The power of the coroner declined rapidly after the fourteenth century, especially with the abolition of the murdrum fine and with the rise of the justices of the peace. Though officially the coroner never had any judicial functions, his brief being to ‘keep’ rather than to ‘hold’ pleas of the Crown, he did often try criminal pleas, and in 1215 the Magna Carta included a provision (Ch. XXIV) that prohibited coroners (amongst others) from exercising this judicial function, which was from then confined to the Country Courts.
With the decline of the medieval inquest, the office of coroner went into limbo for many hundreds of years. By 1500, almost the sole remaining function of the coroner was the holding of inquests into violent deaths, but even these no longer held the same importance as in the thirteenth century. In 1487, Parliament tried to induce the coroner to carry out his duties more diligently by providing a fee for every inquest and a fine if he omitted to do so.
It was not until 1751 that any significant action was taken to improve the status of the coroner. Fees were increased and traveling expenses were granted. But it was the nineteenth century that saw the revival of the office of coroner into what we recognize today. Due to the advent of comprehensive registration of deaths after 1836, the whole administrative system was tightened up and the coroner’s function in investigating unusual deaths became strengthened. In the same year of 1836, an Act gave coroners power to order a doctor to perform an autopsy and to attend an inquest: the jury could also demand a second medical opinion. A series of Acts during the latter part of the eighteenth century and further Acts in this century established a salaried, though still mainly part-time, coroner service. The Coroner’s Society itself was founded in 1846.
At last proper facilities and incentive for post mortem medical examinations were provided, for until this period the medical aspects of death investigation were virtually nil. The Coroner’s Act of 1887 declared that the function of the coroner was no longer that of protecting the financial interests of the Crown, but that of investigating deaths for the benefit of the community. It was with the increased interest in the public health and the collection of statistical data that causes of death became of importance from the medical point of view, rather than the former rough classification into accident, suicide or murder. A Select Committee in 1910 recommended that ‘a coroner should have the power to order and pay for a post-mortem in cases of sudden death where the cause is unknown and there is no reason to suspect that death is unnatural or violent’. This led for the first time in 1911 to disposal of coroner’s cases without the hitherto inevitable inquest. The Coroner’s (Amendment) Act of 1926 gave recognition to the transfer of criminal investigations concerning deaths from the coroner to the police.
In 1935, a Committee of Enquiry under the chairmanship of Lord Wright enquired into the law and practice relating to coroners, though very few of their recommendations have been implemented. In 1971, a further extensive enquiry carried out during the preceding six years was published, the so-called ‘Brodrick Report’. Much of the recommendations of this wide-ranging enquiry have now been implemented, mainly those dealing with coroner’s practice. Included in the changes brought about between 1977 and 1980 were the abolition of the coroner’s power to commit a person for trial on a charge of criminally causing a death (Criminal Law Act 1977); the abolition of the need for the coroner to view a body before inquest (Coroner’s Act 1980); the acceptance of written instead of oral evidence at inquest (Coroner’s Rules 1980); the referral of criminally-caused deaths to the Director of Public Prosecution (Coroner’s Rules 1977); and the power to dispense with a jury in several types of inquest (Criminal Law Act 1977).
Both the Wright Committee Report and the Brodrick Report re-affirmed confidence in the office of coroner, viewing them favourably in contrast with alternative systems of death investigation.
The main advantages of the coroner system appear to be:
The system has evolved from almost 800 years of experience in the investigation of unnatural, suspicious or unexpected deaths and in spite of rigorous scrutiny on several occasions during the last century; no better alternative system has been devised.
The coroner’s system was introduced progressively into other countries as the English influence spread. It has been mentioned that this came too late in the case of Scotland to displace the well-entrenched legal procedure there, but Anglo-Norman expansion into Wales and Ireland took the legal institutions with it. In the case of Wales, a system of law more highly developed than that of the contemporary Anglo-Saxon laws existed for hundreds of years before the Norman Conquest, codified under Hywel the Good (c. AD 930). This was displaced piecemeal by English incursions, beginning in the south of the country, but the legal system with the coroner did not apply generally until well after the Edwardian Conquest of 1282. With the Act of Union of 1536-37, the law of Wales was completely unified with that of England.
Similarly, English law, carrying the coroner’s system with it, was introduced progressively into Ireland following the beginning of the Anglo-Norman Conquest which started in 1169. Today, both the Republic of Ireland and the Province of Ulster both have a coroner’s system which is almost identical with that of England, except in minor detail.
