Forensic medicine

“ Medical Jurisprudence, Forensic Medicine, or Legal Medicine are terms for that science which teaches the application of the knowledge of all branches of medical and surgical science and art to the solution of every question connected with the conservation of the species and the administration of Justice. ”

“ This new point of judiciary medicine has lately been elaborated by European writers under the title of Dépeçage Criminel, a term which applies to the operation resorted to by an assassin having for its end the getting rid of the body of the victim and to render more difficult the establishment of its identity.
The cleverness of experts scarcely keeps pace nowadays [410] with the more complicated proceedings adopted by criminals. In fact, at a trial of this kind truth and science are often the under dogs in a fight, than which none in forensic medicine is longer and more embarrassing. ”

“ Every practising physician requires thorough [xxix] instruction in medical jurisprudence, which, being strictly legal, is best taught by one whose profession is the law. The general practitioner only requires so much knowledge of the different branches of forensic medicine as will enable him to intelligently fulfil his obligations in such medico-legal cases as will be forced upon him as results of his ordinary practice. He can become a medical expert only by a particular study of and a large experience in some particular branch of the subject. ”

“ The science, the art, and the correct estimation of the value of Medical Evidence is the province of Forensic Medicine.
It is hoped that this little book will aid the General Practitioner when he is called upon to offer medical testimony, so that the ancient inquest jury especially may fully appreciate the bearing of the technical facts he narrates. Those who pose as “experts,” should ipso facto be themselves authorities on the matter and the manner of bearing testimony. ”

“ As to the act of examination itself, the physician should conduct it in such a way as not to harm the wounded person. Often simple inspection is the most that can be done, or the examination may have to be deferred altogether until the physician in charge informs the court that an examination may be safely made. It is often necessary for the expert to get information as to the original lesion from the physician in charge. If the wound has been a fatal one and if we are called in after death, we may examine the wound on the dead body with much more freedom. ”

“ The classification of the various topics of forensic medicine has ever been a fertile source of controversy; and we will venture to assert that, from the diversity, as well as versatility of the numerous subjects involved in the study of medical jurisprudence, no arrangement can ever be constructed which shall vie, in perspicuity and precision, with that of most branches of natural science, the objects of which, however numerous, maintain a mutual relationship, and admit of being displayed in a striking and natural order of connection. ”

“ It accordingly resolves itself into two great divisions—into Forensic Medicine, comprehending the evidence and opinions necessary to be delivered in courts of justice; and into Medical Police, embracing ii_bthe consideration of the policy and efficiency of legal enactments for the purpose of preserving the general health, and physical welfare of the community.
Under no circumstances does medical science assume so imposing and dignified an attitude, as when regarded as a branch of legislation. ”

“ To battle with the occult forces which play so important a part in determining the course or consequences of disease, it is absolutely essential that the physician should know all that is possible to be known of the patient’s history, and of the history of the patient’s family. ”

“ As soon as the medical men are armed with the proper authority, no time should be lost in order to get the body as fresh as possible, and at once prove or disprove the accusation of the crime, which, in the case of innocent persons, cannot be too quickly removed. The best time to take up the body, if in the summer, is early in the morning; and, in all cases, the examination, if possible, should be made during daylight. ”

“ The head should be opened and the brain examined first, and not last, as is often done in the ordinary autopsy.
Careful notes should be taken during each step of the examination, to be reread, verified, and signed at the completion of the autopsy.
It must be remembered that most of the lesions of disease which are found, indicate the disease rather than the cause of death; that often the lesion found will seem hardly extensive enough to cause death, and that from accidents and injuries apparently trivial, death may result. ”

“ If he deems a further examination necessary and is authorized so to do, he must make an autopsy in the presence of two or more discreet persons, whose attendance he may compel by subpœna if necessary, and he must then carefully reduce or cause to be reduced to writing every fact and circumstance tending to show the condition of the body and the cause and manner of death, together with the names and addresses of the witnesses. ”

“ Your duty is to request the woman to allow of the necessary examination, giving her the warning which every magistrate or coroner is bound to give to any person charged with a crime, before requiring an answer to a question which may be used in evidence against her at the subsequent trial. The innocent and the guilty may alike object to an examination, but the presumption is against the party declining, if several have voluntarily submitted. A young lady committed suicide rather than submit to an examination by two medical men under an order from the coroner. ”

“ If the operation is skilfully performed, and yet the patient dies from secondary causes, such as those above enumerated or any others, the prisoner is still responsible, and the medical testimony is concerned with the performance of the operation and the secondary causes of death. The relative skill of the operator or surgeon is probably not a question for the jury in criminal cases, on the ground that the man who inflicts the injury must take all the consequences, good or bad. ”

“ Any bodily or mental infirmity or ill-health which may result from an injury and its necessary treatment in the past and future, all these questions and many more unnecessary to mention may be required of the medical witness. No general rules can be laid down for all such cases. In giving his testimony the medical man must depend in any particular case upon his knowledge, judgment, and experience. ”

“ In some states where no discrimination in this respect is made between misdemeanors and felonies, the crime would be murder, punishable by death; and it has always been the law that an empiric or quack holding himself out as a regular physician is bound to have and exhibit the degree of skill and care which he professes, and will be strictly held to the standard of skill of educated and licensed medical men. ”

