المجلد 3 , العدد 6 , ذي القعدة 1425 - كانون الثاني (يناير) 2005 |
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تاريخ الطب الشرعي: من التشريح إلى بَصم الـ DNA
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History of Forensic Medicine:
From Anatomy to DNA Fingerprinting
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Abdo R. Jurjus1, Imad S. Nahle2 and Doreid Oueidat3 |
1Faculty of Medicine, American University of Beirut, Beirut, Lebanon
2American University of Beirut, Beirut, Lebanon
3Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon |
A Review Article
مقال مرجعي |
الملخص Abstract |
سارت التقدمات في الطب الشرعي الطبي بشكل متلازم مع التقدم في العلوم وطرق الممارسة المتضمنة لباً مكوناً من التشريح في كافة مستوياته العيانية والمجهرية والخلوية. ولقد وجدت أولى التعليمات الناظمة المتعلقة بالطب الشرعي في قوانين Manu في الهند منذ 3102 قبل الميلاد. من ناحية أخرى، فإن أول دستور تشريع معروف، ذلك الذي وضعه حمورابي ملك بابل في 2200 قبل الميلاد. أما في أوروبا، فإنه في نهاية القرن السادس عشر كان هنالك أدب متزايد مسبقاً عن الطب الشرعي، وأصبح الموضوع معروفاً بذاته كوحدة مستقلة بشكل واضح. لكن تطوير الطب الشرعي لم يكن سهلاً في الولايات المتحدة، والتقدم به ما زال مستمراً. لقد تم تطوير الطب الشرعي في إيران بسرعة كبيرة خلال الستين عاماً الماضية. فبإنشاء وزارة العدل في عام 1942، بدأت منظمة الطب الشرعي فعالياتها في طهران. وفي معظم مناطق العالم العربي، إن الأنظمة الشرعية الطبية قيد التطوير وما تزال بحاجة إلى تحسين أكبر.
لقد تظاهر تطبيق البيولوجيا العامة والجزيئية للاستقصاءات الشرعية على المستوى الجزيئي ليس فقط في وضع بروفيل DNA، وطرق في الوراثيات الجزيئية، لكن أيضاً في الدراسات المناعية والكيميائية الحيوية التي يمكن استخدامها لتحري الهوية الفردية في عينات بيولوجية، مثلا الدم، المني، الأشعار، الأسنان، العظام واللعاب. |
I. Introduction |
Medico-legal medicine is also known as forensic medicine, medical jurisprudence, or legal medicine and in certain cases state medicine. It is the field of expertise in which the law and medical science interface. If it has a very long history of advancement, it is actually but one facet of the history of man and his institutions. It is not merely a recording of men long dead or of ideas long superseded, but a search for the sources of our current knowledge and a way in which a full appreciation of the present state and inter-relationships of the subject can be achieved. It is the key to our past, the explanation of our present, and indeed, a signpost to our future (1).
The advances in medico-legal medicine went hand in hand with the progress in the sciences and techniques practiced including a consistent core of anatomy in all its levels of gross, microscopic and cellular. Actually, all civilizations and countries, including Lebanon, have recognized the need for medico-legal investigations in their civil and criminal justice systems to variable extents and has to respond to such a need in various ways. |
II. An Overview on the Medico-legal Medicine in the World |
A. The Early Practices of Forensic Medicine in the Ancient Civilisations
Medicine and law have been strongly linked since the ancient times, and the reasons for this union could be explained by the religion, the superstition and the magic which were so inextricably mixed by primitive peoples (1).
The first codified instructions regarding forensic medicine were found in the laws of Manu in India since 3102 B.C. Similarly the “Vedas”, the sacred literature of India, which were written between 3000 B.C. and 1000 B.C., mentioned crimes and their punishments, as well as the diagnosis of various forms of poisoning and their management.
In ancient Egypt, Imhotep (3000 B.C.), Grand Vizir, Chief Justice and Physician to king Zoser of Egypt has been considered as the first medico-legal expert for combining the science of medicine and law. There were legal provisions relating to the practice of medicine. The medical man had to treat his patient in the way laid down in the writings of the ancient physicians. If the patient were treated otherwise, and died, the physician was guilty of a capital crime. Stab wounds were differentiated, and there was a description of fracture of the skull without visible external injury. The Egyptians knew of the natural mummification and later developed methods of artificial preservation of bodies. Procured abortion of infants were punished by law and there was a considerable knowledge of poisons (1, 2).
