Part 2

There are no medical secrets which may be kept between a patient and his medical adviser when they are probed in a court of law: if, however, you strongly object to answer, appeal to the President of the Court, or answer in writing.

Think twice before adversely criticizing the actions of another medical man; remember, =symptoms and signs may alter= from day to day.

You may not quote text-books of living authors, but you may say what authors support your view.

If a text-book is quoted for or against you, =strictly verify= the text, the context, and the date of publication, before affirming or denying the quotation.

After giving evidence, hand in the labelled and numbered =exhibits= which have been handed to you by the police or found by yourself. “Real evidence” is, however, capable of fallacious handling, e.g., “Here’s the note! I made it at the time!”—but _did_ you?

It may be wise to take an “anatomical” skull into court for illustration.

The body of the Coroner’s officer is always available for ocular =demonstrations= to the jury of the sites of injuries, etc.

If any important point has been omitted by the questions (e.g., of a non-medical Coroner), volunteer the undisclosed information which you possess.

In conclusion, state the probable =cause of death=, especially assuring the jury if it was, in your opinion, natural; and if it could have been retarded by efficient medical advice.

Beware of being didactic on non-medical matters; such action is a fruitful source of the “differences of doctors.”

Before leaving the witness-box, =compliment= the conduct of the police or other persons who rendered worthy “first aid” to the deceased man.

“The best brief is a copy of the depositions.” When criminal or civil proceedings are likely to follow an inquest, carefully read over and correct where necessary your depositions as taken down by the Coroner’s clerk; initial any alterations you make, then sign them as a correct record. Never sign any statement without having perused it previously.

You can thus readily _identify the depositions_ later, when you may have to repeat your evidence in a higher Court where counsel will have scrutinized minutely not only the _facts stated_ but also the _facts as stated_: and so will be able to criticize keenly your second version.

In criminal cases the Coroner will _bind over_ the medical witness by recognizance to appear at the trial and give evidence; usually such cases are taken first at the Assizes.

FOOTNOTES:

[1] Say “I solemnly, sincerely, and truly declare, and affirm, that I will tell the truth, the whole truth, and nothing but the truth”; _or_, raising the right hand, say: “I swear by Almighty God, as I shall answer to God at the last day of Judgment, I will tell the truth, the whole truth, and nothing but the truth.”

II. RULES AS TO FEES.

=No fee= can be claimed for merely =volunteered= information, given either in Court or previously.

If you attend the Court after being _sub-pœna’d_, the fee is due, even should =no evidence= be called for.

=Do not= sign a receipt before you have received the money.

Apart from agreement to the contrary, an assistant or _locum tenens_ must hand his fees to his principal.

Where the authorities =compel attendance= in the public interest, definite fees are scheduled: if you appear on behalf of the prisoner, the plaintiff, or the defendant, a =private arrangement as to fees= (preferably in writing) must be made between the solicitor and yourself.

=1. THE CORONER’S COURT.=

There is =no fee= allowed for the =preliminary enquiry= and report to the Coroner; he can allow a fee only at an inquest.

No fee will be paid for an unordered anatomical _post-mortem_ examination.

=Only one= medical witness is called by the Coroner; additional evidence may be ordered by the inquest jury.

A second fee is =not allowed= for attendance at an adjournment.

A _post-mortem_ examination must =not be conducted= by one accused on oath of negligently causing the death in question.

No fee, for evidence or for _post-mortem_ examination, is payable to the medical officers (even if honorary) of voluntary medical institutions where the deceased died under the care of the officer; his attendance may, however, be excused if he sends a certificate as to the facts to the Court.

_No fee allowed_: Lunatic Asylum; Public Hospital or Infirmary (including Cottage Hospitals).

_Fee usually allowed_: Prison; Parochial Infirmary.

Where the deceased was “brought in dead,” the usual fees may be claimed by medical officers of institutions.

Travelling expenses seldom can be due to medical witnesses at inquests.

