The most primitive societies likely had a well-developed sense of the causative relationship of trauma, old age, and illness to death, and early “investigations” occurred even in tribal societies to determine why a member of the family group had died, though they were more likely to invoke superstition or magical thinking instead of the “rational” methods employed by modern societies.
Early Mesopotamian civilizations, and those of ancient Egypt, Greece, and India, had well-developed legal codes (the earliest being the Code of Hammurabi, 2200 B.C.), and these laws often referenced medical issues, such as duties of physicians, allowable fees, the viability of the fetus, and discussions of injuries. These cultures also had well-developed medical systems, ut there is little or no reference in their extant writings to suggest that medical practitioners were regularly involved in the investigation of death. Rather, common sense and experience were applied by various officials, magistrates, or priests in an attempt to explain why and how individuals died. Some of the earliest death investigations probably involved deaths due to suicide, which most societies have considered to be an unacceptable act for religious or superstitious reasons.
Taking one’s own life might result in denial of funeral rites, reprisals against the decedent’s family, or other penalties, so a rudimentary death investigation was necessary in such cases to determine if a death was self-infected.
The earliest written documentation specifically related to formal death investigation has been discovered in archaeological excavations in China.
Here, bamboo strips unearthed and dated from the period of the Chain Dynasty (221-207 B.C.) have been found inscribed with writings giving instructions to civil servants charged with the examination of corpses who died under suspicious circumstances.
Death investigation in ancient Athens was largely a private matter instead of a concern of the state.
As such, investigations by a governing body were not consistent, and Greek physicians were apparently not involved in certification or investigation of death, though there are reported instances of their testimony in legal proceedings involving injury.
In early Roman legal writings, such as the Numa Pompelius (approximately 600 B.C.), the Twelve Tables (approximately 450 B.C.), and the Lex Aquila (572 B.C.), certain medical regulations were put forth, and questions of a medical nature were posed. Roman courts could also call various “experts” as witnesses in court cases, including physicians. Trey could be retained by the disputants, or the magistrate or judge could call on them to advise the ourt. This latter group formed a class of witnesses known as amicus curiae, or “friends of the court,” and they were appointed by the court to provide expert advice in a nonpartisan manner.
The actual investigation of death, however, does not appear to have involved the medical community in most cases, though there is apparently some disagreement on this point among historians of the period.
A well-known exception is the death of Julius Caesar.
The writings of Suetonius, a secretary and historian of the Emperor Hadrian, give an account of the examination of the body of Caesar by the physician Antistius. According to the historian, he physician examined Caesar after his assassination and opined that only one of his multiple stab wounds was fatal (though one wonders exactly how this was determined without an autopsy). Even so, there is no indication as to how the physician came to be involved in the case of Caesar’s assassination.
It is not known if he was appointed by a magistrate or was merely called into service by the associates of Caesar. If the former, there is little evidence that this was a common procedure in Rome, for in the majority of extant writings about early Roman court cases, there is a notable absence of physician involvement in death investigations.
In the later Roman period, during the reign of the emperor Justinian (483-565 A.D.), the laws of Rome were brought together and codified. In this corpus, often referred to as the Justinian Code, reference is made to physicians as expert witnesses, though again their involvement in the investigation of death is not directly discussed.
Postmortem dissection or autopsy examination was forbidden in most ancient cultures, but Egypt was something of a remarkable exception due to the fact that the elaborate funerary preparations of that culture provided some rudimentary degree of anatomic knowledge.
In contrast to Athens and Rome, early Egypt also appears to have had a formal system of death nvestigation that did involve physicians.
After the Ptolemaic era, and during the period of Roman rule in Egypt, there were physicians known as the demosioiiatroi, or “public physicians.” The extant legal writings of the time are apparently replete with reports by these individuals, known as prosphoneseis, regarding their examinations of deceased persons. However, the actual investigation of death was under the control of an administrative official known as a strategies. This individual had the authority to dispatch an assistant, known as a hyperete, and a physician to conduct an examination of a deceased person and render a report on their findings. It seems that the relationship of the physician to the hyperete was of a subservient and secondary nature, similar to that found in the modern coroner system.
