Medicine in criminal and malpractice cases

DEFINITION: Scientific field that encompasses all activities and technologies involved in the process of restoring and maintaining human health and preventing disease.

SIGNIFICANCE: In addition to its health maintenance and restoration functions, modern medicine maintains a significant role in preventing disease through research and discovery of disease-causing organisms and the development of vaccines to prevent their spread. Medicine’s most prominent role in the forensic sciences lies in the reinforcement of the relationship between cause and malady as it applies to criminal or malpractice cases.

Medicine is a social science that began with the earliest and even the smallest human social units. Tribes discovered ways to alleviate pain, stem blood flow, heal wounds, and cure common ailments through the judicious and often experimental use of local herbs. As tribal units grew in number, some members became specialized in these techniques and became the “healers” or “shamans” of their tribes. They were tasked with day-to-day healing and also with the transmission of medical information from one generation to the next.

The transition from tribal medicines to modern medical science is embedded in the growth of human civilization. The formal start of modern medicinal use is considered to have taken place in Mesopotamia, but ancient societies of tribes and other social units practiced the healing arts thousands of years prior to the civilizations of the ancient Near East. The formalization of medicine as a distinctive science undoubtedly dates first from the Egyptians and shortly thereafter from the Alexandrian Greeks, who acquired medical information from their conquest of India and Egypt and introduced it to civilizations of the Mediterranean.

Early Egyptian and Indian Medicine

The Greeks learned much from the Egyptians, who, in turn, had learned from the civilizations of Mesopotamia. Ancient Egyptian physicians treated diseases in ways both physical and spiritual. They developed a basic understanding of anatomy and used this knowledge to perform surgeries more than forty-five centuries ago.

Ancient papyrus accounts reveal that Egyptians knew how the body worked and had a broad understanding of the heart, the pulse, blood, and breathing. These documents clearly show that the Egyptians knew about the spleen, heart, anus, and lungs and their functions. They also addressed female issues such as menstrual flow and birthing problems, and the records include a reference to the first known female physician, Peseshet, who lived and practiced in the Fourth Dynasty (c. 2613-c. 2494 BCE). The first medical hospital, called “the Life,” was established in the Second Dynasty (c. 2775-c. 2687 BCE), and by the Twelfth Dynasty (c. 1991-c. 1786 BCE), Egyptian workers had pensions, medical insurance, and sick-leave benefits.

Physicians in the subcontinent of India in ancient times also demonstrated an understanding and knowledge of medicine and dentistry. A tradition called Ayurveda, now more than two thousand years old, encompassed religious beliefs important in healing as well as instruction in herbal practices that demonstrated the understanding of the concept of holistic healing of diseases. The early Ayurvedic text known as the Charaka Samhita defined the purpose of medicine: to cure the diseases of the sick, to protect the healthy, and to prolong life. Toward these goals, the text detailed medical examination, diagnosis, treatment, and prognosis for many sicknesses; among many other procedures, it described rhinoplasty and cataract surgery. The study of medicine involved acquiring a knowledge of distillation, operative skills, and skills in cooking, horticulture, metallurgy, sugar manufacture, pharmacy, mineral analysis and separation, metal compounding, and preparation of alkalis. Training took up to seven years, and students had to pass a medical board test before they could become physicians.

Ancient Greek, Roman, and Islamic Medicine

Hippocrates, considered the father of medicine, was born in Greece in about 460 BCE. He believed that observation and recording of patients’ symptoms were critical aspects of patient care. In the twenty-first century, Hippocrates is best remembered for his ultimate contribution to the growth of medicine, which is embodied in the Hippocratic oath.

The ancient Romans were a practical people, and their medicinal science emphasized public health and personal hygiene. Functional toilets, baths, water pumps, and a city sewage system improved health by making possible a constant supply of clean water. To prevent disease, the Romans embarked on a major program of draining marshes, which, they correctly believed, bred disease-carrying mosquitoes.

Among the major medical advancements made by ancient Islamic civilizations were contributions to the fields of anatomy, ophthalmology, pharmacology, pharmacy, physiology, and surgery. Islamic physicians set up universities and wrote many texts of their findings that were used in universities in the Middle East and Europe. The text De gradibus connected mathematics to medicine in its quantification of drug dosages. Many medical tools invented in ancient times by Islamic physicians are still in use in the twenty-first century; these include forceps, ligatures, surgical needles, the scalpel, the curette, the retractor, the surgical spoon, the surgical hook, the surgical rod, the bone saw, the speculum, plasters, and catgut.

