|Sažetak rada na drugom jeziku (engleski)|| |
Medicine and law, two areas of human activity that have been throughout history in constant correlation, were closely linked throughout the time of the Dubrovnik Republic in three significant areas. These include: regulating public health hygiene, adopting laws to monitor medical practice and medical expertise for the needs of the court in the criminal proceedings.
The obligations to report woundings and suspicious deaths and to provide medical forensic reports in court procedures were part of the contractual obligations of the commune physicians of Dubrovnik. in Dubrovnik in the 14th and 15th century, although they were seldom performed, and were recorded with a rudimentary vocabulary that does not provide any opportunity Medical expert testimonies for the evaluation of medical knowledge, do show that the judges, in passing their judgements, relied on the prognoses of survival and the estimation of the incapacity for work of the experts called when it was a matter of serious injuries. The frequency of medical expert testimonies in criminal cases of physical assault at the beginning of the 14th century comes to 3.5%. Only in two cases initiated by a private suit (of the total of 38, or 5%) were forensic expertise carried out at the demand of the court. All other medical expert testimonies were carried out in procedures initiated ex officio. The medical experts called were on the whole surgeons, and less often physicians, but it is not always possible to determine their professions since they were recorded with the neutral expression of medicus. Not a single case is recorded of a notification being made by a barber, and they were not invited to give medical evidence in court.
A medical expert, who was not always the notifier, at the summons of the court, immediately before it arrived at a judgment, would express his professional opinion without an explanation of the danger of the wound to the life of the injured party, which afforded the judges the opportunity to wait before passing judgement, if the life of the wounded party were in danger. Most often subject to medical expertise were wounds to the head, and, in terms of the means of commission, those that were made with blades and objects of iron. All wounds examined were accompanied with bleeding. Such wounds were obviously considered more dangerous, and their outcome more uncertain. Medical expertise concerning the consequences that would ensue from a wound in the shape of incapacity for work helped the judges to award the injured party a just compensation for lost wages. The means of the wounding and the presence of bleeding, facts necessary for the determination of the amount of a monetary fine, were determined by the evidence of the wounded party and the witnesses present. There is no proof of any interaction between the rector who led the enquiry and the judges and medical forensic experts present.
The research samples from the beginning, middle and end of the 18th century were chosen bearing it in mind that essential changes in the direction of progress and prosperity started to occur in the mid-century, and it can be hypothesised that in this period there was a fall in the level of violence. Economic and social conditions in Dubrovnik in the 18th century changed under the influence of political and social developments. The insecure times consequent up on the constant wars, epidemics of infectious diseases and shortages of cash in the state coffers meant that at the beginning of the century only one commune surgeon was employed at any one time. Hence in one third of the cases, medical expertise were entrusted to barbers. A pragmatic pattern can be observed in the behaviour of the judges in criminal cases. Barbers were instructed to examine wounded or poisoned persons, and they also did autopsies in distant places in search of the causes of death. If a crime occurred in the city, the medical examination would be carried out by a surgeon. Physicians would be present at autopsies in the city, and the role of the barber would be reduced to that of dissector.
In the middle of the century the economic recovery allowed for Dubrovnik men to be given scholarships for studies of medicine and surgery and for the employment of foreign surgeons and physicians. Three surgeons of the commune carried out most of the medical expertise in the period of 1751/60, independently of the kind of crime, including medical expertise during investigations. Such a practice was kept up to the end of the century, when there were six surgeons in the employment of the city at the same time. The profession of barber was thoroughly marginalised, and the few reports of forensic examination they provided to the court were appended to private suits as proof of the existence of a crime, and in most cases they did not examine the wounds, but described the procedures of treatment carried out.
Physicians appeared seldom in court, and their participation was greater at the beginning of the century, when they were called upon to identify poisons, to be present at and voice their opinions about autopsies or to determine the causes of unclear death. At the end of the century the need for their expert knowledge ceased, for barbers and empirical surgeons were replaced by trained surgeons who were competent to provide forensic expertise in all kinds of crime.
In the Dubrovnik criminal records, midwives appeared as experts in evidentiary procedures related to the crimes of infanticide and rape, which included the determination of the age and cause of death of the newly born and of the absence or presence of pregnancy and the lactation period of the suspected woman, as well as expertise of the victims of rape in the search for traces of violence and loss of virginity, outside the periods observed in the first decades of the 18th century. In the periods observed, there were only four such cases. From the middle of the century, medical expert expertise were taken over by surgeons.The distribution of medical experts clearly shows that the economic and social progress of the Dubrovnik Republic in the 18th century shaped in medical terms the court practice at the criminal court in Dubrovnik. The pragmatism and frugality of the early part of the century was replaced by the need for a choice of the most qualified persons at their disposal.