Somewhat ironically, greater progress in the medical investigation of death may have occurred after the barbarian invasions of Rome in the fifth century A.D., during the so-called dark ages. These invading tribes introduced the concept of the were geld, a type of compensation or “blood money” paid to the victim of a crime, or his family, by the assailant.
Implicit in this payment was that a full evaluation of the extent of injury suffered by the victim must be undertaken by the courts. Medical experts were utilized to assist the court in conducting these examinations, as documented in the legal codes of the era. Later, in Charlemagne’s Capitularies, the requirement for medical testimony in certain types of traumatic injury was required, but fern the death of Charlemagne it seems that progress in death investigation anguished in the West for some time.
Much of the understanding of death in earlier times was based on superstition or myth, and nowhere is this more demonstrable than in the vampire legends of medieval Europe.
In an effort to explain epidemics, bad luck, or other untoward occurrences in a village, some individuals readily placed the blame for these events on the recently dead. In an effort to ameliorate the village’s problems and confirm the culpability of a particular corpse, the grave of the recently deceased was sometimes opened. On exhuming the body, typical changes of decomposition would be noted as expected, though they were misinterpreted as indicating something much more menacing than the normal dissolution of the body. For instance, purging of the body is often seen in decomposing corpses. This is the issue of a dark bloody fluid from he oral and nasal passages due to autolysis, putrefaction, and liquefaction of the internal viscera. The resultant fluid is pushed out of the nose and mouth through the airways and esophagus by decompositional gas formation, which causes increased pressure within the thoracic and abdominal cavities.
Tough now recognized as a common postmortem artifact, this purging process was taken to represent blood soiling of the mouth due to recent feeding on the blood of living victims. Further, with decomposition, the epidermis of the skin separates from the underlying dermis, resulting in so-called skin slip. Rather than being recognized as a decompositional change, this slippage of the skin was attributed to the growth of new skin, and decompositional bloating and red discoloration of the body were described as a healthy, ruddy complexion, compared with the sallow appearance of the deceased at the time of burial. As decomposition progresses, rigor mortis (or stiffening of the extremities) disappears, but this suppleness of the limbs was considered a sure sign of vampirism. All of these factors were taken to indicate continued ife beyond the grave, as well as nocturnal feasting on the blood of the living occupants of the village. Detailed methods of investigation were developed in order to confirm the identity of the “vampire,” and there were also prescribed procedures for warding of the revenant, and for putting it to rest permanently. These included such treatments as decapitation, “staking” the ampire through the heart, removal of the heart, cremation, tying the mouth shut, and reburial face down, presumably to confuse the undead when he or she attempted to rise from the grave.
It seems difficult to believe that such misconceptions could occur, particularly as the phenomenon of postmortem decomposition should have been well known (refrigeration of decedents not being available in that era), but such is the case. And even though the beliefs in vampirism were manifestly erroneous by today’s standards, they do indicate a depth of concern about the process of death. They also show the development of a detailed investigative and empiric method, and the development of an internally coherent and systematic way of explaining observations and understanding death and its relationship to other occurrences. Such internally consistent and systematic misinterpretations based on the best learning of the day should serve to give us pause when we become too certain of the validity of our own current positions.
Another example of early death investigation, from an Eastern perspective, can be found in the book Hsi Yuan Chi Lu13 [The Washing Away of Wrongs] (from China, circa 1247 A.D.) as written by Sung Tz’u. This text gives detailed instructions on death investigation, and is probably the oldest extant full text on the topic. It includes discussions of decomposition, determination of time since death, homicidal violence, self-infected injuries, various accidental deaths, and deaths due to natural causes. In spite of its antiquity, the similarities between the investigational methods taught in the book and those utilized today are often striking.
