Medical evidence

“ Medical observation is ever incomplete, unless it take cognizance of all the functions, the aggregate adequateness of which, respectively ascertained, constitutes and is essential to health. The state of each should be accurately examined, however unconnected it may appear to be with the prominent derangement. Diligent scrutiny will often detect a morbid condition where it was unsuspected; and a negative should never rest on surmise wherever direct evidence is attainable. ”

“ As to all the higher questions which determine the starting-point of a diagnosis—as to the philosophy of medical evidence—any glimmering of these can only come from a scientific culture of which country practitioners have usually no more notion than the man in the moon. ”

“ 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. ”

“ 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. ”

“ You can do little with persons who are disposed to accept these curious medical superstitions. The saturation-point of individual minds with reference to evidence, and especially medical evidence, differs, and must always continue to differ, very widely. There are those whose minds are satisfied with the decillionth dilution of a scientific proof. No wonder they believe in the efficacy of a similar attenuation of bryony or pulsatilla. ”

“ There are occasional exceptions to this remark; but the general truth of it is rendered probable by the fact that these cases are always, or almost always, written with the single object of showing the efficacy of the medicine used, or the skill of the practitioner, and it is recognized as a general rule that such cases deserve very little confidence. Yet they may sound well enough, one at a time, to those who are not fully aware of the fallacies of medical evidence. Let me state a case in illustration. Nobody doubts that some patients recover under every form of practice. ”

“ It is not the province of the expert to draw inferences of facts from the evidence, but simply to declare his opinion on a known, or hypothetical state of facts, and therefore the counsel on each side have put to the physicians such states of fact as they deem warranted by the evidence, and have taken their opinions thereon. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ For this reason, we are about to draw the attention of Medical practitioners to the nature and importance of the evidence, which they may be required to give in Courts of Law, on various subjects in which their science is not merely ancillary, but in the highest degree essential to the ends of justice. ”

“ How far and in what cases opinion is evidence, is next to be considered; in ordinary matters where, from a statement of facts, the jury, in the exercise of sound and ordinary understanding, are capable of arriving at a just conclusion, the opinion of a witness is neither requisite or admissible; but in matters of science it is otherwise, provided that he backs his opinion by such reason as may be satisfactory to the understanding of his hearers; and this is the principal qualification of a medical witness, that he make himself intelligible to ordinary comprehensions. ”

“ It is not enough, therefore, in my opinion, that such evidence formed a part of the death-bed declaration. If a fact derived at second hand from the deceased, and stated too by him from memory, is a material element of any of the medical opinions on the trial, it is of much importance that the information be procured by a medical man ”

“ If again a medical man is called to a patient evidently affected with suspicious symptoms, and finds himself obliged to declare such to be his opinion, his thoughts, as soon as he has given directions for the treatment, should be turned towards that part of the evidence, for the securing of which he is naturally looked to as the person best qualified by previous education and his opportunities at the moment. ”

“ Medical men and other skilled witnesses, may give their opinion in evidence, as to the state or condition of a patient or thing at any particular time. Expert evidence is always admissible, but being expensive and not conclusive, is weighed cautiously and little relied upon. ”

“ The great weight of the evidence before us is to the effect that certain types of medical experiments on human beings, when kept within reasonably well-defined bounds, conform to the ethics of the medical profession generally. ”

“ 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 ”

“ From year to year the statistics of the most common diseases must be revised in the light of new conceptions of disease. Through the autopsy there lies within the reach of every practitioner the opportunity of contributing something worth while to the general sum of medical knowledge. ”

“ 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. ”

“ For example, one not an oculist may speak as to the cause of injuries to an eye; one who has not made diseases of the mind a special study may give his opinion as to the existence of insanity; one not a practical chemist or analyst, but understanding the practical details of chemistry and the means of detecting poisons, may testify as to the tests in the chemical analysis of a stomach, and as to the tests usually applied to detect poison (278) . The law will even allow a physician to speak as to the length of time a mule has been suffering from a disease (279) . ”