Medieval to Modern Medicine

Advances in medical science in Europe slowed during the Middle Ages, in part because of the Roman Catholic Church’s dominance over Europe. The Church pressed the idea that human illnesses were caused by sin and insisted that only repentance and redemption could alleviate pain and suffering. In the late Middle Ages, however, many universities were established, and students were encouraged to challenge traditional and folkloric beliefs. This enabled a resurgence of the medical field during the Renaissance that has continued to the present. A major part of this growth involved the discovery and application of techniques from the Muslim world and from India.

The transition of medicine into a modern science occurred over the course of the past two centuries with the recognition of disease causation as well as a revolution in thought concerning how patients are treated and how diseases can be prevented. Joseph Lister developed and used antiseptics during the late eighteenth century, and Louis Pasteur created a vaccine for rabies and developed the process now known as pasteurization, which made milk and wine safer to drink. Pasteur’s experiments demonstrated a causal link between microorganisms and diseases that led to the development of germ theory. Florence Nightingale introduced changes into medicine through her role as a nurse, focusing on alleviating patient suffering and mortality caused by lack of hygiene and nutrition.

The application of scientific method and research produced many new developments in medicine. In addition to concerns with the physical body, modern medicine expanded its role to include mental illness as a new category. Eventually, advancements such as genetic screening and cancer prevention programs were included within the role of medicine.

Medicine and

Forensic medicine, a branch of both health sciences and forensic sciences, is charged with determining and interpreting medical facts in legal cases. Forensic medicine is especially concerned with the areas of biology, pathology, and psychiatry that may be important in criminal and other court cases. It encompasses everything from the signing of birth and death certificates and negotiating insurance claims to performing autopsies and presenting expert medical in courtroom trials. Because mainstream medicine, as taught in hospitals and medical schools, is such an established and accredited science, the testimony of forensic medical examiners is considered extremely credible evidence.

Forensic medicine also includes such common legal medicine procedures as paternity testing, determination of cause of death, psychological evaluation of suspects or witnesses, and (deoxyribonucleic acid) analysis of materials and samples from suspects and victims. A forensic medical expert must know all about human anatomy and human capabilities related to body structure and abnormalities that might be caused by crimes or malpractice. Such knowledge plays a major role in crime scene reproduction, which may lead to indicative or exclusionary testimony.

Forensic pathology focuses on determination of the in legal cases; this area of specialty includes the study of the structural changes caused by disease or injury. A or performs an to determine the exact cause of death, but often cause of death is obvious upon arrival at the crime scene. Investigators are trained to look for bullet wounds, strangulation marks, of drug overdose, and similar evidentiary details, depending on the type of crime. The forensic pathologist and coroner work together to gather information from the crime scene and autopsy, and this information becomes evidence in court.

Toxicological analyses of diseased persons or of dead bodies are also important in both the practice of medicine and the application of forensic medicine. Toxicology studies can determine the physiological cause of death and provide information about the daily life of an individual or about the time immediately before death. Forensic toxicological analyses can provide information about suspects as well. Some cases have been dismissed based on toxicological evidence that proved the suspects may have been in an altered state of mind caused by negative reactions to pharmaceutical drugs at the time the crimes were committed. Negative reactions to prescription drugs can cause delusions, momentary psychosis, and panic attacks, and in cases such as these, the individual’s state of mind is at issue.

Medicine likewise is central to investigating malpractice cases. In the United States, from 2014 to 2018, 3 percent of the 881,876 physicians licensed to practice in the country had at least one malpractice claim against them. All the tools at investigators' disposal could be applied to investigating such cases.

Bibliography

Adelman, Howard C. Forensic Medicine. New York: Chelsea House, 2007.

Hyman, David A., et al. "Association of Past and Future Paid Medical Malpractice Claims." JAMA Health Forum, vol. 4, no. 2, 2023, doi: 10.1001/jamahealthforum.2022.5436. Accessed 16 Aug. 2024.

James, Stuart H., and Jon J. Nordby, eds. Forensic Science: An Introduction to Scientific and Investigative Techniques. 2d ed. Boca Raton, Fla.: CRC Press, 2005.

Payne-James, Jason, Anthony Busuttil, and William Smock, eds. Forensic Medicine: Clinical and Pathological Aspects. San Francisco: Greenwich Medical Media, 2003.

Shepherd, Richard. Simpson’s Forensic Medicine. 12th ed. London: Arnold, 2003.