The history of forensic medicine in times of the Weimar republic and national socialism--an approach

German Forensic Medicine established the tasks and aims of forensic medicine during the period of the "Weimar Republic" (1919-1933). Since 1925, forensic medicine is part of the medical examination regulation. In times of the 3rd Reich (1933-1945), most of forensic pathologists were influenced by and involved in National Socialism. The special subject of forensic medicine was endangered by the absence of political neutral forensic pathologists.     

The development of forensic medicine in the United Kingdom from the 18th century.

Forensic medicine in the United Kingdom includes both forensic pathology and clinical forensic medicine on the living. It began at the end of the 18th century, long after its development in Germany, Italy, France, and other countries in Europe. Initial beginnings were in Scotland, where a program began at the University of Edinburgh with the establishment of a chair in Forensic Medicine by Prof. Andrew Duncan Sr. The development in England began in London's Kings College Medical School with a chair held by Prof. William A. Guy. Later chairs in Forensic Medicine were established in Glasgow, Aberdeen, and in London, where Forensic Medicine was taught at St. Mary's Hospital Medical School, Guy's Hospital Medical School, London Hospital Medical School, Charing Cross Hospital Medical School, St. Thomas Hospital Medical School, and St. George's Hospital Medical School. In other cities in England, Wales, and Northern Ireland, departments were founded in Leeds, Manchester, Cardiff, and Belfast. Many textbooks were prepared during this time by professors from these medical schools and by others working in nonacademic areas. The development of coroner activities and those of the police surgeons is also part of the study of forensic medicine.     

一例药物过敏性休克死亡的医疗问题鉴定分析

目的探讨药物（低分子右旋糖酐）过敏性休克医疗纠纷案件的法医学鉴定思路及关键点，从而为审判提供划分侵权责任及医疗赔偿的科学依据。方法详细报道一例低分子右旋糖酐药物过敏性休克死亡的两级医疗事故鉴定，法医学鉴定及二次不同的法院判决结果的医疗纠纷案例。结果两级医疗事故鉴定均认为该例属医疗意外，不属医疗事故，一审判决驳回起诉。法医学鉴定认为在对该例的抢救过程中确存在不当之处；患者确因药物（低右）过敏性休克死亡，未发现院方有违反医疗常规的行为，对该例的治疗方案属非必要治疗措施。在抢救过程中，肾上腺素没有作为首选用药，肾上腺素应用不及时，药量不充足。因抢救地点的限制致使抢救质量不好。据此，二审判决被告院方对患者方予以赔偿。结论药物过敏性休克的法医学鉴定应注重：①全面审查所提供的详细医疗材料，分析整个医疗过程的临床变化特点；②全面尸检；③进行药品检验、毒物分析；④排除疾病及其它死因；⑤进行确证死因的检验。在此基础上分析确定死因及医疗过程是否存在问题，如存在医疗不当之处，分析此种医疗不当在患者的死亡中的关系比例，并适当表述鉴定意见。     

Unfavorable outcome of medical service: study of the problem in forensic medicine

The main tendencies in the development and study of the problem of unfavorable outcome and expert assessment of quality of medical aid were examined. Russian and foreign forensic medicine and juristic practice were compared. A combined approach to improve of forensic medical expertise and to prevent delinquencies of medical stuff was proposed.     

眼球钝挫伤的法医学研究及其临床意义

眼球钝挫伤在临床上比较多见，且大多涉及法律问题，本文将眼球钝挫伤进行临床分型，通过对４３例法医学鉴定案例分析，发现眼球钝挫伤的损伤规律及法医学特点，并就与法医学有关的临床问题展开讨论，提出了作者的看法和建议。     

国外法医临床学发展史

法医临床学是法医学的重要分支学科,正处于蓬勃发展阶段。研究法医临床学的发展史,对明确其定义和实践范畴,维护司法公正,具有重要意义。本文将从“简介、历史溯源、18世纪之后的法医临床学发展、现代法医临床学、世界法医临床学司法实践现状和结语”六个部分介绍法医临床学在国外,尤其是英国的发展历史,促进我国法医临床学的学科建设和发展。     

