Medicolegal Death Investigation, a history
December 9, 2022
If you hadn’t heard yet – I’m launching my podcast next month! I think you guys are going to love it! We will be exploring the field of medicolegal death investigation through interviews and guest lectures from specialists in forensic science. I’m on a mission to highlight the jobs, histories, struggles, and successes of my fellow last responders. Join me twice a month to hear case studies, lessons learned, and other tips and tricks for surviving and thriving in a forensic science career.
In preparation, I’ve been researching the background of medicolegal death investigation. Did you know that formal death investigation can be traced back to ancient China? The earliest known MDI textbook, translated to The Washing Away of Wrongs, was printed in 1247 during the Song Dynasty. In medieval Europe, the term Coroner appeared in the formal records in 1194, in reference to a position created to ensure the king was paid for any township deaths. Throughout the Renaissance period into the 19th century, anatomical dissections were used for academic purposes, leading to ebbs and flows of unethical practices in body procurement. The question of “why people died” began with better understanding of disease practices and, eventually led to more modern forensic medicine. While the US initially inherited the coroner system, the turn of the 20th century led to medical examiner offices and trained forensic pathologists. Suffolk County (MA) established the first medical examiner’s office in 1877, the City of New York - OCME was established in 1918, and the Maryland statewide office opened in 1938. (Read Dr Victor Weedn’s 2019 article here)
The Bureau of Justice Statistics’ Medical Examiner and Coroner 2018 census (CMEC) reported almost 2,040 medical examiner and coroner offices in the US. Employed at these offices were forensic pathologists, non-physician coroners, death investigators, analysts, toxicologists, administrators, and other investigative support staff and specialists. Medical Examiners and Coroners serve their community by documenting disease, trauma, and/or injuries for the purpose of establishing cause and manner of death and signing death certificates for the purpose of funerary disposition. Coroners will call upon a physician or forensic pathologist when an autopsy is required to establish cause and manner of death. Forensic pathologists are medical doctors who have additional training in the “examination of body fluids, cell samples, and tissues (pathology) AND determination of the presence or absence of disease, injury or poisoning; evaluation of historical and law-enforcement investigative information relating to manner of death; collection of medical evidence, such as trace evidence and secretions, documentation of sexual assault; and reconstruction of how a person received injuries.” (NAME So You Want to Be a Medical Detective). While forensic pathologists have a specific education and career pathway to becoming Medical Examiners, other forensic staff come to the job in many ways. Some people have no college degree while others have doctorates. Some work full time while others work consulting or part time.
And the star of the medical examiners or coroner’s office is the decedent. Without the decedent, there would be no need for autopsy! Since the decedent cannot tell us what happened to them, we use their body positioning, taphonomy, the scene, and interviews of family, friends, law enforcement, and medical professionals to help. The forensic pathologist uses specific tools (usually found at Home Depot or kitchen supply stores) and an autopsy technician to facilitate the surgical procedure, that can take anywhere for 45min to hours. Photographs, xrays, and handwritten notes are taken for the purpose of an eventually formal autopsy report. Some offices do autopsies at a medical facility with their offices elsewhere, while other offices have a standalone, one stop shop. Some offices do their autopsies in the morning a few times a week, while others work all day every day. As far as I know, there are no autopsies performed in the middle of the night, like some TV shows will have you believe. Clothing and other personal effects are documented and released with the decedent. Other supporting roles involved in medical examiners and coroner offices are the Funeral Home, the Family, Law Enforcement, Hospital/Medical staff, and Donation Services (such as Gift of Life, Sharing Network, or Eye Banks).
Did I miss anything? Please share if you can think of any important people or tasks I’ve left out. I’ve been working in this field for almost 15years but there is not a day that goes by I don’t learn something new. I was interested to learn the brief history of our field – I think we have come so far and still have a long way to go!
See you again soon,
Kat
