Historical References

The origins of clinical forensic medicine go back many centuries, although Smith rightly commented that "forensic medicine [cannot be thought of] as an entity.. .until a stage of civilization is reached in which we have.. .a recognizable legal system.. .and an integrated body of medical knowledge and opinion" (1).

The specific English terms forensic medicine and medical jurisprudence (also referred to as juridical medicine) date back to the early 19th century. In 1840, Thomas Stuart Traill (2), referring to the connection between medicine and legislation, stated that: "It is known in Germany, the country in which it took its rise, by the name of State Medicine, in Italy and France it is termed Legal Medicine; and with us [in the United Kingdom] it is usually denominated Medical Jurisprudence or Forensic Medicine." However, there are many previous references to the use of medical experts to assist the legal process in many other jurisdictions; these physicians would be involved in criminal or civil cases, as well as public health, which are referred to frequently and somewhat confusingly in the 19th century as medical police. There is much dispute regarding when medical expertise in the determination of legal issues was first used. In 1975, Chinese archeologists discovered numerous bamboo pieces dating from approx 220 bc (Qin dynasty) with rules and regulations for examining injuries inscribed on them. Other historical examples of the link between medicine and the law can be found throughout the world.

Amundsen and Ferngren (3) concluded that forensic medicine was used by Athenian courts and other public bodies and that the testimony of physicians in medical matters was given particular credence, although this use of physicians as expert witnesses was "loose and ill-defined" (4), as it was in the

Roman courts. In the Roman Republic, the Lex Duodecim Tabularum (laws drafted on 12 tablets and accepted as a single statute in 449 bc) had minor references to medicolegal matters, including length of gestation (to determine legitimacy), disposal of the dead, punishments dependent on the degree of injury caused by an assailant, and poisoning (5). Papyri related to Roman Egypt dating from the latter part of the first to the latter part of the fourth century ad contain information about forensic medical examinations or investigations (6).

The interaction between medicine and the law in these periods is undoubted, but the specific role of forensic medicine, as interpreted by historical documents, is open to dispute; the degree and extent of forensic medical input acknowledged rely on the historian undertaking the assessment.

A specific role for the medical expert as a provider of impartial opinion for the judicial system was identified clearly by the Justinian Laws between 529 and 564 ad. Traill (2) states that: "Medical Jurisprudence as a science cannot date farther back than the 16th century." He identifies George, Bishop of Bamberg, who proclaimed a penal code in 1507, as the originator of the first codes in which medical evidence was a necessity in certain cases. However, the Constitutio Criminalis Carolina, the code of law published and proclaimed in 1553 in Germany by Emperor Charles V, is considered to have originated legal medicine as a specialty: expert medical testimony became a requirement rather than an option in cases of murder, wounding, poisoning, hanging, drowning, infanticide, and abortion (1). Medicolegal autopsies were well documented in parts of Italy and Germany five centuries before the use of such procedures by English coroners. The use of such expertise was not limited to deaths or to mainland Europe. Cassar (7), for example, describes the earliest recorded Maltese medicolegal report (1542): medical evidence established that the male partner was incapable of sexual intercourse, and this resulted in a marriage annulment. Beck (8) identifies Fortunatus Fidelis as the earliest writer on medical jurisprudence, with his De Relationibus Medicorum being published in Palermo, Italy, in 1602. Subsequently, Paulus Zacchias wrote Quaestiones Medico-Legales, described by Beck as "his great work" between 1621 and 1635. Beck also refers to the Pandects of Valentini published in Germany in 1702, which he describes as "an extensive retrospect of the opinions and decisions of preceding writers on legal medicine." In France in 1796, Fodere published the first edition in three octavo volumes of his work Les Lois eclairees par les Sciences Physique, ou Traite de Medicine Legale et d'Hygiene Publique.

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