40 Forensic dentistrypathologist medical examiners. A recent report by the National Academy of
Science also discusses inherent problems with the coroner system.
Partially because of these shortcomings with the coroner system, the
medical examiner system came into being. The title of medical examiner is
not a medical designation, but a governmental title, and it is defined differ-
ently by various jurisdictions (usually at the state level). But in the most basic
sense, the medical examiner (ME) is a properly trained physician charged
with the responsibility and authority to investigate deaths and to determine
cause and manner of death in a particular jurisdiction.^21
One of the first attempts at bringing medicolegal death investigation
under the authority of physicians came in Maryland in 1860, with laws requir-
ing the coroner to obtain the assistance of a physician in the investi gation
of violent death.5,10 Later, in 1890, physicians were appointed in Baltimore as
“ medical examiners” to perform autopsies requested by the coroner or other
officials. In 1877, the Massachusetts General Laws established physician medi-
cal examiners in Suffolk County and the remainder of the commonwealth,
appointed by the governor for seven-year terms. These physicians assumed the
duties of the coroner, but only in the case of deaths known to have come about
by violent means. These physicians also were not able to perform autopsies on
their own authority, but required an order from another official, such as the
district attorney, to authorize this procedure.
The first true medical examiner system was formed in New York City in
1918.3,5,10,23 This change was driven largely by a report of corruption in the
coroner system at that time by the city’s commissioner of accounts. In the
reformed system, the medical examiner took on all the investigative duties of
the coroner, whose office was abolished. The ME was required to be a physi-
cian appointed by the city and had the responsibility and authority to investi-
gate any death occurring by violent means, or suddenly and unexpectedly.
Deaths of prisoners or those not attended by physicians were also included in
the medical examiner’s jurisdiction. Other landmark facets of the New York
system included civil service protection of the ME and the sole authority to
decide what type of examination or investigation was necessary to certify the
death. In the early years of this office, a toxicology laboratory was also added
to the ME’s office, establishing laboratory analysis as a critical component of
death investigation.
When discussing the office of medical examiner, it is necessary to define the
term forensic pathology. The term forensic derives from the Latin word forensis
for “before the forum,” or relating to argument and discussion. Pathology is
the study of disease, or a medical specialty devoted to the diagnosis of disease
by laboratory means. Forensic pathology can be defined as the subspecialty
of medicine devoted to the medical investigation of death. It is one of many
components of the modern forensic sciences, and is a subspecialty of the medi-
cal specialty of pathology. In the United States, training in forensic pathology