In a comparison with the beginnings of medico-legal practice, a significant change appears. In the 14th and 15th centuries, medical expertise were carried out only at the order of the court. In the 18th century, however, the greatest number of such expertises were commissioned by private plaintiffs and were submitted as evidence of the existence of a criminal act.
A computation of the frequency and distribution of medical expertise gives answers to the questions about medico-legal practice and the changes that took place over the period observed. There are no published data for other criminal courts of the time with which comparisons can be made.
The frequency of medical expertise was reduced from the 26% of the beginning of the century to 13% in the middle (by 50% in other words), and it stayed at this level until the end of the century. At the same time, the number of criminal procedures from the beginning towards the end of the century was increased by 80%. The reduction of the proportion of medical expertise, disproportionately to the rise in the number of criminal procedures, confirms the hypothesis that there was a change in the form and intensity of physical violence, which is in accordance with European trends towards a general diminution of violence in the period, which resulted in consequence in a decline for the need for medical expertise in criminal procedures.
An analysis of the distribution of medical expertise in terms of kind of crime against life and person and procedures with a negative outcome of the investigative procedure in the three periods shows the gradual reduction of the number of procedures of the crimes of murder, suicide and manslaughter and at the same time an increase in the frequency of medical expertise in such procedures. In all three periods, the greatest number of medical expertise, as would be expected, relates to wounds and other injuries created in consequence of the crime of assault (629 or 89%), for there were by far the greatest numbers of such crimes (96%).
In the books of indictments of the Dubrovnik criminal court the medical report was regularly written in Italian. In their form and content, the reports in procedures initiated by a court decision do not differ from those initiated by a private suit. Most often there is a concise medical report that contains only the basic elements: the name and profession of the medical examiner, the name of the injured party, the kind and location of the wound and a prognosis of the consequences. It would be appended either to a private suit or to a medical report of knowledge of a criminal act committed.
The time and place of the examination of the injured party and the medical procedures resorted to were not regularly recorded. The time of the examination had to confirm or rebut the time of the commission of the crime. It was particularly important in those criminal procedures in which the judgement awarded compensation for lost wages brought about by the alleged criminal offence. The place of the examination gave the judges information about where the wounded person was in case they wanted to examine him. It additionally provides information about medical practice in 18th century Dubrovnik. A rise in the number of expertise in hospitals from the middle of the century indicates the change in the perception of hospital as place for quality medical care and also about the wish of private plaintiffs to ensure a more compelling proof of their physical injury.
Medical reports do not contain much information about medical procedures. In the text of the reports it is mostly mentioned only that the physician examined or tended the said wounds. As for treatments, compresses are mentioned, medicines to cope with pain and purgatives. It is noted that, particularly at the end of the century, the number of procedures of blood-letting increased. The mention of this procedure that was, indeed, in several cases performed at the request of the patient even when there were no visible wounds, was supposed to convince the judges of the existence and gravity of the crime.
The contribution of health workers, of surgeons, barbers, physicians and midwives, in the efficient control of violence is documented in criminal procedures launched ex officio and by their participation in the investigative procedures in the field. In criminal procedures initiated ex officio, medical expertise were a component part of the report if the reporter were a medical expert or if they were carried out at the order of the court. The number of reports of medical experts was considerably smaller than the total number of procedure initiated ex officio in which we can find forensic medical expertise recorded and because of the paucity of data it is not possible to ascertain it with any confidence. The proportion of procedures carried out ex officio for crimes against life and person fell towards the end of the century, which is interpreted as a reduction in the share of grave crimes. The share of physicians’ reports also fell at this time, but the share of medical expertise in this period rose at the same time. Towards the end of the century the judges had a number of medical experts available to them, primarily trained surgeons, who could help them to arrive at just decisions. In the period of the beginning of the century only did every third report come from a barber, and in later times the notifiers were only surgeons. The professional knowledge of physicians had an effect on criminal procedures from the very beginnings with the categorisation of the crime, which the judges regularly accepted and stopped the procedure or went on with further investigations. Criminal proceedings initiated by a physician by the notification of a death were never continued by an investigation at the site of the crime, which shows that the judges thought the facts alleged were confirmed. If the report of a crime came from a third person, judges could determine to carry out an on the spot investigation. The number of medical expertise was reduced towards the end of the century. The greatest number of such expertise were carried out in unclear cases of deaths produced by accidental falls, drowning or sickness. The results of all the quantitative and qualitative analyses carried out show a change in the quality, and from the middle to the end of the century, forensic medical examination passed into the domain of trained surgeons almost exclusively. The increased frequency of forensic medical examination in proceedings initiated ex officio in later periods confirms not only the greater accessibility of medical examiners but also the increased need of judges for equitable trials.
