Medical case

“ Consider, in addition, that the medical practitioner may be called upon, at any moment, to give evidence in a court of justice in a criminal case; and that it is therefore well that he should know something of the laws of evidence, and of what we call medical jurisprudence. On a medical certificate, a man may be taken from his home and from his business and confined in a lunatic asylum; surely, therefore, it is desirable that the medical practitioner should have some rational and clear conceptions as to the nature and symptoms of mental disease. ”

“ THE PATIENT IS LIVING, AND MEDICAL ASSISTANCE IS REQUIRED. This is the least complicated case that can occur; the medical inquirer has not only the advantage of the patient’s testimony, but that also of his own observations upon the symptoms and circumstances of the case. ”

“ As to the perplexing instead of elucidating, a writer of the highest authority gives the following, “In a case of alleged child murder a medical witness, being asked for a plain opinion of the cause of death, said, that it was owing to ‘atelectasis and a general engorgement of the pulmonary tissue’.” ”

“ Regarding persons whose condition has not been defined by the civil authorities after medical diagnosis, the Assembly on the spot must investigate every case that arises and, after consultation with experts, deliver its verdict. ”

“ The medical man should remember that his is the one great exception to the rule that rigidly excludes opinions, and that scientific men called as witnesses may not give their opinion as to the general merits of the case, but only as to the facts already proved. This qualifying rule being altogether reversed in investigations into personal identity, and the physician’s opinion as to identity being indispensable, it becomes a matter of most serious import that this opinion should be grounded upon absolute and well-attested facts. ”

“ The rule of law on which the giving in evidence the opinion of witnesses, who know nothing of the actual facts of the case, is founded, is not peculiar to medical testimony, but is as a general rule applicable to all cases where the question is one depending on skill and science in any particular department. ”

“ Thus the opinions of medical men are admissible in evidence as to the sanity or insanity of a person at a particular time, because they are supposed to have become, by study and experience, familiar with the symptoms of mental disease, and therefore qualified to assist the court or jury in reaching a correct conclusion. And such opinions of medical experts may be based as well upon facts within their personal knowledge, as upon a hypothetical case disclosed by the testimony of others. ”

“ I congratulate you on being the man who has the first opportunity ever afforded us of questioning an intelligent European case, a case where the patient is fully capable of describing with accuracy his symptoms and his sensations in medical phraseology. ”

“ There are doctors doping people with powerful drugs, who couldn't tell whether a patient had a case of cholera-morbus or was afflicted with an incurable itch for office—who have acquired their medical information from the almanacs and could not distinguish between a bunion and a stone-bruise or find the joints in a string of sausage with a search- warrant. ”

“ That we regard the acceptance by a physician of a fee that is contingent upon the result of a medico-legal case as not in accordance with medical ethics and derogatory to the good repute of the profession, and advocate the regulation of the practice by legislation. ”

“ The data for the medical history of a man's life are the observations made by his physician in his successive illnesses, and I would dwell on the importance of gradually establishing a custom that the medical attendant of each patient should as a matter of course write down such clinical notes of his case as are written at the bedsides of public patients at hospitals. ”

“ Just go ahead and tell the jury about what you know? A. Well, his physical condition, according to everything, is bad or, at least, the doctors say so, you know. I couldn't-as far as the checks, I don't know; but, I do know that he needs medical care. ”

“ 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. ”

“ Cases are found where the patient, possibly on the public platform or at a social gathering, is seized with a consciousness of the malady so suddenly as to render medical assistance futile. Surgical Cases It is impossible to mention more than a few of the most typical cases of diseases of this sort. ”

“ Medical men, for example, may give their opinions not only as to the state of a patient they may have visited, or as to the cause of the death of a person whose body they have examined, or as to the nature of the instruments which caused the wounds they have examined, but also in cases where they have not themselves seen the patient, and have only heard the symptoms and particulars of his state detailed by other witnesses at the trial. ”

“ SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC. Every medical practitioner must have met with a certain class of cases which has set at defiance every effort at diagnosis, baffled every treatment, and belied every prognosis. ”

“ In those days, many families were still old-fashioned enough to have a doctor who not only diagnosed the presence of disease but went on to prescribe for it himself—very much as if you were to put a law case in the hands of a solicitor and he were to take your case into court and plead as counsel. ”

“ No decision process restricted to comparing claimants' medical evidence to a fixed, finite set of medical criteria can respond adequately to the infinite variety of medical conditions and combinations thereof, the varying impact of such conditions due to the claimant's individual characteristics, and the constant evolution of medical diagnostic techniques. ”

“ It is immaterial that another person employs the physician to examine the patient, and to report to the employer, and that the person examined does not appear to desire any knowledge as to his condition; if the examination is made as a professional act, the relation of physician and patient is established between the physician and the person examined, even though it be the only interview. ”

“ Nor are these subjects limited, as might at a first and superficial view appear, to the testimony required of physicians and surgeons in criminal cases, but extends in a greater or less degree through every branch of jurisprudence; nor can we yet assert that we have anticipated every point on which medical, chemical, and surgical questions may arise; as recent examples have evinced, that the rapid progress of science which has marked the last half century above all others, is daily eliciting new points both for scientific and judicial enquiry. ”

“ 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. ”