In =criminal cases= the Treasury may send down recognized experts.

_Fees_: For giving medical evidence after inspecting the body: ONE GUINEA.

For giving evidence after performing a necropsy in accordance with the Coroner’s order (or upon direction of the majority of the jury): TWO GUINEAS.

_Fine_: FIVE POUNDS is the penalty for disobeying the Coroner’s instructions.

=2. CRIMINAL PROCEEDINGS.=

(_Vide_ Home Office Order as to allowances for professional evidence in criminal prosecutions, 1903.)

For common skilled witnesses in petty sessional and police courts, at quarter sessions, and at the assizes, certain maximum =allowances= are specified; it is left to the Clerk of the Court to decide the actual fee in each case.

For =expert= testimony or highly skilled evidence the fee rests with the Court or the Treasury.

For attending to give professional evidence =in the town= or place where the witness resides or practises: If the witness

1. Attends to give evidence in one case only, not more than =one guinea= per diem, even if a disagreeable examination has been necessary in order to qualify as a witness.

2. Gives evidence on the same day in two or more separate and distinct cases, not more than =two guineas=.

For attending =elsewhere= than in any town or place where the witness resides or practises, whether in one or more cases, not more than =two guineas= per diem. “Place” here means the area within a radius of three miles from the Court.

No full-day allowance shall be paid unless the witness is necessarily detained away from his home for =at least four hours= for the purpose of giving evidence, otherwise he shall receive not more than one-half of the full-day allowance.

The fare actually paid is usually allowed to a witness as travelling expenses.

A medical witness, while staying within the precincts of the Court, may be ordered to assist with his professional services.

In case of dispute, the Home Secretary, Whitehall, S.W., should be applied to forthwith.

=3. CIVIL ACTIONS.=

If your services are required by =one party= to a suit, it is for you to arrange terms; the solicitor is not himself liable. =A guinea= per diem usually is regarded as the minimum fee; travelling expenses (which should be paid in cash previous to the journey) are additional.

You can =demand= payment (in Court) before you consent to be “sworn” as a witness; having been “sworn” you are bound to give your evidence.

III. SOME LIMITATIONS TO MEDICO-LEGAL EVIDENCE.

=1. IMPOSED BY RULES OF EVIDENCE.=

A medical witness, =as such=, cannot give evidence which will influence the Court to show

1. That a woman is past the age for procreating and bearing children.

2. That a child born nine months after lawful wedlock is illegitimate.

3. That, in the absence of eye-witnesses, a newly-born dead child was live-born.

4. That in a common disaster a certain person must have died last.

5. That children under seven can commit an indictable offence.

=2. IMPOSED BY INADEQUACY AND UNCERTAINTY OF KNOWLEDGE.=

1. The presence of gonorrhœa cannot be established by microscopical evidence.

2. A small mammalian blood-stain cannot be sworn to be “human.”

3. In a case of sudden death you cannot state whether a bruise was inflicted immediately before or immediately after the death.

4. The sex of a very old or a very young skeleton cannot be determined.

5. The age of a skeleton, after complete ossification, is guess-work.

6. Death cannot be affirmed until putrefaction sets in.

7. Pregnancy must not be asserted until quickening has been felt, or the fœtal parts are palpable.

8. Affiliation to putative parent from personal resemblance is insufficient.

=3. CASES WHERE A POST-MORTEM EXAMINATION IS NECESSARY TO TEST.=

1. _Alleged Drowning_: otherwise in the absence of eye-witnesses of the fatality, “found dead in the water” is the only logical conclusion.

2. _Alleged Overlaying_: otherwise “found dead in bed with the parents” should be the “open verdict.”

In 1 and 2, cardio-respiratory diseases must be noted.

3. _Alleged Still-birth_: for although live-birth cannot thereby be proved in the absence of direct eye-witnesses, the lungs may have functioned.

4. Anatomical _post-mortem_ examinations should be performed wherever possible in medico-legal cases; they are essential in alleged criminal homicide.