Teaching post-mortem external examination in undergraduate medical education--the formal and the informal curriculum

In undergraduate medical education, the training of post-mortem external examination on dead bodies might evoke strong emotional reactions in medical students that could counteract the intended learning goals. We evaluated student perception of a forensic medicine course, their perceived learning outcome (via self-assessment) and possible tutor-dependent influences on the overall evaluation of the course by a questionnaire-based survey among 150 medical students in Hamburg, Germany. The majority of students identified post-mortem external examination as an important learning objective in undergraduate medical education and did not feel that the dignity of the deceased was offended by the course procedures. After the course, more than 70% of the students felt able to perform an external examination and to fill in a death certificate. Respectful behavior of course tutors towards the deceased entailed better overall course ratings by students (p<0.001). Our findings highlight the importance of factors such as clearly defined learning goals and course standardization (formal curriculum) as well as tutor behavior (informal curriculum) in undergraduate education in forensic medicine. Furthermore, we suggest embedding teaching in forensic medicine in longitudinal curricula on death and dying and on the health consequences of interpersonal violence.     

Case histories in forensic medicine

Case histories make up a great part of publications in forensic medicine, especially forensic pathology, although considered low on the hierarchy of evidence based medicine because of its inherent anecdotal nature. Meanwhile some journals exclude case histories categorically from publication. The boom of case histories in forensic medicine has not only opportunity reasons (easily [even mental] and cheap to do) but also structural reasons: due to its tasks in case work many items of forensic medicine can not be simulated experimentally for ethical reasons (violent death, traumatic injuries, sexual assault, poisonings, influence of alcohol and drugs on driving ability and legal responsibility, medical malpractice, adverse events during medical care). In these fields the role of case histories is mainly the augmentation of experience based knowledge. However, quality aspects have to be considered and case histories should be the basis for systematic or hypothesis based research.     

The forensic or medicolegal autopsy. Friend or foe?

The major issue in questioning the performance of general pathologists doing medicolegal or forensic autopsies is that they are very often without a firm basis for performing this task. With minimal training in medical school and minimal exposure during their residency, practicing general pathologists, although expected or even forced to do these cases, may face criticism after their performance in a case. The necessity for teaching forensic medicine and pathology in medical schools is obvious, and the necessity of there being more forensic pathology exposure in residency training programs in the United States and overseas is also obvious. Medical educators are responsible for all phases of medicine being taught to medical undergraduates and graduates and must be pressured to support the practice of all kinds of medicine in American communities, including legal or forensic medicine, in those cases in which questions arise that lead to the performance of postmortem examination.     

Forensic medicine and criminalistics

The supplementary designation "criminalistics" in the title of certain forensic medical institutes in the first half of this century is to be regarded as a reaction to faulty developments in our specialty, which almost led to the elimination of forensic medicine as an independent scientific discipline in the 1960s. The ability to think in terms of criminalistics and the corresponding working procedures has always been a crucial precondition for the forensic physician, since forensic medicine is the application of medical knowledge for juridical purposes. Forensic medicine originated with the appraisal of cases of violent death by doctors, i.e., reconstruction of the facts in the case. To use the term "criminalistics" in the form of a supplementary designation is thus not required. An attempt is nevertheless made to define "medical criminalistics" as a small but important component of criminalistics. They are subdivided into two phases: the first part begins at the scene of the crime or the place of discovery (local evidence). Here, the trained eye of the forensic physician is indispensable to the criminal investigation department and the prosecutor. Medical criminalistic thinking and working procedures continue at the autopsy. Here, forensic autopsy differs from that practiced by the pathologist. Without knowledge of the situation at the discovery location, the forensic physician runs the risk of not recognizing facts that are important for reconstruction and thus becoming a "destroyer of clues". The second part of medical criminalistics is the actual detection of medical clues, i.e., the investigation of medical clues with special methods, including histological and toxicological investigations.(ABSTRACT TRUNCATED AT 250 WORDS)     