The 13 colonies in America were also under English law before Independence and the coroner’s system was retained as the United States expanded to its present extent. However, the system has changed considerably, both in the duties and appointment of coroners, where this office is retained, and in the conversion to medical examiner systems in some states. In contrast to England and Wales, where the coroner is a permanent appointee of local government, most American coroners are politically appointed and their tenure of office is dependant upon political power and patronage. Frequently, the American coroner has no qualification either in medicine or law, as is mandatory in England, and there is considerable variation as to his duties and powers in different states. Due to the numerous weaknesses of the system, the introduction of medical examiners has been a feature of parts of the USA during the present century.
In the English context, there is now a very close relationship between the functions of the coroner and the pathologist, the former being dependent to a considerable extent upon the findings of the latter. In the medical examiner system, this close relationship has been recognized to such an extent that the offices have virtually been fused, the medico-legal expert also having the official executive powers to categories and dispose of the death. Probably the best known example in the United States is that which exists in New York City, introduced in 1915 after considerable criticism of the previous coroner system. The Chief Medical Examiner must be a medically qualified man and a trained pathologist, his appointment is under the Civil Service, and he is appointed by the Health Department, the office being independent of political vagaries.
The medical examiner has to enquire into deaths which are frankly or suspectedly criminal, suicides, sudden or unexpected, accidents and other similar instances where the medical attendant is unable to certify that death occurred from natural causes. Records must be kept of every enquiry into a death reported to his office and if he discovers or suspects that a death is due to criminal action, he is obliged to notify the District Attorney, who is responsible for initiating prosecutions. The medical examiner’s records are made available to the District Attorney and such records are admissible as evidence in American courts. These records are also available to any other interested party, and part of the declared function of the medical examiner’s office is to provide a source of expert opinion that is available to either party in a criminal trial. Unlike the coroner, the medical examiner has no power to initiate an enquiry or to hold an inquest.
Cases are referred to the Chief Medical Examiner from a variety of sources: the police, doctors, the city health department and any citizen, have a duty to report any deaths in which there is some cause to think that further investigation is required. The reporting from doctors is sometimes less direct than in the comparable English system: physicians are required to send to the City Health Department a certificate of death and a confidential medical report containing an opinion as to the cause of death, these documents being in a form prescribed under the City Health Code. Where death is not a straightforward natural event occurring during medical treatment, some doctors report directly to the medical examiner, but otherwise the Health Department have a routine check on incoming documents to decide whether or not the case should be referred to the medical examiner’s office. This is a more extensive parallel with the screening carried out by the Registrar of Deaths in Britain, who has an obligation to refuse to register certain categories of death and to refer them to the coroner. In New York Health Department, specially trained clerks scrutinize medical reports to ensure that the Chief Medical Examiner is notified of all appropriate deaths within his jurisdiction.
Once reported, the Chief Medical Examiner or one of his expert medical staff examines the body and takes charge of the medico-legal aspects of the investigation. As the majority of such deaths are unnatural, it is the rule for the medical examiner to attend the scene of death. Here he makes a full investigation of the circumstances and is empowered to take charge of any objects which might be relevant in the investigation. He also has the power to decide whether or not an autopsy is required: if not, he can issue a certificate of death.
Where an autopsy is performed, it is done at the Chief Medical Examiner’s official premises and if the death is a homicide, the autopsy must be witnessed by at least one other medical examiner. The decision whether to hold an autopsy or not is the responsibility of the Chief Medical Examiner and he may be sued by relatives or other interested persons who dispute his decision.
The advantage of the medical examiner’s system is that a large proportion of all deaths are scrutinized by a trained medico-legal expert and undoubtedly any with a criminal, or potentially criminal, element are subjected to a detailed autopsy and full back-up of forensic investigation. However, the system does not investigate the non-criminal death in any depth, as once the attending medical examiner has decided that criminal aspects are absent, investigation is less through than with similar cases under the English coroner’s system. The total autopsy rate is much lower under the medical examiner’s system, which means that the purely medical and statistical investigation of sudden deaths is less detailed: potentially, there is a greater chance of missing the occult criminal case because of the lack of an autopsy. The advantages of a wide-spread ‘on-scene’ scrutiny have to be weighed against the lower autopsy rate when evaluating the relative merits of the two systems.
