Lithographic lecture notes. A tool of forensic medicine teaching. Observation on the lessons of Paolo Pellacani (1884-1885), forensic physician at the University of Pavia.

We focus our attention on the use of lithographed lecture notes written by professors, or more often by students, in the teaching of medicine and surgery courses, between the late 19th and early 20th centuries, a period in which, to better understand the phenomena underlying life and death, collaboration between medical professionals and natural science researchers was intense (1). In particular, we analyzed the lithographed lecture notes of Professor Paolo Pellacani at the University of Pavia for the course of legal medicine.

Introduction

We reflect on a teaching method used in the late nineteenth century in Italian universities, when lessons printed in the form of “lithographic lesson notes” were offered to teachers and students as an economic tool, able to integrate or replace the published scientific manuals and treatises. This is a topic little studied by medical historiography and the opportunity to enter specifically in the subject was given to us by a small collection of some books and medical manuscripts that had belonged to Alessandro Achille Tettamanti (1859-1931). Today they are stored in the Civic Library of Varese. We here focus our attention on the text containing the Forensic Medicine lessons taught by Paolo Pellacani (1854-1920), professor in Pavia (2). These lithographed lecture notes are bound together with the free course of gynecology held by Alessandro Cuzzi (1849-1895) in the same school year (1884-85) and collected by Cesare Lampugnani.

This lithographic lesson text, collected and transcribed by the students R. Fusari and E. Cesari, measuring 24,5 cm in height, titled “Lezioni di Medicina legale del Prof. Pellacani raccolte da R. Fusari ed E. Cesari l’anno 1884-85”, and divided into 15 lecture notes for a total of 117 pages, was used by students of the Faculty of Medicine of the University of Pavia. The last page carries the date of June 8, 1885, to be understood as the last day of the course.

We know that, after the Magister at Pavia, also in other universities in which Pellacani taught, lithographed lecture notes of his lessons were drafted (3,4).

In Bologna, at the end of the century, there were notes from Pellacani’s medical courses which had been collected by Giulio Obici (Lezioni di Medicina Legale date nell’Università di Bologna nell’anno scolastico 1892-93 e raccolte da Giulio Obici. Parte generale, Bologna, Lib. Fratelli Treves di Pietro Virano, 1893, 114 pagine con 29 figure), additional notes were collected by Giuseppe Zamboni in the year 1899-1900 (165 pages).

There are also lithographed lecture notes by Pellacani for students of law, and we know about those concerning the years 1897-1898 (94 pages) and 1899-1900 (66 pages) and those collected by the student Giuseppe Osti in 1903-1904 (153 pages). Only in 1915 the professor published the first volume of his “Notions of forensic medicine in summary” (in fact the only one published in Bologna at the Salesian printing school, 316 pages).

The lithographic lecture notes

It should be noted that the lithographed lessons were generally used as teaching tools in universities over the decades between the nineteenth and twentieth centuries. We know of lithographed lecture notes for many of the subjects for teaching medicine (5) and they were very popular among students, replacing manuals and treaties for the purpose of education and examinations.

However, today, these volumes are difficult to find in libraries. As a matter of fact, due to editorial modesty and their low value, they were rarely preserved and are often in bad condition.

This is a pity as these volumes represent, in many cases, one of the most important tool to really know - with the precise transcription of the words used by the teacher in the classroom - the modalities and contents of teaching by many professors. The technical panorama of the time had allowed the use of this modality to spread because only a limited number of professors gave the press summary volumes of their specialized knowledge for educational purposes. Therefore, if one wonders what circumstances may have encouraged the development of lithographed lesson notes for forensic medicine, the answer could possibly come from the careful examination of the manuals and treatises present in the libraries of that time. In the second half of the nineteenth century medicine had already embraced the experimental method of positive science, so that even for forensic medicine treaties of a few decades earlier could be partially overcome.

In Pavia, were still circulating volumes of the Fundamentals of Analytical Forensic Medicine (1852-1854) by professor Giovanni Gandolfi, who had held chair from 1866 until 1875. It is this kind of exposure that is hinged on classical models of tradition. Moreover, even in other universities, when it was necessary to update specialist literature, it suffered from delays and there were never enough new textbooks available in bookshops.

It’s interesting to note that the production of medical-legal manuals, at that time, was more frequent at the University of Naples where the work of Giuseppe Ziino and Luigi De Crecchio appeared in the seventies and eighties, as well as the Italian version of the treatise by Alfred Swaine Taylor). In Naples, the Legal Medicine News of Vincenzo Giovene and the Practical Guide to the civil and criminal legal medical reports of Antonio Raffaele were published. A Neapolitan printer also became involved in the Italian translation of the monumental German treatise on forensic medicine edited by Joseph Maschka. This localized and flourishing interest may not be a surprise when we consider the strong tradition of legal studies in the Neapolitan University.