On the other hand, the first known legal code, that of Hammurabi the king of Babylon, was put in 2200 B.C. It made the first milestone in the history of medico-legal relations. This code prescribed punishments as well as civil and criminal liabilities of physicians among other medico-legal issues (2).
In ancient Persia too, around 1000 B.C., classification of injuries was reported. They were divided into seven groups ranging from simple wounds to mortal ones was put, and that there was a regular reference to that literature whenever an injured person was examined (1).
In ancient Greece there was no clear evidence that medical knowledge was called for by the courts. Autopsies generally were not made because dead bodies were sacred. However, various poisons were known including “Cannabis indica”, “Datura stramonium” and “Hemlock” (1). The Greek Herophilus of Chalcelon, founder of the school of anatomy in Alexandria in about 325 B.C., was recognized for his remarquable descriptive work on aspects of the nervous system (3). He has differentiated the hyoid bone, though not its medico-legal significance (1).
Aristotle (384-322 B.C.) fixed the animation of the fetus at the 40th day after conception. This work had great importance to determine induced abortion namely, whether it occurred before or after this time (2). He believed that there should be a law to prevent the killing of deformed children (1).
In Rome, however, an early example of the practice of forensic science dates from the time of Numa Pompilius, about 600 B.C. All women dying during confinement had to be immediately opened in order to try to save the child’s life, and burial prior to this was forbidden. This was also an advance on the earlier, more reverential, attitude to corpses (1). Moreover, the Roman “Lex Aquilla” (572 B.C), dealt with the lethality of wounds and their gravity. In consequent, an assessment of the gravity of wounds became essential and thus an expert medical opinion was required (2). Later, the “Lex Cornelia” of Sulla (138-78 B.C.) provided that prostitution should be supervised, but the giving of an aphrodisiac or inducing an abortion was to be heavily punished, and a physician causing the death of his patient was to be exiled or executed (1). When Julius Caesar (100-44 B.C) was murdered, his body was exposed and the physician Antistius examined the corpse and found that only one of his twenty-three wounds was fatal (
3). Little after, Pliny the Elder (23-79 A.D.), an important Roman author of medical jurisprudence, complained that there was no law to punish ignorant physicians (2).
Charlemagne (742-814), trying to restore the Roman Empire, attempted to give some uniformity to the laws of the vast Roman empire. His bishops drew up the “Capitularies” in which judges were instructed that they must seek the support of medical evidence and rely on the advice of physicians, especially in questions of blows and wounds, of infanticide and suicide, of rape and of bestiality. This was a beginning of legal medicine, but a brief and abortive one since Charlemagne’s empire could not survive the aftermath of his death (1, 2).
The “Assizes of Jerusalem” constituted a code of laws framed for the kingdom of Jerusalem at the instance of Godfrey de Bouillar, in 1100. In cases of murder, the corpse had to be examined and a report made as to what had been found, the locations of the injuries and the likely instrument which caused them. These “Assizes” were derived from laws already existing in Europe and particularly in France. It is therefore probable that such medico-legal examinations took place in Europe too at that time (1).
In Italy in 1140, Roger II required physicians to be examined. Frederick II, in 1224, ordered that students willing to be legal physicians had to be aged 21, and legitimate. Students had to study logic for 3 years, medicine for 5 and serve a year’s apprenticeship. On passing the examination, the physician had to take an oath, “inter alia”, to treat the poor free, to visit his patients twice a day and once at night if necessary. Thus, the law prescribed organized teaching, set courses or examinations, a qualification, and a high standard of medical ethics. Frederick II also ordered that a human body should be dissected in public every five years, an example which was widely followed in Italy. In 1234, Pope Gregory IX requested that the “Nova Compilation Decretalium” be prepared. These “Decretals” called for medical experts in relation to torture, an association which continued until the eighteenth century, and this aspect of medico-legal practice was dealt with in some of the older works on legal medicine.
