(16.1)--ForensicmedicineinChina法医病理学案例分析.pdf
2Med.Sci.Law(1987)Vol.27,NO.1Printed in Great BritainForensicMedicineIn China:ItsHistorytothePresentDayPENGHUAFormer postgraduatestudentat the DepartmentofForensic Medicine,TheLondonHospitalMedicalCollege.NowLecturer in Forensic Medicine,SouthEast China InstituteofPoliticalScienceandLaw,Chongqing,Peoples RepublicofChinaJ.M.CAMERONProfessorofForensic Medicine,DepartmentofForensic Medicine,TheLondonHospitalMedicalCollege,LondonE12ADJIAJINGTAOProfessorofForensic Medicine,FacultyofForensic Medicine,ChinaMedicalUniversity,Shenyang,Liaoning,Peoples RepublicofChinaThe brilliant ancient civilisationofChina is wellrecognized but little is known of modern China tosay nothing ofitsmedico-legalsystem.Thehistory of Legal Medicine in China can be tracedbacktoWarringStates(475-421 BC)withrecordsaboutthe subject in two booksThe BookofRitesandLa Shi Chunqiu.The theme was Bejust when ordered to view the various injuries,analysethefindings,andjudgethecases.Althoughnotconfirmed,it is reasonabletoassumethatjudicial officials atthattime probablyparticipated in living examination,i.e.assaultcases.In 1975,archeologists unearthed 12 tombs inHu Bei Province,and a considerable numberofancient writings were found onbambooin thenumber11 tomb(Figureslaandb),whichdescribed the legal articles and criminal cases atthe end of the Qin State(252-221 BC).In thisdiscovery two booksDialogue to LawandFengZhen Shiwere noted to be primarily concernedwith forensic medicine and criminalistics.Themain subjects in the first book were associatedwith criminal law of Qin State.The Qin lawprotected the infant,but if the infant had beenborn congenitally deformed,its killer would beinnocent.The penalty of the crime depended onthe severityofthe wounding.The second textFeng Zhen Shi(the document patterns for seal upand investigation)dealt with ancient criminal-istics and described many interesting medico-legalcases,e.g.the bloody vaginal discharge from afemale after a criminal abortion wasputinto abasinof water toprovethepresenceof anembyro-thediagnosis beingreached by thisfinding.Another case involved the identificationof a leper.The law statedthatany leprosy patientwho broke the law or any accused so sufferingwould either be segregated or killed.A number ofcases are recordedofdirection of blood stains,the markofhand and foot and the positionofadead body in relation to its environment,andinference as to weapons etc.One hanging casewas dealt withby external examination withspecial attention being paid to the constrictionmark on the neck.The mark did not encircle butwent up to a point,and so suggested hanginganda pepper-colourmarkasproofofante-mortemsuspension.Fromthese cases it isapparentthatmedico-legalmatterswereinvestigatedbydifferent people.The sub-magistrate,Ling Shi,at county levelwas in charge of a dead bodyandliving victim,andhis functionalsoincluded searching theHua et al.:Forensic Medicine in China:Its History to the Present Day3(a)Figure1.Scattered condition of bamboo book in coffin.(a).the upper part of coffin;(b),the lower part of coffin.accused and arresting him etc.Slaves assisted theofficial in doing humble work with doctors beinginvolved in casesofdisease.Little further progress was apparently made inforensicmedicineduringtheHanandTangdynasties(206 BC-907 AD).There was evidence,for example,inFirst Han Annalsthatexamina-tionofwoundswasmandatoryincertaincriminal cases as early as the beginning of theHan dynasty.Later,in 637ADtheTangLawCode,the earliest and most complete feudal codeso far kept in China,was promulgated and itmade a great contribution to the antique medico-legal system.Firstofall,it was stipulated that theobjects to be examined included the body,injuriesand possible malingering.Second,the code gave aconcept to awound-bleedingmeans wound.Third,much was stated on such matters as degreeof trauma,a classification of wounds due tovariouscriminalweapons,suicide,ageand4Med.Sci.Law(1987)Vol.27,No.1cripples etc.The need to confirm a fatal injury asthe cause of death was especially recognized.Because it was thought there was a differencebetween the severe wound and the vital one,andthat the interval between infliction of injury anddeath varied,BaoGu-meaningprotection oftheinnocent-wasaccepted to convict someoneproperly.BaoGutime was allocated as 10-50days,i.e.if death took place during that period,the injuries were thought to be fatal and theculprit would be sentenced to death.If withoutthese dates,death wouldbe assumed uncon-nected and a lesser sentence employed.No complete legal medicine text book wasproduced during these two dynasties,neverthe-less,there are some achievements recorded in atraditional Chinese medical book,such as Twoprinciple ways to prove death,namely weaknessofpulseandshortnessofbreath,andtheDemonstration ofrespiratoryobstructionbyplacing new cotton in front of nostril and mouth.Wang Chong(27-97 AD)first noticed lighten-ingtambooandscientificallyexplaineditsappearance.Healsorecorded