IV. VITAL ACTIVITIES WHICH MAY HAVE IMMEDIATELY PRECEDED SUDDEN DEATH,

1. _Respiration_: Soot or froth may be in the mouth, trachea, or nostrils.

2. _Deglutition and Peristalsis_: Local water or blood may have been swallowed; food may be in the stomach (e.g., of the newly-born); vomit or fæces may have been voided; salivation may have been profuse.

3. _Blood-Circulation_: Much blood may have been lost, possibly having “spurted” (e.g., in the newly-born); the heart and vessels may be empty; there may be true extravasation into or hyperæmia of the tissues (a microscope will reveal reaction to an irritant); the veins may be swollen on the distal side of a ligature; the blood may give spectroscopic tests for poisonings.

4. _Neuromuscular_: Articles may be clutched e.g., weapons, grass (“a drowning man catches at a straw”), hair, mud; _cutis anserina_ may be present; _emissio seminis_ or abortion may have occurred; the eyelids are usually open at death; children are usually born with the eyelids sealed.

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._ The complaints and natural expressions of a patient as to what he feels: his words aid in deciding the course of treatment.

_b._ The natural expressions of a frightened person, who has not had time to concoct a lie: thus after personal injuries, indecent assault, or rape.

VI. PRECAUTIONS TO BE OBSERVED UNDER SUSPICIOUS CIRCUMSTANCES;

WHICH MAY TERMINATE IN THE CORONER’S COURT, AND NEED MEDICAL EVIDENCE.

The primary duty of a medical man is to treat every patient _as a patient_.

=1. Chronic or slow poisoning= (including alcoholic).

_Cautions._ Try all possible preventive means before announcing the suspicion; do not move until your ground is quite sure: otherwise an action for defamation of character may result.

The family medical man must not be misled by the suspicions of weak-minded or alcoholic patients; he must exclude every possibility of an accidental origin of the symptoms. He should know the several personalities of his patient’s families.

The symptoms may appear during medical treatment: poison being substituted as “a lingering dram.”

If convinced, by repeated examination of the patient’s food and excreta, by his symptoms, and by the conduct of the suspected person, that the influence of poison is at work, let it be understood by the patient’s friends that you are not satisfied with the progress made: suggest the possibility of an accidental poisoning. Do not, at present, associate any name as the culprit; suggest a consultation with a medical friend.

Have the patient placed under the constant care of day and night nurses, who, although being instructed to administer personally all food and medicine, need not know at first your suspicions. If the line of defence is circumvented, or is impossible, have the victim removed to a nursing home, or to a hospital.

Your suspicions, without mentioning any name, should be told _viva voce_ to the relatives of the poisoned person, to his solicitor, or to the suspect himself. If this course is futile, the name can be introduced in the information given to these persons, to the patient himself, or, finally, to a magistrate, or to the police. Should the victim die, the Coroner should be asked to order an expert toxicological examination of the body of the deceased.

=2. Threatened suicide.=

“There is a rule of life far higher than professional etiquette—a duty that every right-minded man owes his neighbour—to prevent the destruction of human life.”

“Sign an urgency certificate, so that the patient can be detained in his own house legally. Any step which is taken, which is in good faith, with the intention of certifying, is justified, and is covered by the law.”

=Attempted suicide.=

Special care must be taken to prevent a further attempt by constant unobserved watching. Delirious, melancholic, suicidal, and mentally defective patients are preferably placed on the ground floor.

3. Where a patient dies suddenly from a cause which is obviously not the one under treatment—as when anæsthetized, or after an operation.

Enumerate to the friends the possible explanations of the fatal issue. Affirm that there is no reason to have expected any one of them, and that all the usual precautions had been taken.

Report to the Coroner, or advise, where such report is considered unnecessary, that an anatomical _post-mortem_ examination should be conducted for the satisfaction of all parties concerned.