In fact, the early medico-legal elements in Italy were important as their occurrence helped to explain why it was in that country that legal medicine was first to appear as an entity (1).
In addition, in China about 3000 B.C., a Chinese “material medica” was developed. It provided information on poisons, including aconite, arsenic, and opium (1). In China, a book called the “Hsi Yuan Lu” or “Instructions to Coroners” was first published in about 1250. This volume described different procedures which were obligatory for investigating suspicious deaths (4). There was an external inspection of the corpse and this was made with the greatest care, but internal examination was apparently very limited (1).
In France, since the eleventh century the Bishops of Maine and of Anjou have had medical experts in their service for forensic cases (2). Similarly, there was reference to such surgeon-experts in Norman laws of 1207 and onwards (1). In Paris, sworn physicians, surgeons and matrons were charged with the making of reports on the injured and the dead. Reports by these surgeons were founded on external inspection of the body and of any wounds on it, but no autopsy was made. However, in 1374, the right of autopsy was given to the Faculty of Montpellier by the Pope (1, 2).
In Germany in 1507, at Mainz, a systemized code of penal law, the Bamberg Code (5) was drawn up by the chancellor Schwartzenberg requiring medical evidence to be called in all cases of violent death (1).
The “Constitutio Criminalis Carolina” in 1532 allowed the opening of bodies and thus represented progress towards the practice of medico-legal autopsies as mandatory and general (2). Its application affected a wide geographical area and it opened the way for legal medicine to develop as a separate discipline. It gave to legal medicine, along with the Bamberg Code, its first sound legal basis (1).
The following logical step was for it to become a subject for special instruction, as occurred in the seventeenth century, and by the start of the eighteenth century chairs came to be created in the German universities. |
B. Towards the Modern Era of Medical Juresprudence
An attempt has been made to show that the time was coming in Europe when legal medicine could be born as a separate discipline. In 1575, Ambroise Paré produced a book dealing with medico-legal reports. This work included model reports describing the death from wounds or the impotence or the loss of any member (1).
One year after, an even greater work than Paré’s was published by Fortunatus Fidelis of Palermo, entitled “De Relationibus Medicorum” or “About the Relations of physicians”. It was the first great systematic general treatise on legal medicine. It was in four books which dealt firstly with matters of public health, then with wounds, simulated diseases, medical errors, next with virginity, impotence, pregnancy, viability of the fetus, and finally with life and death, mortality of wounds, suffocation, death by lighting and poisoning (1). Thus, by the end of the sixteenth century there was already a growing literature on legal medicine, and the subject was itself recognized as a distinct entity.
“Chirurgia Forensis of Cheloni” in 1606 was considered the first work of the 17th century on the subject (1). It was followed, unquestionably, by the greatest of the early works, the “Quaestiones Medico-legales” or “Medico-legal Questions” of Paulus Zacchias in Italy, one of the most famous names in legal medicine. His famous work was first published in 7 books at intervals between 1621 and 1635. The books were divided into parts and these, in turn, into specific questions. These “Questions” dealt with subjects such as age, pregnancy, live birth and legitimacy, dementia and insanity, poisons, virginity... Later, Valentini in Italy published in (1701), his “Pandectae Medico-legales” which formed an extensive review of earlier writings and consultations. It was followed in 1711 by his “Novellae Medico-legales”, and the two were incorporated in his “Corpus Juris Medico-legale” of 1722 which was the first work to challenge that of Zacchias (1).
In Germany, in 1629, one of the earliest of German treatises appeared by Bernardus Suevus entitled “The Inspection of Lethal Wounds”. After that, Michaelis gave the first systematic course of lectures on legal Medicine at the University of Leipzig in 1650. In addition, Johannes Bohn produced in 1704 a more comprehensive work “De Officio Medici Duplici, Clinici Nimirum ac Forensis”, which gave rules for professional conduct when visiting the sick and when giving evidence before a court. He advocated complete medico-legal autopsies and described the procedure to be followed . Furthermore in Germany, chairs for legal medicine were created by the 18th century in the German Universities; Leipzig University was being the first in 1720. Two years after, and based on Bohn’s work, Teichmeyer’s “Intitutiones Medicinae Legalis vel Forensic” appeared, which became for many years the principal student’s book. In 1782, an important event took place in the history of modern legal medicine: the first medico-legal journal was born and published in Berlin by Uder and Pyl. Many famous names in Germany were known later; among these were Henke and Mende but above all, that of Johann Ludwig Casper (1796 – 1864) whose classic “Praktishes Handbuch der Gerichtlichen Medizin” (1856), is one of the truly great books in this field, went through nine editions with an English translation (1).
