Everything begins with the disappearance of one person, which might be by chance or due to some severe kind of unnatural death. In this final scenario, knowing the extent of the dead person’s physical injuries is crucial for identifying the perpetrator and assigning “just punishment” at trial. The field of “forensic medicine” has become an indispensable resource for establishing legal facts.
The appearance of the first legal texts
As early as 2100 BC, or around 1750 BC for the Hammurabi code, ancient texts were written indicating the sanctions foreseen against crimes and misdemeanors, but also mentioning the responsibilities of physicians, especially in cases of medical error. At that time, the dead were exposed in order to verify their identity, but autopsies as we know them today were not practiced; they simply removed the wounds and checked the organs affected. It was necessary for this to be done by qualified doctors, and this was how the “Hippocratic Oath” appeared around the 4th century BC: “I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.“
In order to determine the causes of fatal injuries, the function of the forensic physician was born in the 6th century AD. These men became true auxiliaries of justice: they inspected the skin, observed the orifices, and noted the effects of poison.
From the Middle Ages to the beginning of the Empire
The role of the medical expert was clarified by a law mentioning the fact that he had a responsibility, had to give a judgement and had to be an impartial arbitrator. Because in cases of justice, the magistrate had to rely on medical evidence and to ask for the opinion of a doctor in case of blows, wounds, homicides, like the report written in 1532 concerning the murder of the lord of Clanay:
And first, in the head was found a wound on the right side which seems to have been made with a sword, plus another cut on the left side, plus another cut between the eye and the ear which was made with a dagger penetrating to the temple, plus, below the said cut, there are two blows made by a dagger going down to the throat, the width of two fingers, and below these, there is another one similar in width and in depth.
In Europe, Frederick II organized medical studies and promulgated an edict authorizing the dissection of human cadavers in 1241. 130 years later, the pope gave the privilege to the University of Medicine of Montpellier to perform autopsies.
Forensic medicine became very important in the 16th century: a criminal code was written between 1530 and 1532 by Charles V; Ambroise Paré wrote the first notions of forensic medicine in France, in his “livres de Chirurgie“, notions that were understandable for non-medical people. He included all the explanations necessary to write a medical report, with supporting documents, analyses, and habits and customs of the time (embalming methods, products used), using the reports of the families’ memoirs.
The first forensic physician was Paul Zacchias or Paolo Zacchia, personal physician of Pope Innocent X, who summarized his medical experiences in “Quaestiones medico-legales” between 1621 and 1635; Andreas Vesalius, professor of anatomy in Bologna and then in Pisa, wrote books based on his experiences, with illustrated plates “De Humani Corporis Fabrica Libri Septem,” and ended his career as imperial physician to Charles V.
Henri IV, before disappearing, ordered the appointment of two surgeons in each city of great importance in order to analyze the wounded, killed, mutilated, and others. Around 1700, Pierre Dionis, physician to Queen Maria Theresa of Austria and professor of anatomy and surgery at the Jardin du Roi in Paris, recommended that autopsies be performed within twenty-four hours after the death of the individual in order to be certain that he or she was dead and so that the people around him or her would not have bad intentions towards the doctors in terms of their speed in proving the cause of death. The autopsy must be performed at the place where the body was found.
Time progresses, the means change, improve. Bodies were kept better so that they could be dug up if necessary. Because if the mortal causes were not found immediately, the body was opened, the skull was sawn off as in the case of the servant of Saint Nectaire in 1765, who died in an unexplained and fast way, whereas a week before he had just taken a shotgun in the knee! New studies were carried out, and drownings and asphyxias were analyzed.
After the French Revolution, in the years 1794-1795, inventions appeared in great numbers: the microscope, radiology, toxicology, and chairs of forensic medicine were established in each faculty of medicine.
Forensic medicine in the last few centuries
It was the explosion of knowledge in forensic medicine: Haussmann had a morgue built (which was destroyed before World War I and then newly established on the Quai de la Râpée in Paris, taking the name of the Institut Médico-Légal), with all the necessary refrigeration techniques for the preservation of corpses, which until then had been presented to the public for three days without preservation.
In the 19th century, the medical reports became more complete, more precise, and clear, mentioning the rigidity of the corpse, the decomposition, the putrefaction, the complications of diseases, the hemorrhages, the different colors of the skin thanks to the progress and discoveries in the field of blood analysis, infectious diseases, Louis Pasteur, Claude Bernard, Flemming, et al.
Individual behavior was also discussed, and concepts from psychology and psychiatry were introduced into criminal cases. Before, “madmen” were judged like the rest of the population, the notion of “irresponsibility” appeared as proven by the case of Antoine Léger (French cannibal and murderer), in 1824: accused of murdering a little girl, he bled her, drank her blood and ate her heart! He was sentenced to death, even though the lawyer claimed insanity! His skull was autopsied in order to detect neuroses of the brain leading to such acts of madness.
To counteract old beliefs that found this practice harmful to the bodies of the dead, a “treatise on legal exhumations” was published in 1831; however, it turned out that it was often necessary to exhume a corpse to verify the hypotheses of death, which could differ. This was why scientists were interested in doing delayed examinations. These were only requested by the judicial body. The authors of this treatise practiced “experimental” forensic medicine, which meant examining the body to see if it had been altered and observing the conservation after a long burial. As the exhumed body produced unbearable odors, it was sufficient to spread water with chloride of lime. After a complete examination and dissection of the corpse, it was found that arsenic does not delay the corruption of corpses (as was believed in the 16th century), and is an excellent “morbidifier,” but its presence in a body did not mean that it had been poisoned.