“ Evidence.—On the trial of persons charged with the violation of this chapter it shall be sufficient for the prosecution to show that defendant has practised medicine, surgery, or obstetrics within the county where the indictment is found at any time since the passage of the act (1876) , and the defendant shall not after proof be entitled to acquittal until he shows by the testimony of some competent witness upon oath that the defendant has received a medical education, and a genuine diploma from some regularly chartered medical school ”

“ When there is an allegation that the treatment has been unskilful or negligent, and contributory to complications and death, and a defence [Pg 83] raised accordingly, the prisoner has to prove this to the satisfaction of the Court in order to mitigate the offence and punishment. The medical man is expected to have exercised reasonable skill. If the person treating the injury is a registered medical practitioner, and has applied his treatment in good faith and for cure, even if the treatment were improper, the assailant would be held responsible. ”

“ A common instance and illustration of this matter is to be found in the case of homicide by poisoning. A human body is found dead; externally there may be no indicia to show positively the cause of death. Under such circumstances the laws of all civilized countries permit what is called a post-mortem examination by skilled physicians, who, finding no external evidences of the cause of death, are permitted by the officers of the law to remove the internal portions of the body for special and careful examination. ”

“ To save the patient's life, and to place himself in a position to give evidence if called on to do so. If life is extinct, his duty is a simple one. He should make inquiries as to symptoms, and time at which food or medicine was last taken. He should take possession of any food, medicine, vomited matter, urine, or fæces, in the room, and should seal them up in clean vessels for examination. He should notice the position and temperature of the body, the condition of rigor mortis, marks of violence, appearance of lips and mouth. ”

“ A chemical analysis of the contents of the stomach, etc., in suspected cases of poisoning is usually done by a special analyst named by the coroner. If any witness disobeys the summons to attend the inquest, he renders himself liable to a fine not exceeding £2 2s., but in addition the coroner may commit him to prison for contempt of court. In criminal cases the witnesses are bound over to appear at the assizes to give evidence there. The coroner may give an order for the exhumation of a body if he thinks the evidence warrants a post-mortem examination. ”

“ How much more careful, then, should be the medical examination of the remains in the progress of decay, with the distortion and discoloration of the features, and the consequent change or destruction of the peculiar expression of the countenance by which human features are usually distinguished and identified. ”

“ It is conducted before a judge, with a jury if the alleged lunatic demand one, unless the judge is satisfied by personal examination that the lunatic is not mentally competent to understand the demand for a jury. In such a case the medical man is only concerned as a witness. ”

“ Even though a medical examiner reports that a death was not caused by violence, and the district attorney or the attorney-general is of a contrary opinion, either one may, notwithstanding such report, direct an inquest to be held in accordance with the provisions of the statute. ”

“ C. Exposure of the Insane.—While it must be admitted that the insane subject is usually indifferent to matters of temperature, death from exposure to cold may call for special examination. Carelessness, incompetence, or wilful neglect on the part of nurses or keepers of insane hospitals, or deliberate criminal intent in such or others having the care of or an interest in the death of an insane person may lead to a judicial inquiry. ”

“ The medical expert has absolutely nothing to do with guilt or innocence, as that is a question for the jury. He should, above all things, be absolutely free from prejudice, suspicion, or undue suggestion, and should remember that in thus sinking his personality his sole function as a skilled witness in cases of identity is to furnish testimony which, when taken in connection with other evidence in the case, may establish such a corpus delicti as would justify the inference of a crime. ”

“ If this examination, which is necessarily long and excessively technical, results in the discovery of any poisonous substance, such as would produce death, and if it is found in sufficient quantities to produce death, these persons who made the post-mortem examination and discovered the outward indications of the administration and effects of the poison, and the chemists who discovered the poison itself in the tissues of the body, in sufficient quantities to produce death, are called as experts before the jury. ”

“ In the same manner that a very small portion or fragment of the human body may suffice to establish the corpus delicti, so will minute remains or traces, as finger-marks, footprints, and other material surroundings, even smells or traces of perfume, be of great assistance to justice in determining the identity of both culprit and victim, and at the same time throw light on the attendant circumstances of the deed. ”

“ In important cases specialists are often called to give evidence of a skilled nature. Thus the hospital surgeon, the nerve specialist, or the mental consultant may be served with a subpœna to appear at court on a certain date to give evidence. ”

“ We easily forget the true image of persons and things, and time promptly modifies them. The evidence of the senses may be so little trusted in this regard that father, mother, husband, and nurse may attest a false identity in the case of their own children. A nurse has been known to testify to the identity of the severed head of a woman whom thirteen other persons were sure they recognized from characteristic signs, when the supposed victim put in an appearance and thus attested her own existence. ”

“ The Procurator-Fiscal may supply to the medical inspectors portions of the precognitions likely to bear on the medical part of the inquiry. Medical men ought to be on their guard against performing dissections in cases evidently judicial without previously warning the proper law authorities, or without a warrant ”

“ If possible an absolutely new board, large enough upon which to examine the organs, should be at hand, for it may be claimed at a trial that the organs and tissues, if placed and examined on surrounding objects, have become contaminated. ”