPC, CrPC, and the Indian Evidence Act, effective from 1 July 2024. ²¹

The State of Indian Mortuaries

Several Indian hospitals and medical institutes still lack contemporary facilities within their mortuaries. They lack the latest post-mortem toolkits, photographic and videographic equipment, and cold storage facilities for preserving cadavers intended for autopsy. ²³ The government is equipping hospitals with essential facilities. Standard tertiary care hospitals, including AIIMS, have advanced facilities like virtopsy ²³ ; however, extending these capabilities to state and district-level hospitals is crucial.

The Renaissance: Foundations of Modern Forensics

By combining medical knowledge with legal laws, forensic medicine started to form alliances during the Middle Ages, establishing the groundwork for contemporary forensic investigations. By publishing ‘De humani corporis fabrica’ in 1543 and offering meticulous human dissections, Andreas Vesalius transformed anatomy, rectifying centuries of anatomical mistakes and establishing a solid foundation for forensic pathology.

The Renaissance emphasised empirical evidence and direct observation more than superstition and unreliable texts to promote forensic accuracy. In forensic instances, a thorough understanding of anatomy facilitated a better understanding of trauma, cause of death, and injury timing. The ability to assess biological evidence was boosted with the development of early microscopy and better dissection techniques. Anatomists started recording pathological alterations in tissues to establish a connection between physical discoveries and clinical and legal outcomes.

The Renaissance period established a crucial foundation for contemporary forensic medicine through developments in anatomy, critical observation, and early scientific procedures. This period established concepts as the foundation for modern forensic investigations by bridging the gap between mystical beliefs and empirical science.

Conclusion

In toxicology and forensic investigations, artificial intelligence (AI) and machine learning have revolutionised the discipline by facilitating quick and precise data processing. Portable forensic technologies that enable real-time, on-site toxicological testing have been developed because of these advancements. It has also sparked the creation of molecular and genetic techniques that offer a more profound understanding of drug interactions and fatalities.

It must be acknowledged that cooperation between forensic medicine specialists, forensic scientists, legal experts, and technology developers is critical to enhancing the interpretation of evidence and the results of court cases. Every group contributes distinct knowledge and viewpoints that improve comprehension. Furthermore, a significant focus on data protection and ethical norms is required as forensic technologies advance. History demonstrates the significant contributions of forensic medicine to society. Professionals in this field must continue to devote their efforts to advancing their subjects.