“ The advancement of medico-legal science, to which it is proposed that the labours of the Association shall be directed, is of the highest importance. The superiority of our continental brethren over British medical men, in their knowledge of forensic medicine, has been long painfully felt by those who are emulous of their country's fame. ”

“ But when, in an action against a physician for malpractice, the patient testifies as to the manner of treatment, the physician is then at liberty to introduce the testimony of himself or another physician as to the facts thus put in issue by the patient. ”

“ V. HEARSAY TESTIMONY: MEDICO-LEGAL EXCEPTIONS TO THE GENERAL RULE WHICH FORBIDS THE RECEPTION IN COURTS OF SUCH TESTIMONY.
1. The rule is not strictly observed in the Coroner’s Court, wherein an enquiry, and not a trial between parties, is held.
2. Formally recorded dying declarations; the medical adviser often hears “the last whisper of life.”
3. Spontaneous and voluntary confessions are sometimes made to medical men.
4. Where the statement in question was part of the proceedings under investigation, thus:
a. ”

“ Definition, Exceptions.—Any person is deemed practising medicine, surgery, or obstetrics, or to be a physician, who publicly professes to be a physician, surgeon, or obstetrician, and assumes the duties, or who makes a practice of prescribing, or prescribing and furnishing medicine for the sick, or who publicly professes to cure or heal by any means whatsoever ”

“ The want of such information must be every day more and more sensibly felt by the members of the bar; inasmuch as from the zeal with which medical jurisprudence is now cultivated by the medical profession, the evidence it supplies will be more frequently appealed to, and must have a great influence in legal proceedings; and, besides, the very arts that civilize and refine multiply the offences, for the detection of which scientific skill is required. The same science that provides a remedy against pain and suffering, arms the hand of the murderer with his most deadly weapon. ”

“ These are striking examples of the important aid the administration of justice may derive from medical skill and knowledge. They almost lead one to hope that science may one day realize the blind belief of the vulgar, and render it impossible murder can be hid. Less remarkable, but not less useful instances of the value of medical evidence are of every-day occurrence, and of late years are not unusual even in those countries. ”

“ Counsel. "Do you wish to go out to the world as saying that you have never diagnosed a case of morphine poisoning excepting when you had an autopsy to exclude kidney disease?"
Witness. "I do not. I have not said so."
Counsel. "Then you have diagnosed a case on the symptoms alone, yes? or no? I want a categorical answer."
Witness (sparring) . "I would refuse to answer that question categorically; the word 'diagnosed' is used with two different meanings. One has to make what is known as a 'working diagnosis' when he is called to a case, not a positive diagnosis." ”

“ The existence, or nonexistence, of a significant risk must be determined from the standpoint of the person who refuses the treatment or accommodation, and the risk assessment must be based on medical or other objective evidence. Arline, supra, at 288; 28 CFR §36.208 (c) (1997) ; id., pt. 36, App. B, p. 626. As a health care professional, petitioner had the duty to assess the risk of infection based on the objective, scientific information available to him and others in his profession. ”

“ Contributory Negligence.—In conclusion it should be stated that the patient is bound to follow obediently all proper directions given him by his physician or surgeon, as to his diet, mode of life, time of taking and quantity of medicine to be taken, or the care of a diseased or injured member. Any disobedience of such directions which contributes to prevent a recovery will bar him from his right of action for malpractice, even though the medical man may have been somewhat negligent. ”

“ The English and American authorities agree that medical, or other scientific books, are not competent evidence in courts of law; they cannot be put in evidence, although the medical witnesses state that such books are works of authority in medicine. ”

“ This state of things has been occasioned by the circumstance that medical practitioners have often been more given to the formation of theories upon the nature of disease and the mode of its treatment, than to that careful observation and patient accumulation of facts, by which, in other sciences, the phenomena of nature have been unravelled. ”

“ If a patient complains of a long protracted disease, which has rendered his life uncomfortable, and we at the same time perceive that his body has not undergone emaciation, we are naturally led to suspect the truth of his statement; and we shall find little difficulty in verifying, or dispelling our suspicions; nor ought we to forget, in an inquiry of this nature, to learn whether the patient has in truth ever flown to any remedy for relief ”

“ Counsel. "What medical name, doctor, would you give to the plaintiff's present ailment?"
Doctor. "He has what is known as 'traumatic microsis.'"
Counsel. "Microsis, doctor? That means, does it not, the habit, or disease as you may call it, of making much of ailments that an ordinary healthy man would pass by as of no account?" ”

“ We do not understand or accept it as prescribing an inexorable rule that automatically bars reliance of the fact-finding tribunal upon informed medical judgment every time medical witnesses can be produced who blindly adhere to a curative technique thoroughly discredited by reliable scientific experiences. ”

“ In ordinary practice, the physician's time is divided in his consideration of acute, chronic, surgical, and obstetrical cases; in fact, much of it is occupied in riding to reach his patients. His attention is continually diverted from one class of cases to another, effectually preventing investigation in any particular direction. ”

“ Unless the barrister has sufficient medical knowledge to be able to appreciate the force, or to see the fallaciousness of the medical evidence, the administration of justice can scarcely ever derive any solid advantages from the science of medicine. I believe I pronounce no libel on the members of the bar, when I assert, that, with few exceptions, they come to the Profession, both in England and here, and grow old in it, without the knowledge necessary to manage medico-legal inquiries. ”