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Introduction
Forensic Medicine, also called Legal Medicine
as a morphological field is strongly linked with
the detailed knowledge of anatomy and builds on
the latter’s basics for its diagnoses. The relation
between forensic medicine and anatomy in
history can be traced even to the fact that modern
anatomical understanding was gained through
the autopsies of executed criminals, which was, at
the time the domain of forensic medicine, too.
Perfect anatomic skills are chiefly necessary in
forensic traumatology.
It is generally known that due to the
autopsies, which were part and parcel of the
process of mummification in Ancient Egypt the
Egyptian civilization had, in its time, an
unsurpassable anatomical knowledge in com-
parison to other peoples. Mummification and the
autopsy, which was part of it, was, in fact,
a religious matter (Fig. 1).
In the ancient cultures however, autopsies
were more of an exception than a rule.
Examination by a physician or another skilled
person was limited to the visible injuries on the
surface of the body. Examples of such activities
can be found in old religious texts. The Holy Bible
describes a situation, which we can consider
in today’s terms as an examination of
victim’s injuries. In John 20: 25 Thomas raises
doubt over the other disciples’ report they’ve seen
Jesus: “…. But he [Thomas] said unto them,
Except I shall see in his hands the print of the
nails, and put my finger into the print of the
nails, and thrust my hand into his side, I will not
believe. Here Thomas wants to examine forensic
important injuries. From the description of the
crucifixion of Jesus in John 19:1-42 we know of
two kinds of injuries on the body of Jesus - vital
ones by nails and postmortal by spear. Words of
Thomas “thrust my hand into his side” refers to
Jesus’ postmortal injury by a spear of a soldier
(see John 19:34).
Thomas’ desire for evidence was satisfied 8
days later as Jesus appeared again. John 20:27
describes the situation: “Then saith he to
Thomas, Reach hither thy finger, and behold my
hands; and reach hither thy hand, and thrust it
into my side: and be not faithless, but believing.
Thomas took in the mentioned fragment of
The Holy Bible scientific approach which we can
label as “evidence based”. Such approach is to be
expected from every forensic pathologist.
Egypt and Greece
The first physician, known by name and
therefore highly probably an existing person, was
Imhotep (Fig. 2). Later, he was also taken into the
system of Egyptian gods. He lived in the reign of
Pharaoh Djoser from the 3
rd
Dynasty (around
2600 BC). The Canadian Professor of Medicine,
Sir William Osler (1849 - 1919) wrote about him
He was the first doctor, who emerges from the fog
of these ancient times”. Nevertheless, it is of
interest that a certain Hesire (Fig. 3) was
a Doctor in the Court of the same Pharaoh Djoser.
Imhotep surely had a very high status in the
Court, but more frequently he was mentioned as
the principal architect. In spite of this, in later
centuries, during the reign of King Ahmose II.
(after 600 BC.), he was nevertheless proclaimed
the god of Medicine.
One can understand that the high
development of the Egyptian medicine was a real
reason that around the year 280 BC, the center of
Ancient Greek medicine was the Museion
(Temple of the Musae) in Alexandria.
Herophilos
1
(Fig. 4) (335-280 BC), was
a Greek physician, born in Chalcedon in Asia
Minor (now Kadiköy, Turkey). Herophilos was
Soudní lékařství 23
History of Forensic Medicine
First part: General Sources of Forensic Medicine in Europe
from the Ancient Times
Hirt, M.,
1
Kováč, P.
2
1
Institute of Forensic Medicine, Medical Faculty of Masaryk University and St. Ann’s
University Hospital, Brno, Czech republic
2
Institute of Forensic Medicine, Comenius University, School of Medicine, Bratislava,
Slovak Republic
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24 Soudní lékařství
Fig 4. HerophilosFig 3. Hesire
Fig 2. Imhotep
Fig 1. Anupev
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one of the most significant representatives of
the Alexandrian medical school. He is also
considered to be the first anatomist. His works
were lost but fragments of his writings mainly on
anatomy survived until today because they were
quoted by Galenos. Herophilos had remarkably
profound anatomical and physiological know-
ledge; he carried out autopsies of animals and
presumably even humans, though this is not
confirmed since he did not extend the knowledge
about mammals to humans, as was the custom in
his time. It is true, however, that he gained much
of his skill during experiments, which dealt with
the vivisection of animals. Herophilos distin-
guished between sensory and motor nerves, and
between the cerebellum and the brain. He also
noted that the brain cortex was folded into
convolutions and named the ‘duodenum’.