The position is admirably summarized by the members of the British Inter-departmental Committee on Death Certification and Coroners, which made a detailed survey of other systems for comparison with the coroner’s system. They commented: ‘But, like the Procurator Fiscal, the enquiry of the medical examiner into deaths from which potentially criminal causes can be rapidly excluded, is thereafter too perfunctory to provide an acceptable model of accurate certification of the medical cause of every death. It has never been possible, even in New York, to produce statistics about causes of death in the form which such records can be produced in England. In many cases, the medical examiner is doing no more than providing evidence of the fact of death of certain individuals which cannot be provided in any other way. Unlike the coroner, his jurisdiction stops well short of adequate enquiry into the circumstances of those deaths which are singled out for special investigation for other than purely medical reasons. Given the predominantly medical bias in the medical examiner’s training, it is not surprising that the medical examiner’s investigation of the circumstances surrounding a death is sometimes not regarded as sufficiently thorough in removing public doubts and suspicions. When an English coroner accepts jurisdiction over a death, he is obliged to certify the cause of death as well as to provide (in inquest cases) the information required for registration purpose.
The above description of the New York medical examiner system is paralleled to a great extent by other medical examiner organizations in various states or part of states of the USA. Another well-known model system is that which exists in Virginia. It contrasts with the high density of population in the New York area by having to deal with an area roughly four-fifths of the size of England, with a population of only about 4 000 000. In these circumstances, the Chief Medical Examiner has a number of assistant Chief Medical Examiners to conduct autopsies but also several hundred medical examiners, who are primarily physicians but who attend scenes of death to make the primary decision as to whether further investigation is necessary especially an autopsy. The autopsy rate in Virginia is around 20%, compared with well over 80% in Great Britain. In the State capital, Richmond, this percentage rises to over 60%, but, again, is comparably much lower than the 97% achieved in some large British cities. For an excellent account of the Virginia medical examiner’s system, the reader is referred to the paper by the present book.
Continental (European) Systems
Though there are considerable national variations between the different nations in Europe, all are much more akin to each other than to the coroner or even the medical examiner system. The common and major difference is that no official comparable to the coroner or medical examiner exists to investigate or supervise the handling of deaths in the community-this interest is retained by the executive and judicial officers of the law enforcement apparatus. Most of the countries have a rigid Criminal Code which defines the procedure for the investigation of criminal or suspicious deaths. Each citizen has a statutory duty to report circumstances relevant to such deaths directly to the police, who are the initiators of all investigations into which are other than innocuous and natural. No enquiry into deaths, comparable with the English inquest, exists on the continent outside the criminal trial.
As an adjunct to this purely law-enforcement-orientated procedure, medico-legal experts (almost always specifically recognized and approved by the legal executive) exist to assist the police in their investigation. They have little or no power to initiate any investigations, but are there to provide expertise upon the request of the police or judiciary. Thus, although the scientific standard of legal medicine may be as high or even higher than anywhere in the world, its application may be frustrated by the absence of any stimulus or even acquiescence from the law enforcement officers.
In practice, this means that in many continental countries, a suspicious death will be referred by the police to a legal medicine institute where an external examination will be conducted. If this examination, taken in conjunction with the circumstances, seems to exclude criminal action, then the matter is dropped. Where criminality is suspected or evident, then the police will probably request an autopsy and repot the matter to the Public Prosecutor, in the same manner that the American medical examiner reports to the District Attorney. Depending on the result of the medico-legal investigation, the Public Prosecutor, who often has to be present at the autopsy, may institute criminal proceedings. There are a number of countries where the permission of the Public Prosecutor is necessary before a request for autopsy from the forensic pathologist is approved.
As with the medical examiner system, this leads to a situation where criminal deaths are thoroughly investigated, but the remainder of unnatural – but apparently innocent-deaths tend to receive much less attention than under the English coroner’s system.
The Development of Medical Jurisprudence and Forensic Medicine
Until now, we have examined the origins, development and present state of the death investigation machinery in its official governmental aspects. However, the medical and scientific study of legal problems developed alongside the establishment machinery. Often it responded to the contemporary needs of law enforcement and at other times it was well in advance, even stimulating administrative improvements.
Medical jurisprudence is the older term in English usage, but now forensic medicine or legal medicine have become more common descriptions, except perhaps in Scotland. The history of legal medicine extends through millennia and probably the best concise account is that of Richard Myers and Robert Britain.
The salient points in the history of forensic medicine extend back to the early civilizations of Babylon, Egypt and China, but in the European context, from which virtually all present-day systems have originated, the early sixteenth-century saw the dawn of modern legal medicine, mainly in Italy and Germany.
Various codes and laws which related mainly to the practice of medicine and sometimes to the examination of criminal deaths are extant from Babylon around 2000 BC and from China, India, Egypt, Persia and Greece before the time of Christ. In the Roman period, from which codes of legal practice arose which are the antecedents of continental laws, the famous Twelve Tables of 449 BC set the limits of the duration of pregnancy at 300 days, which was identical with that fixed by the Code Napoleon long afterwards. Medico-legal factors concerning the insane, the unborn child and personal injuries were codified. External post mortem examination in criminal deaths was obviously carried out, as the body of Julius Caesar was carefully examined by the physician Antistius. The Justinian Code, a vital milestone in the development of law, recognized the status of the doctor as an expert witness and as an impartial assessor. This code, dating from about AD 550, dealt with a considerable number of legal situations in which medical evidence must have been important, especially in connection with sexual and obstetric problems.
