Medical probe

“ From such a requisition he has no escape; he cannot shift his responsibility to another, and it behoves him, therefore, to acquire a knowledge of Forensic Medicine, in order to guide him, when so called upon, to give such evidence as will enable a judge and jury to arrive at a just conclusion. The relations of all medical practitioners to the State are twofold—first, as healers of disease, and secondly, both as guardians of the innocent against unfounded criminal charges and aids towards the detection and punishment of crime. ”

“ 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. ”

“ 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. ”

“ Few professions require more careful preparation by one who seeks to enter it than that of medicine. It has to deal with all those subtle and mysterious influences upon which health and life depend, and requires not only a knowledge of the properties of vegetable and mineral substances, but of the human body in all its complicated parts, and their relation to each other, as well as their influence upon the mind. The physician must be able to detect readily the presence of disease, and prescribe appropriate remedies for its removal. ”

“ 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. ”

“ 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. ”

“ When in doubt run no risks; better let a patient perish from disease or injury, than while attempting uncertain experiments with the surgeon’s knife or the use of dangerous drugs. The safe rule is to take no chances, unless there is a consensus of judgment of several physicians. It may be objected that if no experiments are tried no new medicines or surgical devices could be discovered, or their effects observed. ”

“ After these results of judicial medical investigation, the public need be under no apprehension. No doubt intelligent and clever criminals, with a view to thwart the surgeons, will sometimes have recourse to very active poisons little known by the mass, and difficult of detection, but science is on the alert, and soon overcomes all difficulty; penetrating into the utmost depths of our organs, it brings out the proof of the crime, and furnishes one of the greatest pieces of evidence against the guilty. ”

“ Whether any literary forgery can be innocent is questioned—but a forged medical report is a drawn dagger which the arm of a credulous physician may any day plunge into the heart of his defenceless patient. ”

“ 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. ”

“ Broughton Brandenburg, Imported Americans, 208.
[18] This imaginary sketch adheres in every detail to the facts. The medical examiners and inspectors become exceedingly expert in detecting disease, disability, or deception. If an overcoat is carried over the shoulder, they look for a false or stiff arm. The gait and general appearance indicate health or want of it to them, and all who do not appear normal are turned aside for further examination, which is thorough. The women have a special inspection by the matrons, who have to be both expert and alert to detect and reject the unworthy. ”

“ 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. ”

“ Do not employ a hammer or a chisel.
Remember that it is dangerous to attend lying-in women after making an autopsy.
If the mortuary attendant does the manual work you must watch each step.
If portions of organs are retained for subsequent examination, have the fact witnessed.
Drawing up a Medico-legal Report.
In most cases the witness must recite the report in open court.
For a complete investigation three sets of facts must be collated:
1. The details of the environment of the corpse, when and where first seen.
2. The personality and personal history [Pg 25] of the deceased. ”

“ Forensic medicine is an applied science, partly legal, partly medical, calling for information and investigation in widely divergent lines, and becoming more minutely ramified with the progressive advances in medical knowledge and in those sciences of which medicine is itself an application. Its development has been dependent partly upon the slow though progressive tendency of medicine from the condition of an empirical art toward that of an exact science, and partly upon the more rapid and more advanced development of criminal jurisprudence. ”

“ 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. ”

“ It is obvious that the power of observation and the skill, which the skilled chemists and physicians used as the basis of their reasoning in this case, were such as an ordinary man, unskilled and inexperienced, would not possess, and the ability to use them must have come from the study of treatises on such subjects, and from teaching and experience, to such an extent as to entitle the persons so testifying to be considered by the courts as qualified to express an accurate and sound opinion on the matters and things under investigation. ”

“ Florid looks, energy of frame, buoyancy of spirits, are no criterion, and may be deceptive, for all these may co-exist for a time with a state of constitution, which, if not amounting to disease, is fast approaching it; a deeper scrutiny is necessary for verifying the alleged health which such persons are supposed to enjoy. ”

“ 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. ”

“ 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. ”

“ Moreover, under the system which prevails there, it has been possible for men to be educated up to a high degree of skill and experience in the particular branches of physiological or psychological or physical investigations which they pursue, while here in America, and to a certain extent also in England, experts are such for other reasons, and by the operations of other causes, than the fact of their permanent employment in that capacity. ”

“ Before defining what is meant by the term expert witness, or treating of the rules which determine the status of such witnesses in court, and their duties, it seems advisable to introduce the subject by a brief consideration of the distinction between ordinary witnesses and expert witnesses. When medicine and law are united in the purpose of investigating facts, and bringing about a legal determination as to what are or are not facts, they co-operate with each other in this way. ”

“ If not a graduate, a person practising medicine or surgery, unless in continuous practice in this State for not less than five years, of which he must present to the board satisfactory evidence in the form of affidavits, must appear before the board for examination. All examinations are in writing; all examination papers with the reports and action of examiners are preserved as records of the board for five years. The subjects of examination are anatomy, physiology, general chemistry, pathology, therapeutics, and the principles and practice of medicine, surgery, and obstetrics. ”

“ 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. ”

“ 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. ”

“ He then—that is, after testifying that he is a practising physician—is clothed with the garment of authority. The only way in which his knowledge can [59] be tested is by cross-examination as to his experience and skill, and possibly by contrasting him as he appears upon the witness-stand and his history as he gives it, with other and more or less experienced and skilful men who follow him.
The rule is, that when a witness is produced to give an opinion on a medical question, he is interrogated by the counsel who produces him as to his qualifications. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Organic Chemistry is filling our libraries with its new facts and experiments. The imperative demand therefore of the medical expert is constant study. The exigencies of the position require, in justice to the profession, a thorough acquaintance with all that is old, and an equal familiarity with all that is new. The range of judicial inquiry often embraces the entire field of medical and surgical knowledge, as well as all their collateral branches. No obsolete [Pg 5] theory, no unborn or possible fact is too remote for searching investigation. ”

“ In short, a physician or surgeon cannot contract with a patient that the patient shall waive any claim for damages growing out of his want of ordinary care and skill. Nevertheless, the physician or surgeon may frankly inform his patient of his want of knowledge and experience as to the particular kind of treatment required by any special and unusual disease or injury. ”