FORENSIC MEDICINE: HISTORY, FUNCTIONS, BRANCHES, METHODS - MEDICINE - 2025

The forensic medicine is a medical discipline that applies medical and biological knowledge to address legal issues. The so-called legal medicine combines medical knowledge with other elements of law, natural, humanistic and exact sciences, to make biological aspects understandable and solve situations of a medical nature in the field of justice.

This specialty of medicine is responsible for evaluating individuals who have been injured or have died due to external influence, but also individuals who are suspected of having injured others. This means that both victims and suspects are examined by a specialist in the area.

Work that represents a doctor contemplating the heart of a young woman who is performing an autopsy. Source: Enrique Simonet

Forensic medicine is also called medical jurisprudence or judicial medicine, and the specialist in the area is often called a coroner or forensic doctor. In most countries it is a specialty that falls within the legal system rather than within the health care system.

History

Old age

The first written references to medico-legal texts date back to the 18th century BC. C. in Mesopotamia. There, in the Code of Hammurabi, some elements typical of forensic science are detected, such as medical fees, medical professional responsibility, compensation, diseases that invalidated the sale of slaves, among other concepts that were later useful.

In other remote cultures, including Chinese, Israeli and Indian, some references are also detected, such as, respectively, the legal medical text Si-yuan-lu, the annulment of marriage for medical reasons and the assessment of injuries.

It is impossible to ignore the findings of Egyptian culture, which was noted for all the advances in techniques of conservation and embalming of corpses.

For its part, in Greek culture we can identify various contributions related to the practice of medicine. The study of poisons as a cause of death also began there. While in Rome, another of the classical cultures, rules were established related to compensation for damages caused to the injured according to the severity of the injury.

Middle Ages and Renaissance

During the Middle Ages, anatomical studies and dissections of corpses began to be authorized, but they were limited to executed individuals. In this period, there are references to Visigothic legal texts that deal with medical-legal aspects such as compensation, clarification of rape, some applicable penalties and mental illness as a cause that restricts criminal responsibility.

With the arrival of the Renaissance comes a series of key contributions to the area of ​​forensic medicine. It is in these years that the Bamberg Code was promulgated, in 1507, in Germany. This is the first legal text where reference is made to the need to consult a doctor on a mandatory basis in case of homicide, medical errors or to determine the cause of death of a corpse with injuries.

In 1532, during the reign of Carlos I of Spain, the Constitutio Criminalis Carolina was established, which indicates the mandatory intervention of a doctor, surgeon or midwife, as a medical expert in cases of injuries, homicide, suicide, poisonings and medical errors, among other cases.

Later on, an ordinance is drawn up for the Duke of Brittany, organizing the beginning of legal medicine.

To close the contributions of the Renaissance years, there is also the work Medical legal questions, a famous classic of the discipline that is made up of three volumes written by Pope Innocent X's personal physician, Paolo Zacchia.

18th to 21st century

In 1789 the first official chair of Legal Medicine was created in Naples, which meant its consolidation as a medical specialty. During these years the first works on premature burials by Jean Jacques Bruhier were recorded. Pierre Hubert Nysten also enunciated the laws of cadaveric rigidity.

Later in the 19th century, a golden age for classical forensic medicine appeared. Many were the still valid contributions of great masters such as Buenaventura Orfila, Tardieu, Lacassagne, Balthazard, Tailor, Lombroso, Bouchut, Megnin, du Saulle, Rivalta, Jellinek, Calabuig, Piga and Pascual.

Already today, the amount of knowledge that has been generated in the field of legal medicine, something characteristic also of the information age, has led to a progressive differentiation and very particular advances that contribute even more to the subspecialization of the discipline.

Functions of the forensic doctor

Forensic dentist cataloging some dental remains. Source: English: Cpl. James P. Johnson, US Army

It is believed that the main role of the medical examiner is restricted to determining the origin of the injuries sustained by a wounded person or the cause of death of an individual by examining his corpse.

But a broader vision of the profession makes it possible to determine that beyond practicing autopsies, other activities are included, there are other fields of action.

Among them are medical-legal relations, integrated opinions with the use of physical evidence, exhumations, attention to massive disasters, attention in cases of alleged human rights violations, and forensic medical auditing.

The forensic doctor can decide whether or not other doctors acted with due responsibility and help the judge to resolve doubts related to medical-biological phenomena in the midst of an alleged criminal act.