However, in France at this time the most notable figure was Antoine Louis. He was a medical expert to the courts for 30 years and was the first to teach legal medicine and public health in France (1). Chausssier, a prison and hospital physician at Dijon and an expert to the courts, published a “mémoire” in 1790, in which he showed the necessity of study and teaching of legal medicine. Three professorships were next created, in Paris, Strasbourg and Montpellier (2). In 1829, the “Annales d’hygiene publique et de médecine légale” were founded which soon became the most important periodical publication on the subject. M.P. Orfila (1787 – 1853), professor of chemistry and legal medicine at Paris, brought precise chemical methods to toxicology. He was properly considered as the founder of modern toxicology which he made the most exact and objective part of legal medicine (1).
A full professorship in legal medicine and hygiene was established at Vienna in 1804, some forty years before similar recognition was granted to pathological anatomy (2). Thus, the first professorate in a German-speaking country was founded in Vienna (6). And since Hoffman’s professorship in 1875, the professor of the institute of forensic medicine was personally responsible for all forensic and health-police autopsies. At that time, Vienna became a pre-eminent center for the teaching and practice of legal medicine in the world (6).
In England, Samuel Fars wrote the first systematic book on medical jurisprudence. It was published in London in 1788, and was entitled “Elements of Medical Jurisprudence”. In addition, the first British teacher of legal medicine was Andrew Duncan, senior. In 1792, he published his “Heads of Lectures on Medical Jurisprudence or the Institutiones Medicinae Llegalis” (1). His next and most important contribution was to try to have a university chair in forensic medicine established in the University of Edinburgh. The Government created the professorship in 1807, and this was the first chair in the English-speaking world (2). Other chairs were then established in the University of Glasgow in 1839, and in the University of Aberdeen in 1857 (1). At the time, there were excellent books and outstanding men in England but the organization and academic recognition of the subject were defective. By far the most famous name in English legal medicine in the 19th century was that of Alfred Swaine Taylor (1806-80) who was known for his prodigious work “Principles and Practice of Medical Jurisprudence”. The medico-legal Society was founded in 1903, however this was very much doctor-lawyer oriented. In the 1950s, with the founding of the British Association of Forensic Medicine and the British Academy of Forensic Sciences, the investigation of medico-legal cases often required collaboration with those in other disciplines (1).
The development of legal medicine in the United States has not, however, been an easy and continuing advance (1). In the USA, the early English settlers brought with them the English law and the Coroner system of inquiry into death (4). Perhaps, the earliest autopsies on record in North America were those made by one of Champlain’s surgeons, Estienne, near the start of the 17th century. Later on, in 1647, the General Court of Massachussets Bay authorized an autopsy to be made once in four years for the benefit of medical students, the subject has to be a criminal. After this period records of autopsies in medico-legal cases were practiced. Up till the start of the19th century nothing had been written on legal medicine in the United States nor was it a subject of instruction. James S. Strigham (1775-1817) of New York was the first to lecture on legal medicine in the United States in 1804, and the first professor of the subject there in 1813. Benjamin Rush (1745-1813) of Philadelphia published in 1811, a book entitled: “Sixteen Introductory Lectures”. In 1812-1813, Charles Caldwell gave a course of lectures on legal medicine in the University of Pennsylvania. The next advance was an immense one and was due to the brothers T.R and J.B Beck. T.R Beck was the author of “Elements of Medical Jurisprudence”, a two-volume work of some 900 pages, published in Albany in 1823. Moreover, S.D. Gross wrote on strangling in 1833, on wounds in 1843 and on foreign bodies in the air-passages in 1854. As a result, and since 1835, Legal medicine has been taught in most American medical schools. And lately, the medico-legal centers in places such as Harvard University, New York, Baltimore, Philadelphia and Cleveland have made great contributions to the advancement of legal medicine by the amount and quality of work they have done in their research (1).