VII. SOME STEPPING-STONES OF MEDICAL EVIDENCE.

1200 Pledge to answer truly appears.

1215 Trial by Ordeal abolished.

1275 The Coroner’s Ordinance. The inquest jury were the witnesses also; inspection of external appearances was alone necessary for the jury’s _post-mortem_ examination.

1290 The Court, after being advised by physicians, direct the jury as to the legitimacy of a posthumous child.

1345 The Sheriff is directed to summon the foremost London medical men to consider the severity of a recently inflicted wound.

1354 A charge of surgical malpraxis narrated in the City Records.

1450 Common witnesses are summoned to appear before the jury.

1506 Dispute as to the province of the Court or the surgeon to decide upon the severity of a wound.

Anatomical _post-mortem_ examinations occur, though pathology is primitive. “Searchers.”

1542 Thomas Vicary advises the Lord Mayor in a case of battery.

1562 Witnesses summoned _sub-pœna_.

1575 Ambrose Paré publishes typical “medico-legal reports.”

1632 College of Physicians report in full on a corrosive poisoning case.

1665 Sir Thomas Browne affirmed in Court his belief in witches.

1699 Baron Hatsell objects to Dr. Crell quoting “Ambros Parey’s” opinions.

1723 Mr. Justice Tracey enunciates “the wild beast” theory of responsibility in lunacy cases.

1767 _Slater_ v. _Baker & Stapleton_—a case of surgical malpraxis; damages £500.

1781 John Hunter gives expert evidence in an alleged poisoning case: “I can give nothing definite.”

1788 Samuel Farr’s _Elements of Medical Jurisprudence_.

1795 Matthew Baillie exposes the fallacy of “Death from polyp of the heart.”

1807 Chair of Medical Jurisprudence established in Edinburgh.

1823 Last “cross-road” burial of suicides in England.

1827 Orfila doubts detection of blood-stain with the microscope.

1830 The first Medical Coroner elected. “A medical Crowner’s a queer sort of thing.”

1831 Sir Thos. Watson lectures at King’s College Hospital, and Swaine Taylor at Guy’s.

1832 The Anatomy Act, after Burke and Hare scandals. “Burke Hare too!”

1836 Registration of “the cause of death” introduced.

Sir Dominic Corrigan’s clause as to fact of death: “As I am informed” (1874).

1837 The Medical Witnesses Remuneration Act allows fees for medical evidence at inquests; inquests and autopsies increase, pathology advances.

1843 Swaine Taylor’s _Manual of Medical Jurisprudence (Principles and Practice, 1865)_.

Rules as to the test of criminal responsibility of the insane (McNaughten’s case).

1844 Rudolph Virchow’s _Die Sections-Tecknik_ commenced.

1845 Telegraph first used for arrest of a prisoner (Tawell).

1846 Anæsthetics introduced. “Gentlemen! Here is no humbug!”

1848 The first Public Health Act.

1851 Stas devises his process to detect poisoning by alkaloids (nicotine).

1857 Lord Chief Justice Cockburn discredits microscopical evidence.

1858 “Railway shock” appears.

The Medical Act registers medical practitioners.

1862 Hoppe-Seyler suggests medico-legal use of the spectroscope (Muller’s case, 1864).

1863 Photography applied to surgery. (1871, criminals photographed).

1864 Listerism introduced.

1868 Crown Office (Scotland) memorandum for medico-legal examination of dead bodies (revised 1897).

1883 Bertillonage employed (France).

1879 The first Inebriates Act.

1886 The triple qualification necessary.

1887 Retford ptomaine poisoning.

1888 Witnesses emancipated from “kissing the Book.”

1893 Phonograph heard in the Chancery Division.

Report on Death Certification.

1896 Skiagram of ankle produced in an action for damages.

1897 Finger-print records recognized (India).

1897 Cinematograph used in Medicine.

1901 Medico-Legal Society founded.

1902 A “thumb-print” accepted at the Old Bailey.

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Transcriber’s Notes

pg 47 Added period after NECESSARY TO TEST