For all these activities, the legal medicine professional not only requires technical knowledge, but also legal knowledge. It is important that you take into account what are your limitations, responsibilities and obligations as an expert within the criminal investigation.

Branches of forensic medicine

Forensic medicine as an auxiliary science of legal issues must be prepared to produce detailed scientific knowledge in all areas that an investigation requires, therefore there are several branches of specialization or sub-disciplines. Among them are:

-Forensic anthropology

-Traffic accidents

-Ballistics

-Forensic biology

-Dactyloscopy

-Forensic entomology

- Forensic physiognomy

-Forensic Genetics

-Hematology

-Fires and explosives

-Lesionology

-Necropapiloscopy

-Forensic Odontology

-Forensic pathology

-Forensic psychology

-Forensic psychiatry

-Serology

-Medicolegal sexology

-Tanatology

-Forensic toxicology

Main concepts

Death

It refers to the definitive and irreversible cessation of vital functions, that is, respiratory, cardiovascular and nervous. Its diagnosis is made on the signs that are detected, which can be cardiocirculatory, respiratory, nervous, skeletal-gumentary.

Death is classified according to its signs in real, apparent, encephalic. Depending on the duration of the agonizing period, it can be sudden, unexpected or rapid. According to the cause, it is divided into natural, violent and doubtful.

Bichat tripod

This is the name given by the biologist Xavier Bichat to the three essential organs for life: heart, lung and brain.

Taylor sign

It refers to the persistence of a muscular contraction after death, which is also known as a cadaveric spasm.

Autopsy or thanatopsia

It is the set of operations that the forensic doctor performs on the corpse to determine the cause and the mechanism of death.

Rigor mortis

It is the recognizable sign of death due to a chemical change in the muscles, which creates a state of rigidity and inflexibility that makes handling of the corpse difficult.

Rivalta test

It is a method developed by the Italian Pompeo Rivalta to differentiate transudate and exudate human patients. Transudate is a plasma filtrate with a low protein content, as it only contains albumin. The exudate is made up of cells, proteins and solid materials, which can be generated in areas of infection or inflammation.

Injury

It is the product of a trauma or the sequel that an organism experiences as a consequence of an external factor.

It involves damage either by generating changes in the internal or external morphology of the organism or because it causes detriment to the mental or functional health of the individual.

According to the intention they are divided into malicious injuries and culpable injuries. According to morphology, they are classified into internal and external injuries.

Amussat sign

It is one of the lesions that can be detected in individuals who have suffered hanging or strangulation, being described by the French urologist Jean Zuléma Amussat. It involves the tearing of the tunica interna of the primitive carotid below its bifurcation.

Methods

In addition to applying inductive and deductive methods, which are used as evidence-based science, the application of the expert method in forensic medicine is important.

The expert opinion involves the recognition, analysis and assessment that an expert performs in relation to a person, object, phenomenon or procedure, to establish or exclude an identity.

The first phase of recognition requires the methodical and systematic examination of scientific observation. This observation must be selective, interpretive and objective.

The expert method supposes the analysis as a second phase because after selectively observing the knowledge that is had or that is investigated on the subject is classified and compared.

Finally comes the assessment that in forensic medicine involves making a judgment, defining a possible model or pattern, as well as concordances or disagreements in the object of analysis.

Among the general parameters of the expert method, it is recommended to admit as true only what is proven with evidence, order said evidence from the simple to the complex and list all the information elements without omitting anything.

References

1. The Editors of Encyclopaedia Britannica (2018, December 19). Forensic medicine Encyclopædia Britannica. Recovered at britannica.com
2. Forensic Medicine. (2019, October 03). Wikipedia, The Encyclopedia. Recovered from wikipedia.org
3. Patito, JA (2000). Legal Medicine. Buenos Aires: North Central Editions.
4. Menéndez de Lucas, JA et. al (2014). Manual of legal and forensic medicine for medical students, Spain: Elsevier.
5. Malik, Arif. (2017). Forensic Medicine V / S Forensic Pathology. (A Difference That Everyone Should Know). Annals of King Edward Medical University. 23. 10.21649 / akemu.v23i1.1504.
6. Téllez Rodríguez, NR (2002). Forensic Medicine: Integrated Manual. Colombia: National University of Colombia.