Medical expertise of wounds and other injuries arising in consequence of the crime of assault are as expected the most numerous such expertise in the periods under observation of the beginning, middle and end of the 18th century. Data from the reports about the kind of injury, the location, the means and the prognosis offer the judges the necessary guidelines in the evidentiary procedure and contribute to the verdict being made with greater justice.
In all three periods, the greatest numbers of medical expertise were of wounds that bled, and according to anatomical location, wounds of the head. The expertise of the most serious wounds regularly contained a pathological anatomical description, and sometimes listed which vital functions were jeopardised. The prognoses of the consequences of wounds were not uniformly framed, rather recorded in numerous expressions that in the early period often contain an indefinite formulation, which provided the expert protection against wrong evaluations. There was not always an explanation of the prognosis, which speaks to the confidence of the judges in the physician’s evaluation. Medical expertise of the means of commission was always present in cases of wounds with edged implements, for more severe penalties were enjoined for such crimes. When it was necessary, medical experts would evaluate the degree of physical impairment and the duration of incapacity for work pursuant to which the injured party would be awarded monetary compensation.
The contents and numbers of medical expertise of wounds and other injuries arising from crimes of assault make them a valuable source for research into the history of violence. Data from medical reports provide certain data about the consequences of assault. The reduced frequency of medical expertise in the cases of assault in the second period observed speaks of the smaller number of serious injuries for the evaluation of which expert opinion is required. The prognoses of medical examiners about the consequences to the health and life of the injured parties and textual descriptions of the wounds clearly show that blows became less powerful and inflicted less serious injuries on the wounded. The trend towards the diminution of the intensity of violence went on until the end of the century.
In spite of the small number of investigations carried out the proceedings of criminal procedure in cases in which poisoning was suspected can serve for the identification of the patterns of court practice. Not in a single procedure initiated by a private suit did the court order medical expertise. In the five cases that the court initiated ex officio after a notification, only one of which was a notification by a medical practitioner (a barber), the court instructed an expert (barber, physician or surgeon) to examine the poisoned person. In two procedures when no medical expert was sent to examine the person suspected to have been poisoned, the victims had already been interred when the notification was made. Although this is a small sample it can be seen that the barber was sent to distant places, while surgeons and physicians carried out their medical expertise in the city.
Medical experts found evidence of poisoning by a visual inspection of the body (skin, nails and oral cavity), the appearance of foaming at the mouth, the presence of vomiting and fever and in the general improvement of the state of the victim after they took an antidote. The most important part of the evidence, say the barbers and the physicians, was the test for the robustness of the hair. In a demonstration of knowledge about differentiation of symptoms of poisoning and of sickness, and of medical authority, the Dubrovnik physician Marko Flori stood out in a procedure in which he deterred the judges from a criminal prosecution of the apothecary Remedeli for having issued the wrong medicine. Only in one case of poisoning was evidence provided by an examination of the internal organs. After the barber had “opened up the corpse”, the physician and surgeon carried out the examination. The presence of poison was confirmed by the finding of arsenic crystals attached to the membrane of the ventricle where they had caused inflammation and deterioration of the tissue.
If there were signs that the poison had been administered in food or drink, the suspect remnants were taken to the court. Identification of poisonous subjects was usually made by city physicians by a visual inspection. They showed uncertainty and a poor knowledge of toxins. There is no record of them having used the sense of smell or having carried out any other kind of experiments. The contents of vomit would also be examined. Toxicity was demonstrated by biological experiments using animals, dogs or cocks, in the courtyard of the Rector’s Palace. There was no exchange of information between those experts who carried out expertise of the victims in the search of symptoms of poisoning, and those who were supposed to determine the kind of poison used, physicians and surgeons. Although the evidentiary procedures were lengthy and costly, and although the medical forensic experts in most cases claimed with confidence that the victim had been poisoned, not a single procedure was concluded with a verdict.
With their numerousness and contents, records of medieval forensic expertise of the Dubrovnik criminal court in the 18th century have permitted diverse kinds of analysis, the results of which explain the involvement of medical practitioners in the control of violence as well as supplement our picture of the criminal legal system in the Dubrovnik Republic. Data valuable for the history of medicine were also obtained, adding to existing knowledge about health culture, healthcare workers and establishments, sicknesses and treatments in the observed period. Thus, a better overall understanding of this historical period of the Dubrovnik Republic will be attained. With its diversity, the information should prompt other researchers to employ this valuable and very capacious set of archival records in the area of history of medicine, social history, the history of everyday life, historical anthropology and women’s history.