Historically pathology closely followed anatomy in setting the foundations of medicine as a science; today pathology is most frequently practised through routine and complex laboratory tests of tissue and fluids from the living that help to choose the correct diagnosis. These factors have immense bearing on the bedside practise of medicine through understanding the cause of disease or injury (and, for example, how they could be related through environment). So, whether to understand the origin of a disease as being inherited or infectious, or to interpret injury, pathology becomes important in formulating treatment and its outcome for the patient--especially in malignant and infectious disease. The pathologist is the doctors doctor! Pathological diagnosis, represented by a wide variety of "lab tests," is increasingly the anchor of sound medical and surgical management.
Not surprisingly, with its deep roots in cause, pathology also retains its birthright as a basic medical science, contributing much to medical research in areas such as the study of the molecular basis (DNA) of disease. One now begins to sense that pathology neither begins nor ends with death and autopsy.
Forensic Pathology: Detectives in White Coats
The word forensic comes from the Latin forum, hence court. Forensic practice is also found in applied sciences (engineering, psychology), in accounting, in biological sciences (entomology, anthropology and botany) and other areas where experts provide opinion evidence in civil or criminal proceeding, often before a court of law.
How is pathology related to civil or criminal proceeding, and to the needs of legal counsel and others concerned with the consequences of alleged injury, negligence or criminal wrongs? Let's look at the issue of personal injury, malpractise and causation.
When disease or injury is plain and the origin(s) and the mechanism not, a pathologist is probably the preeminent medical specialist above all to provide interpretation, i.e. an understanding of the process(es) and the direction to proceed. He/she also best understands mechanism and relationships of injury in assault, or whether safety restraints or other protective devices including helmets were effective during driving, recreation or work.
Use of the term "pathology" in the context of personal injury could, taken to broad limits, imply issues neither plainly definable nor quantifiable: for instance the extent of emotional hurt or pain. Hence, one might ponder, "What is the pathology of this?" Be aware, in the absence of identifiable and measurable disease or injury, that quantifying, indeed, even justifying hurt and pain may of itself be the only issue. This is not the ground of a pathologist. Efficacy or validity of medication, including anaesthesia, is not commonly an arena for pathology, nor are choices in surgical management. However, misuse or toxicity of drugs may well be, as may be disease or the effect of toxins related to the work place, or apparent miscarriage of a surgical procedure.
One most often relates forensic pathology to crime...the Quincy factor! Criminally related acts with weapons invoking injury (assault, child abuse) or death involve expert interpretation of wounds and the relationship of wounds to the supposed weapon(s), the amount of force, and the effect of preexisting disease on an apparently violent death. These are the embodiments of forensic practise related to criminal law. The time of death and identification of the dead are also basic elements of forensic pathology practised in the arena of criminal justice. And both the time of death, identification and the mechanism of injury or cause of death may also have relevance to civil issues, for instance insurance and estates. Forensic pathology knows no allegiance to anything within this arena other than the pursuit of justice.
If the law has made you a witness remain a man of science. You have no victim to avenge, no guilty or innocent person to ruin or save. You must bear witness within the limits of science.
Paul H. Broussard
Chair of Forensic Medicine
Sorbonne, 1897
