HISTORY OF MEDICINE

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Medicine and the Law in the Ancient World

Close-up of the fingernail at top of the Stele, upon which is carved Hammurabi’s Code of Laws.  (Hammurabi, Babylonian Priest-King 1792-1750 BC)
One nearly complete example of the Code survives today, on a diorite stele in the shape of a huge index finger, 2.25 m or 7.4 ft tall.   The Code, consisting of 282 laws, is inscribed in the Akkadian language, using cuneiform script carved into the stele, today on display in the Louvre, in Paris.  The Code was also carved into clay tablets.

The establishment of the calendar and the invention of writing marked the dawn of recorded history. The clues to early knowledge are scanty, consisting of clay tablets bearing cuneiform signs and seals that were used by physicians of ancient Mesopotamia. In the Louvre there is preserved a stone pillar on which is inscribed the Code of Hammurabi, who was a Babylonian king of the 18th century BCE. This code includes laws relating to the practice of medicine, and the penalties for failure were severe. Law # 215 says, “If a physician operates on a man for a severe wound (or make a severe wound on a man) with a bronze lancet and save the man’s life; or if he open an abscess (in the eye) of a man with a bronze lancet and save that man’s eye, he shall receive ten shekels of silver (as his fee). And, law # 216 says, “If he be a freeman, he shall receive five shekels.”

Legal medicine is considered to be the field of study and accumulation of materials that deals with the application of medical knowledge to the administration of justice. Medicine and law have been related from the earliest times. The bonds that first united them were religion, superstition, and magic. The functions of the physician and the jurist were united in the priest, the intermediary between God and man. In early civilizations, primitive legal codes, religious doctrines, and social precepts were often ill distinguished, and laws with a medical content were often found within their context. Ecclesiastical courts and canon law were concerned with much that related not only to religious matters but also to medicine – for example, impotence, divorce, sterility, pregnancy, abortion, and period of gestation. The oldest of these written records, the Code of Hammurabi, includes legislation pertaining to the practice of medicine, dating back to the year 2200 BCE. It covered the topic of medical malpractice and set out for the first time the concept of civil and criminal liability for improper and negligent medical care. Penalties ranged from monetary compensation to cutting off the surgeon’s hand. Fees also were fixed. The Code discussed various diseases of a slave that would invalidate a contract. Also included were references to incest, adultery, and rape.

In ancient Egypt, the acts of the medical man were circumscribed by law. Stab wounds were differentiated in the 17th century BCE. The Egyptians had a thorough knowledge of poisons. There is evidence that priests made determinations regarding the cause of death and whether it was natural or not.

The Chinese published information about poisons, including arsenic and opium 3000 years BCE. In ancient Persia, wounds were put into one of seven classes, ranging from simple to mortal. In ancient Greece, there was a knowledge of poisons and laws against abortions. However, autopsies were not performed, since a dead body was regarded as sacred.

In Rome 600 years BCE, a law was passed requiring that a woman who died in confinement should be immediately “opened” to save the child. The investigators of murder were selected from the citizenry. When Julius Caesar was assassinated in 44 BCE (March 15), the physician Antistius examined his body and concluded that only one of the 23 stab wounds was mortal.

The legal code in ancient Greece (about 460 BCE) was very elaborate. In addition, it was a time of great advances in medicine. Though there is no clear evidence that medical knowledge was officially made use of in establishing proof in courts of law, it is known that Hippocrates and others discussed many genuine medicolegal questions. These questions included the relative fatality of wounds in different parts of the body, the average duration of pregnancy, the viability of children born before full term, and other matters. Moving across the Mediterranean, there is in existence a papyrus, found in Egypt and dated from pre-Christian times, in which a medical officer in Alexandria submitted a report on a suicide about which there had been some suspicion of murder.  Source: Cyril H. Wecht, MD, JD

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