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Forensic Medicine: the Story, Clinical Nexus and Challenges of the Practice in Nigeria EDITORIAL FORENSIC MEDICINE: THE STORY, CLINICAL NEXUS AND CHALLENGES OF THE PRACTICE IN NIGERIA OMO-AGHOJA Lawrence 1* AIMAKHU Christopher 2 ZINI Mudiaga 1 1 Department of Obstetrics and Gynecology, Faculty of Clinical Medicine, College of Health Sciences, Delta State University, Abraka, Nigeria. 2 Department of Obstetrics and Gynecology, College of Medical Sciences, University of Ibadan, Nigeria *corresponding author email: [email protected] KEYWORDS: Forensic Medicine, Historical perspective, Clinical Nexus, Challenges, Nigeria BACKGROUND The synonym of forensic medicine is forensic corpse. The scope of modern day forensic pathology1,2. Also called legal medicine or medicine has expanded far beyond autopsies to medical jurisprudence3. Forensic medicine is a include exciting subjects of forensic field that involves collection and analysis of anthropology; forensic odontology; forensic medical evidence (samples) to produce objective entomology; ballistics, fingerprint, crime scene information for use in the legal system2,3. It can and blood spatter analysis; toxicology; DNA; therefore be aptly summed as the science that arson and fire investigation; evaluation of the deals with the application of medical knowledge sexual assault victim; to legal questions. It is also extremely useful in forensic psychiatry (which is used to determine cases where a patient dies without having made the mental health of an individual about to a definitive diagnosis2. The primary tool of stand trial, and thus, his blameworthiness) and forensic medicine has always been more1,2 . It is therefore instructive that the the autopsy2. Frequently used for identification forensic medical services cut across all of the dead, autopsies may also be conducted specialities of medicine with the primary areas to determine the cause of death2. In cases of of medicine that are commonly involved and death caused by a weapon, for example, the harnessed in forensic medicine practice being forensic pathologist - by examining the wound anatomy, pathology, and psychiatry. - can often provide detailed information about To render efficient and effective forensic the type of weapon used as well as important services in any setting, the forensic pathologist contextual information. works with a number of support staff including: In a death by gunshot, for example, he can accident scene investigator; autopsy determine with reasonable accuracy the range technician; coroner; forensic investigator; legal and angle of fire. Forensic medicine is a major consultant; trauma, emergency medicine or factor in the identification of victims of disaster, psychiatric nurse; sexual assault nurse such as landslide or plane crash4. In cause-of- examiner; social services investigator and/or death determinations, forensic pathologists can advocate and more2. also significantly affect the outcome of trials dealing with insurance and inheritance5. Access this article online Though the autopsy is performed by a forensic pathologist or a medical examiner, particularly Quick Response Code during the investigation of criminal law cases and civil law cases in some jurisdictions2, Coroners and medical examiners are also http://ijfmi.com/index.php/hom frequently asked to confirm the identity of a e/article/view/21 Int. J of Forensic Med Invest | Mar 2016 | Vol. 2 | No. 1 | ISSN: 2489-0278 Omo-Aghoja, Aimakhu & Zini; Forensic Medicine: The Story, Clinical Nexus and Challenges of the Practice in Nigeria HISTORICAL PERSPECTIVE forensic toxicologist gives evidence on such topics as intentional poisoning and drug use. The history of Forensic science i.e. applying The toxicologist plays an increasingly "scientific" principles to legal questions is long important role in matters of industrial and and intriguing. Notable examples of its environmental poisoning7. evolutionary timeline include: The story in Africa and Nigeria is very sketchy In 44BC following the assassination of Julius in the literature. However, what is sure is that Caesar the attending physician, Antistius there has been paucity of forensic medicine proclaimed that of the 23 wounds found on the practice as a well-defined subspecialty across body ‘only one’ was fatal. In the 5th century the continent. Though anatomic pathologist Germanic and Slavic societies were believed to has been in practice in several countries of be the first to put down in statute that medical Africa in the past couple of decades of medical experts should be employed to determine cause practice, only few has had formal training and of death. In 1247, the first textbook on forensic indeed practiced forensic medicine in the real medicine was published in China which among time sense. other things documented the