“ 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. ”

“ When medical opinions are founded on experiments, I will, whenever it is practicable, repeat those experiments before you, and show you exactly how medical men, in such cases, arrive at their conclusions. ”

“ Nowadays, all this is past, in medical science. As to the causes of disease, we know that they are facts of nature,—various, but distinguishable by diagnosis and research, and more or less capable of prevention or control or counter-action. ”

“ It is by an immense number of experiments or trials on a large variety of cases, at different times, by different observers, and under varying conditions, that medical science has been able, after centuries of doubt and struggle, to arrive at some few real scientific facts in regard to the action of medicines. If these six elements of error had, from the first, been everywhere recognized and comprehended and systematically guarded against, the process of finding the truth in this department might have been abridged by hundreds of years. ”

“ 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. ”

“ 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. ”

“ It is not one of those certain or exact sciences in which truths become established and fixed, but is essentially progressive in its nature, enlarging with the growth of human experience, and subject to those changes and revolutions incident to any branch of human inquiry, the laws of which are not fully ascertained. The labors of the anatomist, the physiologist, and the chemist have contributed an immense storehouse of facts; but the manner in which this knowledge is to be applied in the treatment and cure of diseases has been, and will probably continue to be, open to diversity of opinion. ”

“ Examination of the Living.—With regard to the identification of the living, the presence of a medical man is seldom required, but there are many occasions when his opinion may be sought. Thus, under the Factory Acts, he may have to examine children about whose age doubts may have arisen. ”

“ DISEASE HAS CERTAIN UNMISTAKABLE SIGNS,
or symptoms, and, by reason of this fact, we have been enabled to originate and perfect a system of determining with the greatest accuracy the nature of chronic diseases without seeing and personally examining our patients. In recognizing diseases without a personal examination of the patient, we claim to possess no miraculous powers. We obtain our knowledge of the patient's disease by the practical application of well-established principles of modern science to the practice of medicine. ”

“ And in most cases in which bad treatment has been ruinous in its results, the evidence is not such, even at the conclusion of the case, as will satisfy the public, at least that portion of it which is inclined to quackery. An examination after death is not always obtained; and when it is, it will not always afford us as clear evidence, as was seen in the case above related, for both disease and medicine may destroy life, without leaving any manifest and undisputed traces of their action, to be revealed by the knife of the anatomist. ”

“ Every malady is accompanied by its characteristic indications, some of which are diagnostic, i.e., they particularize the affection and distinguish it from all others.
Medical diagnosis is both a science and an art; a science when the causes and symptoms of a disease are understood, and an art when this knowledge can be applied to determine its location and exact nature. Science presents the general principles of practice; art detects among the characteristic symptoms the differential signs, and applies the remedy. ”

“ A medical expert is sometimes confronted upon the witness-stand by long quotations from well known medical text-books, and he is asked whether the doctrines, opinions, etc., there laid down are sound. ”

“ The greatest exactness in detail, careful statistics even in the smallest matters, and a scholarly statement embracing all sides of medical experience are here united, in order to preserve and transmit to contemporaries and posterity in the greatest possible completeness, the knowledge purchased at so vast an expense. ”

“ Facts, then, being the foundation of medical science, the first requisite in all attempts to improve it, is to ensure all alleged facts being real truths. Medical facts are principally derived from the observation of phenomena during life, and the examination of structure after death. In both, many sources of fallacy exist, against which the medical enquirer should be on his guard. It will be convenient to consider, in the first place, those which regard the latter subject.
No facts in medicine are relied on with more confidence than those which dissection displays. ”

“ If examination reveals a quantity of blood effused into the substance of the brain, there can be little doubt in the mind of the medical man that the excitement was the principal cause of the effusion. ”

“ Yet there are signs that we are entering on a new phase, and that a realisation of the importance of early diagnosis is slowly permeating through the medical profession. In America we see an increasing insistence on the use of detailed and specialised laboratory methods for exact diagnosis ”