中世纪欧洲法医学溯源

法医学是应用病理学、生物学、生物化学和其他医学科学理论和技能解决法律问题,为侦查和审判提供证据的科学。法医学学科属性是医学,其目的是解决法律问题,因而法医学同时具有自然科学和人文科学属性。现今,我们对于法医学的研究往往局限在自然科学领域,而对其人文学科属性却有所忽视。当代西方法医学起源自中世纪的欧洲大陆,当时罗马法和教会法占统治地位,它们没有设立陪审团制度,而且允许对嫌疑人进行刑讯逼供,而英美法系的司法审判程序设立了陪审团制度。在这两种司法体制下,法医医学证言、证词逐步形成了两种形式：英美法系控诉式诉讼体制下的言辞证据形式和罗马法诉讼中纠问体制下的书证形式。本文将对中世纪欧洲的法医学进行溯源研究,从欧洲法医学的起源和发展角度,完善法医学史研究内容,为世界法医学史比较研究提供借鉴。     

脂肪栓塞综合征的法医学研究进展

脂肪栓塞综合征（fat embolism syndrome,FES）是一种较多见而又威胁生命的临床症候。多年来,FES一直是医学界,尤其是法医学及骨科学领域研究的难点。在法医学中,FES的鉴定因缺乏典型的症状、体征,极易发生误鉴或漏鉴。本文就FES的病因、发病机理、病理学、致死机制以及FES的最新法医学诊断研究进行了回顾。     

网络环境下的法医学循证

法医学是当前司法鉴定中的重要组成部分,其研究内容广泛,具有高度的专业性。随着网络技术的发展、信息资源的增加以及人们法律意识的增强,法医学必然会面临许多新问题,对诉讼证据的要求标准也越来越高。鉴于此,在法医学领域应建立起循证的理念,通过循证的方式在法医学以及相关领域内寻求最合适的解决法医学实务中具体问题的证据,循证不但能够及时解决法医学领域的现行问题,其对于法医学的进步与发展也将具有重大的推动作用。本文综述了循证的基本理论及其在法医学领域的作用,以及循证的途径、方法、证据的评价,并探讨网络环境下法医学循证的应用价值。     

致伤方式推断在道路交通事故再现研究及责任认定中的作用

本文从法医学的角度,论述了道路交通事故致伤方式推断的方法、特点以及与涉案人员交通行为方式鉴定、死因分析的相关性,强调了致伤方式推断在事故重建及涉案人员责任认定中的重要性。并以3起真实的道路交通事故为例,阐述了致伤方式推断分析的过程,进一步结合碰撞软件对事故进行计算机仿真研究,再现过程表明致伤方式推断的正确性,初步验证了从致伤方式推断入手分析涉案人员交通行为方式、死亡原因的可行性;同时指出对于致伤方式不明确的道路交通事故,可通过事故遗留的制动轨迹、速度等进行计算机模拟研究,对于致伤方式推断具有一定的参考价值。     

新生儿医疗纠纷相关因素的初探

目的　从法医学和管理学的角度初步探讨新生儿科医疗纠纷的防范与处理。　方法　收集华中科技大学同济医学院法医学系 1994— 2 0 0 2年 8年间 2 7例新生儿尸体解剖案例 ,进行回顾性分析研究。　结果　 2 7例新生儿尸体解剖案例中 ,男性患儿 12名 ,女性患儿 15名 ,平均年龄 18.2 2天。其中围产期 10例。其家属要求均为查明死因。经过鉴定 ,其中医疗事故为 0例 (3 7.0 3 % ) ,不是医疗事故 17例 (62 .97% )。　结论　新生儿医疗纠纷的防范应从医方、患方以及国家与社会 3方面努力进行防范 ;在处理方面 ,及时的尸体解剖和病理检查是解决医疗纠纷一种行之有效的方法。     