anexperimentwhich suffocated an animal.Zhang Ju,a countrymagistrate,succeededindifferentiatingante-mortem from post mortem burning.The prosecu-tion case beingthata woman had killed herhusband and then set him on fire,the defencebeing thatofself conflagration.Zhangused twopigs as experimental animals,one killed and theother alive,burnt them in public,thus indicatingthatanythingburntalivewouldhavecharpowder in the mouth and nostrils whilst this wasabsentinthedead.Hethusprovedtheprosecution case and the woman finally admittedherguilt.ItwasduringtheSongdynasty(960-1287)that there was any true developmentof forensic medicine.There was a tightening up ofall medico-legalprocedureswithaseries ofstatutesbeingformulatedregardingexternalexamination subsequent to 1000AD.Accordingto these new laws,all suspicious deaths had to beexaminedandall violentdeathshadtobereported and re-examined.The body was dividedinto four parts from the head to feet,upon whichthe coroner recorded wounds,fatal wounds,thecauseofdeathandpersonalcharacteristics.Failure to comply with these procedures wouldresultinpunishment.Frequently,however,silence was practised to avoid the expenseandhard work as a witness.Itwas not until the Songdynastythatit became a statute rule for judicialand other officials to participate in the examina-tion of the deadandliving.In 1174,Zheng XingYi,CommissionerofJusticein Western ZheJiang,establishedastandardformModerndocument of post mortem,to be distributed toevery district in the province.When a murder wassuspected,three copiesofthe form were issued tothe official assigned to perform the enquiry.Datarequired on the form included the nameoftheprosecution,the presiding official at the inquestand his assistant,his warrant,the timeofarrivalat the place of the inquest,the numberofwoundsfound on the deceased together with the causeofdeath.The coroner includednotonly judicialofficials but also those names,WuZuowhowere similar to the slaves in the Qin dynasty.They usually performed such humble things asremoving the dead,annointing the body withwine or vinegarto discover the injuries,themarking of wounds(injuries)under the directionofthepresidingofficialetc.Doctorswererequired for living examinations.A number of papers exist fromtheSongdynasty on the role of the coroner,in particular,XiYuan Ji Lu(Figures2 and 3)which wastranslatedintoEnglishasInstructiontoCoroners or Washing awayofWrongs.Thebook was compiled by Sung Tzu(1186-1249),ajudicial official whose termofoffice can be tracedto the reignofthe Emperor Li Tsung(1241-1252)in the Song dynasty.Although SungTzuappearsto have been promoted to the rank of accom-plished scholar as early as 1217,his public careerseemed to have begun in the fourth yearofChiaHsi,which corresponds to the yearof1240.Having servedthe Central Government in anumber of advisory capacities,he rose steadily inthe bureaucratic hierarchy becoming a prefectand eventually the CommissionerofJustice forHunanProvince.In order to meet the need offeudal codeandcater for the strict medico-legalprocedures and popularity of external examina-tion,SungTzuwrote his famousXi YuanJiLuwhen he was in the province,which was based onthe earlier sources and covered most problems ofmodern forensic medicine.Published in 1247,thebook immediately became a comprehensive texton external examination designed as a practicalmanual for magistratesandtheir coroners.ThisHua et al.:Forensic Medicine in China:Its History to the Present Day57(-.:,II*!Zr!.J=1:t-.-JFigure2,Xi YuanJiLu(based on Yuan dynsaty block-printed edition),Right,frontcover;left,insidefrontcover.text has been considered the oldest book onforensic medicine in the world and itsauthorisregarded as the greatest figure in Chinese forensichistory,The Yuan dynasty,(1271-1368)was a lessproductive period for forensic medicine with littlechangeapartfrom the fact that judicial officialswere required only to watch the examination andnot the performingofsame.WuZuo seemed tobe a real coroner,being able to perform thefunctionhimself provided he wrote a pledge.During the Yuan dynasty the authorities simpli-fied the roleofthe coroner by creating in1304Cadaver Sketches(Figure4)and so only thevital information was included.Oneimportantfeatureduringthisperiod,however,was the appearanceofseveral texts.Nearly 50 years after the publicationofXi YuanJiLuin1247there appearedlieAn Shi.Theintentionofthis book was to inform judicialofficials regarding conclusions fromcivil andcriminal cases.Itdealt with,in its 53 items thesubjects of the dead body,injury,disease andevidence.In1308,Wang Yu,(1260-1346),wrote anew book calledWu Yuan Luwhich was sub-sequently translated into Korean and Japanese.Later,this text was an official manual directingthe forensic practice in the two countries whichdidmuchtoimprovethecultural exchangebetween China and those countries.During the Ming dynasty(1368-1644)morefirm regulations were established for the coronerto follow in the examination procedures of boththe living and the dead,but this had no