However, the advances in the subject became so rapid, the number of notable contributors so increased, and so many were the publications that it became impossible to trace further the developments in Europe and America and indeed in many other parts of the world.
Today, forensic medicine in certain countries like Britain show the specialty of Forensic Pathology on the decline, while some disciplines like Clinical Forensic Medicine of the Association of the Police Surgeons is thriving. In contrast, other countries like USA have further specialized into sub-specialties like Forensic Toxicology, Forensic Pathology, Forensic Ondontology, Forensic Psychiatry, Forensic Serology, Forensic Anthropology, Clinical Forensic Medicine, Forensic Radiology, Forensic Entomology, Forensic Herpetology or study of snakes, even Forensic Archaeology and recently Forensic Cyber-crime experts (2).
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C. Development of Modern Legal Medicine in some Countries of the Middle East and the Arab World
Forensic medicine in Iran has developed very rapidly during the past sixty years. In 1942, with the establishment of the Ministry of Justice, the Legal Medicine Organization (L.M.O.) began its activities in Tehran. Since then, the Medico-legal Centers (M.L.C.s) have gradually been established in the cities across the country. The first Iranian textbook of modern forensic medicine “The Legal Autopsy” was published in 1941 by Dr. Gholi Bavandi. The first chair of legal medicine was established in Tehran Faculty of Medicine in the 1940s. In 1991, the specialty of forensic medicine was created in Tehran Faculty of Medicine by professor Hassan Towfighi. Today, two organizations in Iran are involved in the forensic medicine field: the Universities of Medical Sciences (U.M.S.s) on one hand, and the (L.M.O.) and its (M.L.C.s) on the other hand. Moreover, the national journal of forensic medicine, the “Journal of Legal Medicine”, founded in 1965 is edited by the (L.M.O.) and published in Iran with abstracts in English (7).
In Turkey, legal medicine has an educational background that goes back to 1839, and the first autopsy in modern terms was performed in 1841. The recognition of the importance of the subject in Turkey was the major force for the establishment of the Institute of Legal Medicine and Forensic Sciences by a special article of the law (section 2547) as a training and research center in 1982. The Institute being the first and only institution giving master's and doctorate degrees in Forensic Sciences, has 3 major departments: the Medical Sciences Department, the Basic Sciences Department and the Social Sciences Department. Graduates of various fields ranging from medical doctors specialized in any field, biologists, chemists, lawyers, district attorneys, psychologists and other related fields are composing the multidisciplinary structure of the institute. The main research fields of the Institute are: population genetics, paternity investigation, child abuse, and identification of human remains (8). Nowadays, in Turkey, research programs are taking place in the Institute of Forensic Medicine in Istambul and the Department of Physical Anthropology in Ankara (9).
In the majority of regions of the Arab world, the modern medico-legal systems are underdeveloped and still in need of more improvement. Societies of legal medicine have been created in many countries and conferences about legal medicine have been organized. For example, the first International Medico-legal Congress in Damascus, Syria was held in April 3-5, 2000 in cooperation with the German Society of Legal Medicine (10), and recently the third Congress was held in April, 2004 (11). Similar steps include the second Mediterranean Academy of Forensic Sciences Meeting which will be held in Monastir (Tunisia) in June 22-25, 2005 (12).
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III. Legal Medicine in Lebanon |
In view of this fast evolution of forensic medicine in the world, Lebanon had to be influenced by his surrounding and to start building the basis of his medico-legal system.
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A. Origins of the Medico-legal System in Lebanon
At the local scene, legal medicine did not show roots going before the second half of the 19th century. In fact, in Lebanon, the medical system is under the influence of both the American and mostly the French medical systems since 1866. Actually, the two medical schools, the American University of Beirut and the French University were the only medical faculties until less than a decade ago, whereby, other four medical schools have started. However, the influence of the French medico-legal system is and remains the predominant one in Lebanon.