Chronologically, the next important event was the publication in China of the book ‘His Yuan Lu’, a text of medical jurisprudence published about AD 1250, which was reprinted right up to the end of the nineteenth century. However, it was in Europe that legal medicine as we recognize it today began to evolve and as in so many aspects of the Renaissance, it was Italy that took the initiative. Bologna had medico-legal experts as early as the thirteenth century, the emphasis again being upon obstetric, homicidal and toxicological matters. Autopsies were carried out and a number of cities had medico-legal physicians. Pope Innocent III provided for the appointment of doctors to the courts in the thirteenth century and shortly afterwards Pope Gregory IX issued Decretals which contained may medico-legal connotations, once more primarily concerned with aspects of reproduction: it was here that the ‘Proof of Congress’ in alleged impotence was devised. For the next few hundred years in Italy, various Popes ordered further medical assistance to the ecclesiastical courts, mainly in matters of sexology, public health and disposal of the dead.
Though the premier site of the development of forensic medicine in Europe was Italy, it was some what haphazard and it was left to the German states to begin the orderly regulation of forensic medicine that still characterizes the excellence of their numerous institutes today. The first systematic code of criminal law and procedure in Europe was promulgated by the Bishop of Bamberg in 1507. This Bamburg Code required that medical evidence was required in investigation of all deaths from violence and other German states adopted its provisions.
It led within a few decades to the even more comprehensive and famous code of the Emperor Charles V. This Caroline Code of 1532 has widespread geographical application over the Empire of Charles and its provisions were more far-reaching than the Bamburg Code. Internal autopsies were made much more frequently under the Code and the range of conditions dealt with included homicide, suicide, abortion, infanticide, serious injuries, complications of pregnancy and a number of other medico-legal matters that look so similar to present day practice. The courts were required to call medical evidence more frequently and the Caroline Code can justly be said to be the charter for modern forensic medicine.
During the rest of the sixteenth century, other codes followed in Germany and their example was reflected in advances in France and Italy.
Publications began to appear in the field of legal medicine, now that a recognized discipline had emerged fortuitously at the time when printing techniques were causing a communication explosion in Europe. The first individual names of medico-legal appeared such as Sebidz, Zittmann and Behrens.
The next period was one of consolidation and steady advance in academic legal medicine. Teaching of medical students now included public health and legal medicine, which were closely allied as they still are today in some universities and in the International Academy of Legal Medicine and Social Medicine.
In 1575, the famous Ambroise Pare wrote a treatise on the surgery of trauma, including much of medico-legal importance. At the end of the sixteenth century there were a number of other books published, most of which emphasise the sexual and reproductive aspects of medicine, often from a legal point of view. Some of these also included traumatology. In 1598 the famous work of Fidelis of Palermo was published, with four volumes dealing with all manner of medico-legal matters.
In the next century the paramount work was that of Zacchias, one of the physicians to Pope Innocent X. This book, ‘Medico-Legal Questions’, was published at intervals over 14 years, and dealt with a wide range of forensic subjects, again with considerable importance attached to matters connected with sex and pregnancy.
In this seventeenth century, there were a number of German treatises, including those of Sebitz, Welsch and Johannes Bohn.
In the eighteenth century, France was prominent in legal medicine, with personalities such as Louis, the first teacher of legal medicine in the country. Three chairs of forensic medicine were created, towards the end of the century, in Paris, Montpellier and Strasbourg. Mahon was the first professor in Paris and published a well known textbook in the first year of the nineteenth century. A subsequent and very famous holder of the Paris chair was Qrfila who is well known as the founder of forensic toxicology. His ‘Treatise on Poisons’ was translated into a number of languages and was the standard textbook for many years.
In Germany at this time, the main figure was that of Casper who taught in Berlin and wrote the classic ‘Practical Handbook of Legal Medicine’ in 1856.
From this point onward, the era of modern legal medicine in the continental European countries can be said to have commenced. From these energetic beginnings in the sixteenth to the nineteenth centuries, the present extensive network of academic medico-legal institutes was consolidated in Italy, Germany and France and spread to Central and Eastern Europe, which have developed numerous institutes on the German pattern.