Another equally important doctor of this
school was Erasistratos from Julis, on the island
of Kea (ca 250 BC). He was a personal physician
of Seleucus I Nicator, founder of the Seleucid
dynasty. Erasistratos wrote two anatomical
writings and a book about the causes of diseases.
It is known that Erasistratos performed
numerous human autopsies and his approach is
rightly considered the true origin of the
pathological-anatomical deliberation about
health and illness. This is praiseworthy as even
in the 1
st
Century AD, the Roman doctor Celsius
refused to accept the autopsy, saying that it is
enough to study the large numbers of injured
soldiers from battles and gladiator arenas.
Hipprocrates (460 BC–377 BC) based his
medical practice on observations and on the study
of the human body. He held the belief that illness
had a physical and a rational explanation.
Hippocrates traveled throughout Greece prac-
ticing medicine and teaching his ideas. His works
contain reports of medical malpractice and
negligence which were common in those times.
Hippocrates quoted as the main reason for the
unusual high count of bad physicians the fact that
physician’s incompetence remained un-punished.
In the speeches of Lysias (approx. 459
BC–380 BC), Demosthenes (384 BC – 322 BC)
and Antiphon (479-411 BC) cases where patients
died during treatment by a physician were
mentioned. Ancient judges solved these cases
without participation of any physicians.
Roman Empire
One of the most important physicians of
ancient Rome was Galenos (ca 129–199) from
Soudní lékařství 25
Pergamum (in present-day Anatolia). He was
Emperor Marcus Aurelius’ personal doctor. Since
autopsies of people were forbidden at that time,
Galenos performed autopsies of animals,
particularly monkeys and pigs. No wonder that
as a result, he sometimes reached incorrect
conclusions about the structure of the human
body.
Physicians of the Roman Empire already
used the term “mortal wound”. In the work of
Suetonius De Vita Ceasarum in 82
nd
capitol of
Gaius Iulius Caesar’s biography (Divus Iulius)
we can find text describing Ceasar’s assasination:
“.... he [Gaius Iulius Ceasar] was stabbed with
three and twenty wounds.... of so many wounds,
none turned out to be mortal, in the opinion of the
physician Antistius, except the second one in the
breast.
2
Two roman laws – lex Aquilia and lex
Cornelia - targeted physicians. The lex Aquilia
provided for state supervision of physicians, and
held them responsible for negligence. The lex
Cornelia severely punished practitioners whose
carelessness or culpable ignorance caused the
death of a patient.
Some parts of Corpus Iuris Civilis from 6
th
century (reign of emperor Justianus) mentioned
terms “dementia”, “menta capti”, “moria” and
“insania”. These mental states were reason for
exculpation of crime perpetrator. Not a physician
but the judge himself decided whether the
perpetrator was capable of understanding his
action and could be held responsible.
Use of torture was prohibited on pregnant
women. It was midwives, not physician’s, duty to
examine woman’s possible pregnancy. We can
consider these midwives as some kind of forensic
examiners.
Unfortunately, in the times spanning from
the fall of Ancient Rome until the Renaissance, it
was impossible to carry out any form of
anatomical practice and therefore medical
science was not evolving. During that period
medicine was based almost exclusively on the
work of Galenos.
Doc. MUDr. Miroslav Hirt, CSc.
Ústav soudního lékařství
Tvrdého 2a
602 00 Brno
tel.: 420 543 426 511
fax: 420 543 426 519
E-mail: hirt@med.muni.cz
2
“.... atque ita tribus et uiginti plagis confossus est
uno modo ...nec in tot uulneribus, ut Antistius
medicus existimabat, letale ullum repertum est, nisi
quod secundo loco in pectore acceperat.
1
sometimes Latinized Herophilus
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... The word "forensic" derives from the Latin "forensis", meaning "in open court" or "from the forum", and it is thought to have its origin in 44 BC, when a Roman physician, Antistius, was summoned to examine the corpse of Julius Caesar. 1 Antistius presented the details of his examination and the resulting conclusion to the forum, stating that although Caesar had been stabbed a total of 23 times, it was the second stab wound to his chest that actually killed him. 2 This type of evidence to the "forum" or court has become known as forensic evidence, and the Oxford English Dictionary now defines forensic as "relating to the application of scientific methods and techniques to the investigation of crime". ...
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