The history of legal medicine in Lebanon can be divided into two chronological periods. The first period was before 1946 whereby only fragmented information was reached after a thorough search in libraries, faculties of Medicine, and daily magazines. The second period started when the government recognized the importance of this specialty, after the independence of the country, and established then the division of legal medicine in the Ministry of Justice (13).
Since then, and at periods, new programs of specialization were introduced and implemented at random by the French Faculty with the assistance of french specialists to produce new graduates of legal medicine.
B. Forensic Medicine in Lebanon Before (1946)
In Lebanon, only few publications on legal medicine were found, most of them could be considered as introductory and descriptive of what is legal medicine. Perhaps, the first valuable work published was that of Dr. Fouad Ghosn in 1965, “Al Tob el Chari w Ilm el Soumoum” (or Forensic Medicine and Toxicology) (14). Dr. Ghosn was the head of the division of legal medicine in Lebanon, and the lecturer on legal medicine in the American University of Beirut. He was also a member in the International Academy of Legal and Sociological Medicine, and the Royal Academy of the Health and Protective Medicine. Later on, in 1975, a similar work by Dr.Emile Garios appeared “Al Tob el Chari” (or Forensic Medicine), (15).
Another work in 1993 “Al Tob el Chari w el Soumoumiyat” (or Forensic Medicine and Toxicology), was edited by a group of experts in legal medicine from the faculties of medicine of the Arabic universities and published by the World Health Organization. This book was considered as a first step in the translation of medico-legal studies to the Arabic language (16).
As mentioned before, exercising legal medicine in Lebanon was not recognized as a separate discipline until 1946, three years after the independence of the country. Before, if the judge and the police needed a medical opinion concerning certain circumstances of death, of accidents, or aggression, they had to go to physicians, generalists or specialists, often to academic physicians of the two schools of medicine in Beirut (13).
C. Creation of the Post of “Legal Physician” in 1946
In 1946, at the request of the Lebanese Parliament, a project of conception of the post of legal physician was approved by a presidential decree numbered 7384 (14 articles). This law tried to define the functions of the legal physician, it did not mention the qualifications, studies and diploma required to occupy such a post. The title “Legal Physician” is granted by a presidential law, and the physician is charged of exercising his functions in a precise region (caza). This post is normally occupied until the age of administrative retirement, fixed at 64 years (13).
Moreover, the law determines the number of medico-legal doctors in the administrative regions (Mouhafazat) of the country as follows: 11 in Beirut, 9 in North Lebanon, 8 in Mount Lebanon, 6 in Bekaa, 5 in South Lebanon, and 3 in Nabatieh (17). This could lead to a conclusion that 42 legal physicians could cover the whole country of Lebanon.
D. Forensic Medicine as a University Subject
Almost all the Lebanese medico-legal doctors operating in Lebanon are graduates of the French system. In fact, a complete specialty of legal medicine is not yet available in Lebanon. However, in the sixties a one-year program was organized in the Saint-Joseph University and a group of doctors got their specialty then and most of them are working today. However, in order to complete their specialty these doctors collaborated with French instructors. This program did not include neither the psychological studies nor even the laboratories and the centers of dissection (17). There was no room for training in Anatomy or laboratory diagnostics including DNA fingerprinting. Recently, a similar program is available in the Saint–Joseph University. This new collaborative program was prepared between Lebanon and the Routh Academy in France, and it is made of 6 courses or study units. And ever since professors in legal medicine from France come to Beirut every two months to give lectures about the topic (17).
E. Creation of the Institute of Legal medicine of Beirut (IMLB)
With the start of the civil war in Lebanon in 1975, the central morgue in Beirut Hospital, the Quarantina sector, where all judicial autopsies were done, stopped all its activities. Another building was constructed in the same district in the 80s and it was proposed to be dedicated for the morgue and the medico-legal institute. This building was never functional. Nowadays, the “Institute of Legal Medicine of Beirut” is part of the Ministry of Justice. Its offices are localized at the 6th floor of a building, near the Justice Palace in Beirut. Its services are more limited to administrative functions. The autopsies are usually done in the morgues of the governmental hospitals, much less in the private hospitals (13).