The acceptance of the continental institutions in medical jurisprudence was much slower in Great Britain. Although British scientists and men of letters were in constant and close touch with the centers of learning in Europe, the traditional insularity and difference in the legal system have caused the academic acceptance of legal medicine in Britain to be both later and less secure, contrasted with that on the continent. The first Chair in Medical Jurisprudence was established in Edinburgh in 1807, though it was the source of political ridicule at the time. Prior to this, the first publication in legal medicine in English was a translation of Fazelius’ ‘Elements of Forensic Medicine’ of 1767, made by Samuel Farr in 1788.
Scotland took the first real interest in academic forensic medicine, a tradition which it thankfully preserves to this day. Andrew Duncan was the first teacher of legal medicine at Edinburgh, combining his Chair of Physiology with lectures on public health and legal medicine. These lectures were published in 1792 and his personal efforts at arousing interest in legal medicine culminated in the establishment of the Chair in 1807, which was first occupied by Duncan’s eldest son, also Andrew. A later incumbent was Sir Robert Christeson, the most well-known of the early nineteenth century British medico-legists. He was primarily a toxicologist and published a treatise on poisons which was very similar to Orfila’s book of the same name. The Edinburgh Chair remained pre-eminent for much of the nineteenth century, with famous names such as Traill, Henry Littlejohn and his son of the same name. Much more recent holders of this famous Chair include Sir Sidney Smith and Douglas Kerr, who died in 1960. A Chair was established in the University of Glasgow in 1839 soon after the next Chair in Britain, that at Guy’s Hospital in 1834. The latter was held by Alfred Swaine Talyor, probably the most famous name in England legal medicine and originator of the standard work emanating from London, this present book being the direct successor of Taylor’s original, well over a century ago.
Legal medicine never became so well established in the universities of England and Wales as it did in Scotland. The established Chairs in London lapsed, even that of Swaine Taylor and the present professorships are but personal Chairs. In fact, there is only one established Chair of Legal Medicine in the whole of England and Wales, at the University of Leeds: even this came near extinction in 1972. Unlike the well-established institutes on the European continent, legal medicine in Britain has had little support from the government and a reluctant partnership with universities, so the quality to of British forensic medicine has been due mainly to the quality and enthusiasm of individualists. It was hoped that a turning point might be the Brodrick Report which appeared in 1971 after six years gestation. To date (1982) no implementation has been made of those recommendations which advocate government support for declining academic departments of forensic medicine, which would infuse new life into a small but vital part of the administration of justice in the country.
Like Britain, the development of legal medicine in the United States has been a patchy and individualistic process, rather than the more orderly system on the European continent. The English styled law was transplanted by the early settlers and the coroner’s system and medical examiner’s system have developed from that. The medical aspects of law developed slowly until the nineteenth century, again a parallel state of affairs to that in Britain. The first lectures in forensic medicine were given soon after the commencement of those in Edinburgh – J.S. Stringham being the first professor of legal medicine in New York, appointed in 1813. He was in fact an Edinburgh graduate. His contemporary in Philadelphia, Benjamin Rush, was also Edinburgh-trained. Both these early academics wrote the first medico-legal treatises in the New World. Rush was, in fact, one of the signatories to the Declaration of Independence. The first major publication was that of T. R. Beck, Professor of Medical Jurisprudence at Albany, who published ‘Elements of Medical Jurisprudence’ in 1823. His brother J. B. Beck was professor in the same subject at the College of Physician and Surgeons in New York and later collaborated with his brother in later editions of the work, which was extremely popular in many countries outside the United States.
Following this, a number of well-known names are recorded in the annals of American legal medicine, including Gross, Amos Dean, Hamilton Godkin and Reese. Later in the century, a major work was that of Whitthaus and Becker. In the early part of this century, practitioners and writers in legal medicine came thick and fast, such as Culbertson, Peterson and Haines and also Herzgog.
In the modern era, the best known textbooks were those of Gonzales, Vance and Helpern in 1937 with a second edition in 1954 adding Umberger as additional author. Alan Moritz contributed the well-known ‘Pathology of Trauma’ and R. B. H. Gradwohl, a prime mover in the establishment of legal medicine in the United States, edited his ‘Legal Medicine’ in 1954.
No mention of American legal medicine would be complete without acknowledging the preeminence, not only in the USA but world-wide, of the late Professor Milton Helpern, Chief Medical Examiner and Professor of Forensic Medicine in New York. Retiring in 1974, his expertise and leadership in the field of legal medicine has been felt not only in the New World but in many parts of the globe.
In summary, the present state of affairs appears to be that the scientific and academic face of forensic medicine is often well in advance of the legal and administrative arrangements. In many countries, its full potential cannot be realized, due to frustrations in governmental machinery for applying the technical advances of past years.