WHAT IS FORENSIC MEDICINE.

Introduction.
Forensic Medicine concerns the use of medical knowledge for the purposes of the
law and the study of the law as it relates to medical practice.
Forensic is derived from forum- the Latin word for the market place.
The relationship between law and medicine dates back to the times of the Bible
when the Priest functioned as Physician and the custodian of the laws of God. Medical
historians assert that there were documents about medicolegal problems dating back to the
time of Aristotle(4BC)
The subject can sometimes be divided into 4 sections of equal importance:1. Law relating to medical practise- Medical Jurisprudence.
2. Clinical Forensic Medicine.
3. Toxicology.
4. Forensic Pathology.
LAW RELATING TO MEDICAL PRACTISE.
1. Medical Acts and Medical Councils.
2. Medical Certificates.
3. Dangerous Drugs.
4. Medical Ethics:- consent; negligence; professional secrecy.
CLINICAL FORENSIC MEDICINE.
Examination of the hospital patients for the purposes of the law. All hospital
patients are potential medicolegal cases. Clinical Forensic Medicine cases include :Drunks; Victims of Rape, Accidents, Industrial disease and Accidents.
TOXICOLOGY.
The study of the signs and symptoms of poisoning in the living and the recognition
of poisoning in the dead. Poisons can cause sudden death and must therefore be excluded
in all cases of sudden unexpected deaths.
FORENSIC PATHOLOGY.
Concerns the examination of the dead for the purposes of the law. All the citizens
of a country belong to the state. The state is therefore interested in the circumstances and
the cause of death of the citizens.
ORGANISATION OF FORENSIC PATHOLOGY SERVICES.
There are three systems:1. The Coroners System.
2. The Medical Examiners System.
3. The Procurator Fiscal System.
The Medical Examiners System.
This system operates in more than half of the States in the USA. It is headed by the
Medical Examiner who is normally a physician. In some of the states the Medical
Examiner is also the chairman of the department of Legal Medicine in the State University
Medical School.

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There are two types of assistant medical examiners:

1. Type 1 is a physician, and he is the first to be invited to the scene

of an incident. He can certify deaths when he is sure that the death is from natural causes,
and he is reasonably certain of the cause of death.
Type 2 is a pathologist, and he performs autopsies on all the other
cases.
The assistant medical examiners prepare reports of their findings and these are
filled in the library in the office of the Chief Medical Examiner. There are no inquests in
the medical examiners system.
THE PROCURATOR FISCAL SYSTEM.
This is the system in Scotland and most of the Countries in the continent of
Europe. It is headed by the Procurator Fiscal who is qualified in law. The appointment is
made by the Lord Advocate, and he performs the functions equivalent to that of the DPP
and the Coroner
The Procurator Fiscal makes enquiries into all cases reported and he orders
autopsies. There are two types of autopsies in this system:a. Double pathologist autopsy- reserved for murder cases.
b. Single pathologist autopsy - for all the other cases.
There is always an inquest in all accidental deaths. At the inquest the Sheriff sits
with a jury of 7, and the Procurator Fiscal prosecutes the case.
All the cases that go to trial are also prosecuted by the Procurator Fiscal.
THE CORONERS SYSTEM.
This is the oldest medicolegal investigative system, its origin dates back to 1194 in
England. It is operative in most parts of the UK, more than half of the States in the USA,
and in all the Commonwealth Countries that were former British Colonies. This is the
medicolegal investigative system in Nigeria.
Appointment. In Nigeria a Magistrate is ex-officio the Coroner for the district. In busy
districts the State Governor may appoint any other fit person to assist the Coroner. In the
original English system the Coroners were appointed by the Crown from the gentlemen in
the district. In recent times Coroners are appointed by the local councils from senior
members of the legal or the medical profession.
In Nigeria the Coroners are assisted by the local police officers as coroners
officers. All coroners' cases are reported to the local police station where the officers make
all the preliminary investigations and later inform the Coroner.
Deaths to be reported to the Coroner.
1. All sudden unexpected deaths, including deaths that occur within 24 hours of
admission to the hospital.
2. All accidental deaths including road traffic and domestic accidents.
3. All suicides.
4. All homicides.
5. All deaths from poisoning
6. All deaths from industrial disease
7. All deaths from industrial accidents
8. All deaths in prison custody.

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9.All deaths in police custody.
10. All deaths resulting from termination of pregnancy.
11. All deaths that occur in public institutions.