F. Modern Techniques of Molecular Biology used in Forensic Medicine
In general, the complementary examinations are done in the laboratories accredited by the Ministry of Justice: “Laboratoire de criminalistique” of the Lebanese Internal Security Forces, the laboratory of the Saint-Joseph Hospital in Dawra, Beirut, for the toxicological analyses, and the laboratory of the molecular biology of the Chronic Care Center (CCC) for the analysis of the DNA (13). And lately, it was reported that the laboratories of research in the American University of Sciences and Technology (AUST) are well-equipped and capable of doing the researches and analyses related to legal medicine in the three following domains: all what has to do with genetics, toxicology, and enthomological studies related to forensic medicine which includes also the analysis of insect activity on corpses. This advanced science is present only in three European countries in addition to the United States (15). The application of general and molecular biology to forensic investigations is manifested at the molecular level not only in terms of DNA profiling, and techniques in molecular genetics, but also in biochemical and immunological studies that can be used to detect the identity individuality in biological samples, such as blood, semen, hairs, teeth, bones or saliva. And today, with the easy way of catching advances in any field through the internet, people practicing legal medicine in Lebanon are aware of the latest immunological tests done, the new discoveries in protein polymorphisms and DNA fingerprinting as well as recent areas of study such as forensic botany, and palynology or pollen analysis.
And in order to develop laboratory skills, laboratory sessions and tutorials are being offered. These sessions introduce the latest techniques used to analyse biological molecules of forensic relevance, such as nucleic acids and proteins. Such techniques also include spectro-photometry, agarose and polyacrylamide electrophoresis, restriction endonuclease analysis, centrifugation and labeling of biomolecules.
G. The Place of Anatomy in the Shaping of the Medico-legal System in Lebanon
In all these training specialty programs anatomy maintained a space, an important part of the curriculum, be it pathologic anatomy, tissues or even cellular and sub-cellular studies. Experts in the field consider a good knowledge of anatomy as essential to the proper functioning of a medico-legal physician. The golden age where anatomy as a science occupied a high priority in the advancement of medicine began mostly in the 18th and 19th century particularly in France and Vienna and at the turn of the 20th century in Berlin. They considered anatomy as being of crucial importance and essential need to medical sciences in general and forensic medicine in particular. Anatomy had the advantage of providing the ground for understanding health and disease states. Thousands of diseases and numerous therapeutic modalities and techniques have been defined and studied through anatomical sciences. Despite the great advances in medical technology and medical imaging and the countless successes recorded in these fields, anatomical sciences retain a crucial role in making the final decision in at least 30% of medico-legal cases where other means fail to give the right answer.
For all the above reasons and many others, anatomical sciences continue to be a basic need for any medical training and in particular for any medico-legal curriculum. Anatomical sciences preserve a central role in the medical field and in the practice of medicine. After reviewing the curricula of some medical schools in the country and discovering that a few do not even dissect a cadaver, one had to wonder about the kind and quality of physicians they are producing in the 21st century.
H. The first Arabic Conference on forensic medicine held in Beirut
In Lebanon, the society of legal medicine has been established only recently and organized its first international meeting in Beirut. This conference was held in Lebanon between 18 and 20 September, 2003 in the AUST, in collaboration with the Lebanese Society of Legal Medicine. About forty legal physicians were participating from Egypt, Syria, Jordan, Saudi Arabia, Iraq, and Lebanon. Also among the participants were experts in this field from the USA and Europe (18).
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IV. The Present Situation and the Future Plans |
At this point in time, there is no central morgue belonging to the Lebanese government, and no specialized facility to perform autopsies. However, there is a plan to establish a national academy for legal medicine which would help solve the actual problems, and preparespecialists for the future and serve as an archive that could be valuable for subsequent studies. This academy would include a library, laboratories of biology, chemistry, cytology and histology, radiology and modern morgues for dissections and autopsies (7).
In other words, Anatomy as a discipline should be implicated in this futuristic approach in all its levels of Gross Anatomy dissections, Radiographic Anatomy, Microscopic Anatomy, Cellular as well as Subcellular Molecular testing.
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المجلد 3 , العدد 6 , ذي القعدة 1425 - كانون الثاني (يناير) 2005 |
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