In the north of Italy, the outlook was not as bright: Giuseppe Lazzaretti, a professor in Padua, published up to 1880 updated editions of his treatise (Forensic medicine, a rational method for solving civil and criminal matters) that had first appeared in 1853. According to Laura, in charge of teaching in Turin for a year in 1873, he printed his Treaty of Legal Medicine in 1874, but three years prior to this his lessons had already appeared. The major foreign authors were also circulating in Italy, and among the French, at that moment, the Handbook (Naples 1853-1854) of Joseph Briand and Ernst Chaudè remained very popular, and above all the well-known work of Alexandre Lacassagne, which was translated into Italian in the early twentieth century. Perhaps the Italian edition of the Practical manual by Johann Ludwig Casper, who was also an author often cited by Pellicani, still made sense at that time. Furthermore, in this period, there was the question of the legislative update of the country that had inherited the civil and criminal codes of the old states; this update was not irrelevant for legal doctors, who were very interested on the discussion concerning the new legislation, which, finally arrived at the fundamental stage of the Zanardelli code (6, 7).

Considerations

Pellacani’s scientific production had been particularly rich in and demonstrative of the specific interest that we partly find in the lithographed lessons we are dealing with today. In scrolling through these pages, it emerges how the professor presented himself to his students : he always demonstrated a secure approach based on deep knowledge not only in the theoretical part but even in the practical exercise of the discipline.

Lithographed lecture notes are unambiguous documents of all the course content given by the professors and therefore offer an authentic testimony of how the lectures took place during the course of an annual program. We can assume that they are demonstrating the major, or more specific, interests of the teacher, or the lines of practical commitment that represent the decisions made by the professor in the classroom. We can see that the course had been articulated well in some chapters, which, however, did not exhaust all the topics of the discipline, but it is not our intention, here, to go into the details of all the chapters. Pellacani had been quite critical about the problem of the discipline in Italy and his lessons were demonstrative of the attention he wanted to pay on the practical part and on the exercises (7). In a systematic and clear way, he explained what he thought to be necessary to guide physicians in the field of law, putting precise questions to which he responded with precise answers. Reading the text we can notice that his expressive modalities did not highlight those asperities that had been witnessed by Raffaele Guerrieri, his assistant in Bologna, who remembered the difficult character of the professor, who changed 18 assistants between 1891 and 1920, and consequently lived almost isolated. To explain the concrete applicability of forensic medicine, in addition to the continuous citations of the articles of the penal code concerning the various topics, there was no lack of listing the possible questions in criminal cases to which the doctor had to answer, to assert the arguments in the Court. Pellacani entered the formal part of forensic medicine by placing the students in front of the first question: the coroner is a witness and like any other professional, he must lend his work if legitimately called upon. On this, the code of law then in force was absolutely clear. He recalled students of their duty to comply with reporting cases of judicial interest, citing the risks arising from inobservance, including suspension from the profession or even criminal penalties.

The teacher was quite precise when detailing how to notify authorities with anything that might be of interest and how to draw up a legal-medical notification in all its various parts: preamble, stating facts, discussion, judgment, conclusion, avoiding all that could give rise to ambiguity or interpretive contentions. We can see that, if the professor insisted on these aspects and on the responsibilities of the physician obliged to the crime notification, in all his lessons the risk of being accused for lack of skill or imprudence in the exercise of the profession was however never mentioned.

Didactics dealt with the theme of personal injury and suspected poisoning, circumstances that obliged to inform the authority. So a large part of the course was reserved for exposing the so-called personal injuries with a detailed discussion of the damaging agents: usual and unusual weapons. Emphasizing the difficulties inherent in the evaluation of dating the injury or the precise determination of the weapon used, he listed the aggravating circumstances with the presentation of concrete evaluation examples, accompanied by the issues of differential diagnosis emerging from time to time; he explained the forensic concepts of organ, danger of life, functional impairment, consequences of the injuries at work and the permanent disfigurement of the face, at a time in which crime involving disfigurement was frequent.

The bodies of crime included blood, which, when appropriately examined, offered many subjects of study. The analyses required to carry out an accurate search for blood in suspect areas were illustrated.

Another frequent causes of violent death was asphyxiation, of which were presented the common characteristics, in addition to the anatomical-pathological picture resulting through external and internal examination of the corpse.

Once the formal part was finished, the professor proposed some casuistic exercises concerning infanticide or procured abortion also recalling the most frequent questions asked by the judge in this regard. Finally we note that the most substantial part of the lesson notes is formed by themes in the toxicological field, which seems to have been dominant in Pellacani’s interests.

We can notice that aspects of tanatochronology had been completely neglected, whereas, as we know, they appear as one of the principal topics in his scientific production, in harmony with the teaching of his teacher Arrigo Tamassia.

Evidently to the student Pellacani offered a summary presentation, useful to a generic professional, while when it was necessary to deal with legal cases he already highlighted the need for special medico-legal skills and, like other university colleagues, he asked aloud the courts to entrust the task of experts only to physicians specifically prepared in medical-forensic matters.

Anyway not all arguments of forensic medicine were presented and some topics that could not be ignored by the students were excluded. This suggests that even if the professor restricted the field of exposure from the chair to what we can read in the lithographed lectures, for the exam preparation it was likely necessary for the student to equip himself with treaties or manuals of scientific publishing.