损伤程度鉴定中的临床资料分析

作者根据１８１例损伤程度鉴定档案，与用于鉴定的病历材料作对照比较进行回顾性研究，并依据二者表现出的各自特点及差异，从损伤程度鉴定的角度，就法医临床学与临床医学的学科间关系作了初步探讨。     

Origin and development of forensic medicine in the Kingdom of Saudi Arabia

The medicolegal death investigation system in the Kingdom of Saudi Arabia (KSA) is unique in the world. It is exclusively derived from Islamic judiciary based on Shari'ah law, which is the definitive Islamic law or doctrine. This law is applied on Saudi citizens as well as foreigners. This is different from other Islamic countries, which have a combination of Islamic and other judiciary systems.The forensic medicine centers in KSA are related administratively to the Ministry of Health (MOH) and its subdivisions in the different governorates. They are concerned with forensic medical examination and autopsy, as well as the clinical forensic medical examination of sexual assault cases, and those injured in civil and criminal cases. The assisting laboratories (forensic histopathology, microbiology, serology, forensic chemistry) are working independently under the funding of MOH, whereas the DNA laboratory and other departments of forensic sciences, for example, counterfeiting and forgery unit are related administratively to the Ministry of Interior represented by the Administration of Criminal Evidences. Efforts concerning crime scene investigations are shared with Administration of Criminal Evidences' crime scene investigators.Forensic medicine education in KSA developed in the past few years after the foundation of Saudi specialty certificate in forensic medicine. The certificate is a postgraduation qualification equivalent to a doctorate degree in forensic medicine and requires completion of a 4-year training program in both MOH- and Ministry of Interior-related departments, as well as passing annual evaluation and examination.This review is aimed at providing in the next decade the medicolegal centers with national forensic specialists throughout the kingdom and granting skillful headships for the next generations. Moreover, this review suggests more scientific associations with the academic universities in the various fields of forensic sciences through academic cooperation.     

Forensic medicine in Great Britain. I. The beginning

This paper briefly outlines the evolution of modern forensic medicine in Great Britain from the coroner system originally implemented. It focuses on the role of Andrew Duncan, Sr. in creating a chair in medical jurisprudence and establishing a precedent for the teaching of forensic medicine to students and practitioners alike.     

论鉴定留置的若干法律问题

鉴定留置指为鉴定被告心神或者身体状态，而将被告送入医院或者其他适当处所之处分。鉴定留置的存在是与法医学的发展休戚相关。从某种意义上讲，现代去医学发展的不成熟是鉴定留置制度存活的土壤。鉴定留置应定性为一种依附性行为。即依附于强制鉴定，其本身属于调查程序。而非强制处分。鉴定留置属于强制鉴定延伸的自然结果．而强制鉴定将在一定程度上限制被告人的行动自由。应当接受司法审查。强制鉴定作为一种独立的强制措施．对自由的侵犯程度不可与羁押同日而语，甚至其结果可能减轻或者免除被告人的刑事责任。因此在司去审查控制下的鉴定留置期间不应当计入羁押期间。     

The forensic radiographer: a new member in the medicolegal team

Multidetector computed tomography is becoming more widespread in forensic medicine. In most services, autopsy assistants perform the radiological examination. We introduced professional radiographers into the legal medicine service and hypothesized they would also be able to take over duties currently reserved for other specialists. The aims of this study were to evaluate if radiographers could be trained as "forensic radiographers" by (1) integrating graduated medical radiographers into the legal medicine service, (2) investigating the advantages of this collaboration, and (3) defining the duties of the forensic radiographers.The study was performed prospectively on a group of 8 recruited radiographers who underwent a testing period with special training. They learned the basics of medicolegal case treatment, the autonomous execution of postmortem computed tomography angiography, and postprocessing of data. Seven of 8 radiographers finished the training and were integrated into our service. Although all radiographers were able to fulfill the duties demanded after the training period, some radiographers could not enter or complete the program because they were unable to work with dead bodies.Our study presents the advantages of integrating radiographers into the medicolegal team and proposes how to train the forensic radiographers. In addition, the duties and responsibilities of these new specialists are defined.