Army pathologist turned writer Bradley Harper performed over 200 autopsies before penning crime books A Knife through the Fog, Gallery of Death and his latest historical thriller Queen’s Gambit set in 1897 London. For Crime Thriller Hound he looks at the oldest known surviving forensic manual.

 

During the Sung Dynasty in China (960-1279 C.E.) the Imperial court had between ten to fifteen thousand civil servants tasked with controlling a vast land mass with a population of around one-hundred million. This placed an enormous burden on the few officials in the hinterlands placed into positions of responsibility for matters judicial, administrative, and law enforcement. While a prefect, responsible for a vast area, was experienced, the sub-prefects placed within communities of up to seventy-five thousand, were usually young men with an education in art and letters and with little to no technical training.

 

 To rectify this gap in knowledge Imperial scholars were tasked to produce various manuals to guide their rural brethren on various aspects of administration, to include the investigation of suspicious deaths. Since a local official could be punished for errors in death determination (one-hundred blows from a heavy rod was common), it was important to get it right. The accuracy in determining manner of death was vital in some cases, as it was not uncommon for a suicide to be made to look like homicide by the family member who discovered the body so as to charge an enemy clan with murder.

 

The oldest known surviving forensic manual was written by a Chinese scholar named Sung Tzu and printed in 1247. It makes reference to even earlier documents but alas, they have not survived. The title of the work literally translates as The Washing away of Unjust Imputations, but The Washing Away of Wrongs is the title used by the translator of the version I'm reviewing today.

 

One of the first things that struck me as a pathologist with forensic training was the emphasis placed on how to examine a body. There is some anatomical information and how the manner of death can affect the rate and manner of decomposition. I can personally attest that those who die of sepsis decompose far more rapidly than normally, so the writer had more than a passing acquaintance with his subject matter.

 

Some of the causes of death however I could not find in my pathology text, such as death by possession by malevolent ghosts (hsieh-mo). In such instances the young sub-prefect is advised that, "There will be frothy saliva at the mouth, but no signs of other causes of death on the body." Were I to examine such a corpse and found no other injury, I might suspect a seizure disorder, which many cultures throughout history have interpreted as demonic possession.

 

In death by trampling by a horse or buffalo the writer notes that the bowels may protrude, which could be caused by the compression of the abdomen by the animal's hooves. Those who die from a serpent's bite should have a dark swollen face. I can attest that a great many poisonous reptiles have a hemolytic poison which causes the rupture of red blood cells within the vascular system, and would produce such a face.

 

Another cause with which I am not familiar is death from acupuncture or moxibustion. Moxibustion is the burning of mugwort on top of the skin in certain vital areas, a practice I hadn't heard of before reading the book. In such cases the investigator is required to summon another practitioner to basically do a "peer review" to see if the person performing the treatments met the accepted "standard of care," not unlike what we do today in hospitals.

 

In death from sexual excess the man (apparently women are immune to this condition!), the erection will persist after death. No mention is made as to facial expression, but I do believe that males being the only gender to die from this activity proves which is the weaker sex.

 

My favorite however is death from tiger bite. The manual dryly notes that "feces will have been expressed."

 

You think?

 

While we like to believe that medicine is based upon science, I have seen it practiced in various cultures, and can attest that the art is still very much affected by local beliefs and practices both in life, and in the investigation of death. While I did find some good scientific basis for many of the manual's instructions, I learned quite a bit more about the society that required it. While not a fast read, I highly recommend it to scholars of either Chinese culture, or of forensics.

 

Bradley Harper MD, Fellow, American College of Pathology

 

Queen's Gambit is out September 2019.