effect onthe medico-legal system.Over the years copiesand re-copies were made ofHsi YuanJiLuwithnumerous adaptations developing an inevitableloss of accuracy in its transformation.The Qing dynasty was the last feudal dynastyin Chinese history(1644-1911).According toQing law every county should establish coroner-ship with three examiners(Wu Zuo)in a bigcounty,two in a moderately sized one and one ina small county,an extra two probationers orassistants,Every examiner was given a copyofXiYuan Lu,having to explain one section of thebook asanannual examination course.Anexaminer was paid little salary,for if he wascompetent,hewouldgetprizemoney,ifhowever,hemalpracticed,hewouldbecommitted,During the time of the Qing dynasty,forensicmedicinewas gradually becominga separatescience and autopsies were popular in Europe.Chineseforensicmedicine,particularlyitsexternalexaminingsystem shouldhavebeen,6qll!It.uI*1,1_IIlillu=,.I,iI,IFigure 3.One part of the content of Xi YuanJiLu(institution Yuan-dvnastv-style book).affected.however.there was no apparent desire tochange this system.On the contrary.the Qinggovernment in 1694 produced a new coronermanual.LuLiGuan Jiao Zheng Xi Yuan LuorRevised XiYuang Luwith amendment casesstating it was so invaluable that every coronermust obey it in their practice.When a coronerwas considering the causeofdeath.he had toconsult the corpse sketch.on which a point meanta fatal spot and a circle.a non-fatal one.(Figures6-8.)Slow as the progress in medical jurisprudencewas from the Yuan to the Qing dynasty.one canfind some improvement over the several hundredFigure 4.A document for investigate death promulgated in 1304.inwhichthefindings and the cause of death should be recorded.Hua et al.:Forensic Medicine in China:Its History to the Present Day7II4tJr1)it-:.n;!.-7,1ft.lJlJIL,rtrt.W511K.lA.rt;*1MiI,f4A.11.-J:.i1111iJIf-=m-.1Iil!.it*.;.m*-,pJ;jlIiI(!-f,J;J.,r:h!k:Jtt1JEfiJEIj1f.r.1.:Itt11!,:1IliffJIIJ.mtiJfA1U1U:z;rI/.,ApJ1iFWl,.II-:1tft7J)11J,M*h.:f.)1ft:J,h-EI;fir:j11-1ll!./ilf1SIIItttitH-1-.Ait!Wt.II.u.,it.jJfi/fijl1tJ:UIUI:-eIpFigure5.The first page ofWu Yuan Luedited byWang Yu in 1308.years.In 1593,three new methods for determin-ing deathsweredescribed-nosign showingrespiration in frontofthe nose,no colour changeon impressing the fingers and no heat sensationover the body.In 1777,fractureofthe greaterwing of the hyoid bone was ascribed as a featureofsuspension;the suspended animation fromopiumpoisoning could be identified in 1832.Others included various marks in strangulation,characteristicsoffirearm wounds,morphologyofsodomy,and the comparisonofhomicidal andsuicidal incised woundsofthe neck.All thesefindings if against theYuan Lucould not beaccepted.The Xin Hai Revolution broke out in1911and overthrew the feudal ruling which had lastednearly 3000 years.Though the revolution wasshort lived,it brought aboutnew hopeforChinese legal medicine.In 1912.the CriminalProcedure Law was issued by the Governmentdiffering from the previous legislation in thatinternalexaminationofthedeadwasnowpermitted.In the next year,based on this law,Anatomy Rules were first introduced.whosesecond item said that when the police or judicialofficial thought the causeofdeath could not be.It.Figure6.A picture of investigate death in the Qing dynasty.by coroner(right)andtwoWu Zuo(left).8Med.Sci.Law(1987)Vol.27.No.1Figure7.A sketch of corpses promulgated in Qing dynasty.On the right.front and on the left.back.properly established without an autopsy,a doctorshould be assigned to perform the autopsy.Thisdecision was an obvious watershed between theancient and modern legal medicine in China.Inorder to train doctors,a course of lectures onmedical jurisprudence was instituted in1915inBeiJung Medical School and the Jiang ProvincialMedical School,but this step was like a drop inthe ocean and insufficient to meet the require-ment of doctors.Wu Zuo still stood as anexaminer.Adhering to the old way of estimatingthe cause of death,errors of interpretation wereinevitable resulting in criticism by public opinion.By public demand the government produced anew Criminal Procedure Law in which Item No.160divided forensic practice into two parts:viewing thebody-eitherby doctor or coroner,and dissecting thebody-doctoronly.However,due to pressure by some conservative individuals,the authority hadto yield andallowedthecoroner to explain their findings on externalexamination.Oldtraditionalismseriouslychallenged the spread of the autopsy.In1924,Lin Ji(1897-1951),the pioneerofmodernforensic medicine in China,went toGermany to study the subject.On his return,hetried his best to inform the authorities of the stateof legal medicine abroad and its significance.In1930,he establishedthe first departmentofmedical jurisprudence in the medical college ofBeiJungUniversity.Twoyearslater,inShanghai,the first Forensic Research Institutewasfounded,whoseaimwastodisciplinedoctors,carry out autopsies for judicial bodiesand undertake research.In October1934,the firstjournal speci