12. All deaths where the relatives are not satisfied with the circumstances and the
cause of the death.
NOTIFICATION OF DEATHS TO THE CORONER.
Any person who finds a dead body should report the case to the nearest police
station. Failure to report is an offence in law.
POST MORTEM ON CORONERS CASES.
Coroners' autopsies are performed on the order of the Coroner. This order is
usually made on a prescribed form on which a doctor's name is mentioned. A doctor who
receives this order cannot refuse to perform the autopsy unless there is another doctor
who has agreed to perform the autopsy on his behalf.
Reports of autopsies performed for the Coroner should only be submitted to the
Coroner through the police that acted as coroners officer. The doctor must not disclose
the findings of the autopsy to any person without the consent of the Coroner.
THE CORONERS INQUEST.
Inquests are public hearings where the Coroner sits as the President. The Coroners
officers act as the prosecutor and the relatives of the deceased have the right to be
represented by a solicitor.
The inquest is designed to answer four questions:1. Identity of the deceased. 2. Date and Place of death.
3. The medical cause of death 4. The circumstances of death.
The procedure is the same as in a court of law.
The Coroners verdict: The verdict is a summary of the circumstances of death. The
Coroner can return any of the following verdicts:1. Death from Natural Causes. 2. Accidental Death.
3. Misadventure.
4. Suicide.
5. Murder.
6. Manslaughter.
7. Infanticide.
8. Industrial Disease.
9. Industrial Accident.
10. Self Neglect.
11. Self Neglect.
12. Abortion.
13. Alcoholism.
14. Open verdict.
The inquest may be reviewed by the High Court if the relatives are not satisfied
with the verdict.

SUDDEN UNEXPECTED DEATHS.

DEFINITIONS
All deaths can be divided into two broad categories.
A. Natural. B.
Unnatural.
Natural Deaths are from recognized fatal morbid anatomical conditions.
All other deaths are classified as Unnatural. All Sudden Unexpected Deaths
must be reported to the Coroner / Medical Examiner.
WHY INVESTIGATE SUD.
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Sudden unexpected deaths are investigated for three main reasons.

1. To Prevent Secret Homicide
2. To Prevent recurrent Accidental Deaths.
3. To Facilitate Accurate Death Registration.
CLASSIFICATION OF SUD.
All sudden unexpected deaths can be classified into four categories
1. Healthy Person drops dead
2. Sick Person dies unexpectedly.
3. Sudden Death of Persons who are bedridden.
4. Deaths within 24 hrs of admission to hospital.
TYPES OF SUD.
There are two main types of Sudden Unexpected Deaths
1. TRULY SUDDEN DEATHS
The persons are observed to suddenly collapse and die; The death is within
seconds; These include cases of Instantaneous Physiologic Death.
2. UNEXPECTED DEATHS:
The persons are known to be ill but the death is usually unexpected in
the terminal period.
INSTANTANEOUS PHYSIOLOGIC DEATH.
This is usually a diagnosis of exclusion. The autopsy is essentially negative in
that there is no anatomical cause of death is found after an exhaustive
dissection of the body. The death is usually witnessed and there is no history
of trauma. Toxicology is also negative and there is no significant autolysis of
the body. The victims are usually below the age of 40years and there is no
degenerative di
Age not compatible with degenerative disease.
INVESTIGATION OF SUD.
HISTORY:- Medical history, Social history.
Family history: Marital status, History of
SUD in the family.
AUTOPSY: 1.External Examination
2. Dissection. A. CVS; RS: CNS.

B. OTHER ORGANS: Difficult Case: Examine

carefully; reexamine skin;Toxicology; Review History.
CARDIOVASCULAR SYSTEM
Hypertension.
Idiopathic Cardiomegaly
Viral myocarditis
Asymmetric Left Ventricular Hypertrophy
Fat Infiltration of the Heart.
Ruptured Aneurysm.
RESPIRATORY SYSTEM
Pulmonary Embolism
Amniotic Fluid Embolism
Air Embolism
Haemorrhage. TB. Tumour.
Pneumonia.
BRAIN.
Subarachnoid Hamorrhage.
Pontine Haemorrhage.
Cerebellar Haemorrhage.
Epilepsy
Encephalitis
Meningitis.
GASTRO INTESTINAL.
Gastroenteritis
Gastro Intestinal Haemorrhage
Ruptured Varices
Typhoid
Perforated Typhoid
Perforated Peptic Ulcer.
Volvulus
MISCELLANEOUS
Anaphylactic Shock.
Laryngeal Oedema
Diabetic Acidosis
Fatty Liver
NO ANATOMICAL CAUSE OF DEATH FOUND.
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