procedures to be followed when investigating a suspicious death. SCOPE AND PRACTITIONERS In medieval England, pressure from the church halted the practice of hanging women thought This is a broad and very active field of study to be pregnant. A convicted woman could covering topics that include: forensic escape the death penalty if she ‘pleaded her pathology; forensic anthropology (identification belly’ providing a physician could prove that and investigation of human remains); forensic she was in fact pregnant. The use of medical odontology (dental evidence); forensic testimony in law cases predates by more than entomology (insect evidence); ballistics, 1,000 years the first systematic presentation of fingerprint, crime scene and blood spatter the subject by the Italian Fortunato Fideli in analysis; toxicology; DNA; arson and fire 15981,2,6,7. investigation; evaluation of the sexual assault Inspired by the study of anatomy, medicolegal victim and more1,2. textbooks began to appear by the end of the Forensic pathologists, or medical examiners, 16th century. In German-speaking Europe, are specially trained physicians who examine lectures on forensic pathology were regularly the bodies of people who died suddenly, held in Freiburg in the mid-18th century unexpectedly or violently. The forensic and Vienna in 1804. Scientists like Auguste pathologist is responsible for determining the Ambroise Tardieu, Johann Ludwig cause (the ultimate and immediate reasons for Casper and Carl Liman made great effort to the cessation of life) and manner of death develop forensic pathology into a science based (homicide, suicide, accidental, natural or on empirics. Medical jurisprudence had a chair unknown). After their basic medical training, founded at the University of Edinburgh in they undertake 4-5 years of experience in 1807, first occupied by Andrew Duncan, the pathology residency program. They usually younger. It was imposed on the university by have extensive medical and pathology the administration of Charles James Fox, and knowledge, expertise in the collection of in particular Henry Erskine working forensic evidence and giving forensic testimony, with Andrew Duncan, the elder7. comfort with autopsy procedures, knowledge of The 1877 coroners act ensured that an integral laboratory methods. In addition to anatomy, part of the coroners’ role was to determine the the forensic pathologist may draw upon circumstances and the medical causes of specialized knowledge and training in sudden, violent and unnatural deaths. In 1932, firearms/ballistics and trace evidence. chair of legal medicine at Harvard was A city, county or state may appoint a forensic established. Forensic pathology was first pathologist to act as a medical recognized in the United States by the examiner. Clinical forensic pathologists American Board of Pathology in 19598. examine living patients, usually in cases where In Canada, it was formally recognized in sexual assault or abuse is suspected. Once all 2003, and a formal training program (a the evidence is analysed, the forensic fellowship) is currently being established under pathologist prepares a written report and may the auspices of the Royal College of Physicians also testify to these findings in court. and Surgeons of Canada9. Some forensic pathologists work for the city, Forensic medicine was recognized as a county or federal government, while others specialty early in the 19th century. In the 19th work in hospitals, medical schools or with a century, two other forensic specialties arose, private or group practice which contract namely, forensic psychiatry (which is used to autopsy services to government agencies. determine the mental health of an individual Forensic pathologists spend most of their time about to stand trial, and, thus, his in the lab, performing autopsies or examining blameworthiness) and forensic toxicology. The tissue samples under the microscope. This can Int. J of Forensic Med Invest | Mar 2016 | Vol. 2 | No. 1 | ISSN: 2489 -0278 2 Omo-Aghoja, Aimakhu & Zini; Forensic Medicine: The Story, Clinical Nexus and Challenges of the Practice in Nigeria involve standing for extended periods and Forensic pathologists work closely with the working with small tools. A typical workday can coroner (England and Wales) or medical last 10 to 12 hours or longer, particularly if the examiner (United States)1,2. The examination of forensic pathologist must examine a distant dead bodies (autopsy or post mortem) is a death site. Part of the workday also may subset of anatomical pathology. Often times, a include writing official reports and making coroner or medical examiner has a background court appearances. in pathology. The physical demands are not great, but over Forensic medicine is often used in civil cases. time, the forensic pathologist
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