Broadly, the term forensic medicine can be applied to medicine generally or can denote the forensic aspects of the several specialties of medicine either collectively or individually. Hence the designations forensic psychiatry, forensic pediatrics, forensic pathology, and so on. In the narrow sense the term denotes forensic pathology, which may be defined as the application of the medical specialty of pathology to problems of law. Traditionally, this linkage between law and pathology-the use of a body of knowledge dealing with the reaction of the body to disease and injury to resolve legal questions-has been the province of the medicolegal investigator of death, whether he be a pathologist to the coroner or a medical examiner. It is the task of the pathologist to examine the body of the victim of the homicidal attack, of the suicidal venture, or of the accident, as well as to examine the mortal remains of those who have died under unusual circumstances, or where the cause of death is unknown or questioned.
In Texas there are no coroners. The duties and the responsibilities of the coroner's office are delegated to the justices of the peace. The justices derive their death-investigation powers from the portion of the Texas Code of Criminal Procedure loosely designated as the "Inquest Law." This segment of the code is old and was originally intended to provide for the detection of homicide. It has been modified many times and in the process has been extended so as to include the authority of the justice to investigate suicidal deaths, deaths due to accident, and other deaths. It is not known when a justice of the peace, in the exercise of his duties, first ordered a physician to undertake an autopsy to determine the cause of death. Certainly this was an uncommon practice, not only in frontier days, but also and more recently in the more remote and sparsely settled counties. There is no record of how many times a quick examination of a body was carried out in funeral homes or at graveside by physicians whose primary interest was the treatment of patients, not the performance of autopsies to determine the cause of death. Certainly such examinations were conducted, but no central repository of records exists, and with 254 counties, each maintaining records of its own (sometimes very incomplete), no coherent picture of this phase of the forensic examination of bodies emerges. Physicians who conducted these examinations most probably considered such activity as public service and responded to the order of the justice of the peace as one way of bringing their area of expertise to aid in the administration of justice.
Lost also in the records of numberless court cases and files of the justices of the peace are records of early instances of the employment of pathologists to perform autopsies in the interests of justice. Most certainly this first occurred in Galveston County, where the first medical school in Texas was opened, or in the other populous counties such as Harris County, where pathologists were most likely to be located. These pathologists, whoever they may have been, served not only to bring their expertise to the better administration of justice, but also as a nidus of agitation for the passage of a medical-examiner law in the state. In the late 1940s and early 1950s a coalition of physicians (both pathologists and others), attorneys, and others pushed for legislative action to permit heavily populated counties to establish positions for appointed medical examiners. These were to be physicians skilled in autopsies, that is, pathologists. The so-called Baker Bill was proposed at the 1955 session of the Texas legislature and with some modification was enacted into law and thus became part of the Code of Criminal Procedure. The new law provided that counties with a population of more than 250,000 could establish a medical-examiner system, and if such a county had within its boundaries a medical school then that facility would suffice. Bexar County (without a medical school) established a system. Harris and Dallas counties each had a medical school; the former opted for a medical-examiner system, the latter chose not to establish one. Dr. Gared E. Clarke was appointed the medical examiner for Harris County in 1957. That same year Dr. Joseph A. Jachimczyk began serving as the forensic pathologist to the medical examiner and, upon Dr. Clarke's retirement in 1960, was appointed medical examiner, and held the position in the late 1980s. For many years he worked under very difficult conditions in inadequate facilities. After nearly thirty years of continuous service to the county and several false starts, Jachimczyk was provided a fine new building designated as the Dr. Joseph A. Jachimczyk Forensic Center of Harris County. This was public recognition of long and faithful public forensic service in the interests of justice. The Bexar County Commissioners Court appointed Dr. Robert Hausmann medical examiner in 1956. His office and laboratory were situated in the county hospital and, like that in Harris County, were inadequate for the task. A modern building housing office and laboratory was constructed in 1971. Dr. Vincent J. M. DiMaio assumed office in 1981. In 1965 the Code of Criminal Procedure was changed to mandate that counties with a population of more than 500,000 establish a medical-examiner's office.
Over the years there were a few changes in the basic law, some of which eventually made it possible for any county to adopt the medical-examiner law. As of 1986 the following counties had adopted the law and appointed medical examiners: Bexar, Collin, Dallas, El Paso, Galveston, Harris, Johnson, Nueces, Tarrant, Travis, and Wichita. Other counties were contemplating such action. It should be noted that once a county has adopted the medical-examiner law, all duties and responsibilities of the justices of the peace with regard to death investigation devolve upon the medical examiner; further, there does not appear to be any "escape clause"-having adopted the law, the county must keep the medical examiner's office in operation.
Some of the Texas county medical examiner systems are first class; others are hampered by lack of adequate facilities and support. Also, the personalities of the medical examiners have influenced the advance of forensic pathology, for better or worse. Dallas County, reluctant at first to develop a medical-examiner system, finally adopted the law in 1969. Harris and Bexar counties had at that time operated systems for more than ten years. But when Dallas County did establish a system, it did so with characteristic energy and great foresight. A modern facility in which to house the medical examiner's activities was constructed as rapidly as possible. In addition, a unique arrangement was set up whereby the criminal investigation laboratory (the "crime lab") and the medical examiner's office were combined in the new facility and placed under the same administrative head. This combined enterprise, named the Southwestern Institute of Forensic Sciences, has since been expanded to include other forensic activities such as the examination of rape victims and the functions of the Rape Crisis and Child Sexual Abuse Center. Bexar and Tarrant counties subsequently adopted similar arrangements. An integral part of an adequate medical examiner's facility is the provision of a reasonable forensic toxicology laboratory. Harris, Dallas, and Bexar counties have established these, and others are building them. By the 1980s forensic toxicology had become a complex activity requiring academic education, trained technologists, and highly sophisticated equipment so as to detect, identify, and measure very small amounts of drugs and poison diluted in the tissues of the body. One of the interesting spinoffs of the county medical examiners' offices is their use by other counties. Several of the larger and better equipped medical examiners provide an autopsy service for the justices of the peace of counties still operating under the old Inquest Law. Thus the larger offices are serving, to a degree, as regional forensic centers and provide a service sorely needed for reasonable death investigation.
From time to time there have been some efforts to establish a statewide medical-examiner system. The cost of establishing and maintaining such a system, however, is not inconsiderable, and the legislature has been reluctant to support such proposals. Other concepts, such as the "regional forensic center" plan, have been advanced. With the anticipated shortfall in revenues, it would appear that either a statewide system or a state regional system will be slow in developing. Education is an activity of medical examiners sometimes not recognized, especially when a medical school is located in a county where a strong and active medical-examiner system operates. Because the medical-examiner law mandates that all "unnatural" deaths be investigated by the office, instances of death as a result of all manner of traumas are not available for teaching of medical students and young physicians in residency training. The medical examiner must provide such teaching, especially since trauma is frequently a cause of death in our society.
The medical examiner or justice of the peace also supplies transplantable tissues and organs. In 1977 a law was passed enabling the medical examiner or justice of the peace to remove corneas for transplant. Many thousands of Texans have had their sight restored as a result of this forward-looking legislative action. In 1985 attempts were made to broaden the law; time will tell how effective this new legislation will be. The provision of tissues and organs for transplantation is a predictable extension of forensic medicine, for medical examiners investigate deaths from injuries, frequently of younger people without disease. Perhaps in the long run, this newer activity will be the lever to promulgate better scientific death investigation in Texas.