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diff --git a/old/69556-0.txt b/old/69556-0.txt deleted file mode 100644 index eee720c..0000000 --- a/old/69556-0.txt +++ /dev/null @@ -1,1710 +0,0 @@ -The Project Gutenberg eBook of Golden rules of medical evidence, by -Stanley B. Atkinson - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: Golden rules of medical evidence - "Golden Rules" Series. No. XVI. - -Author: Stanley B. Atkinson - -Release Date: December 16, 2022 [eBook #69556] - -Language: English - -Produced by: Bob Taylor and the Online Distributed Proofreading Team at - https://www.pgdp.net (This file was produced from images - generously made available by The Internet Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK GOLDEN RULES OF MEDICAL -EVIDENCE *** - - - - - - Transcriber’s Notes - Italic text displayed as: _italic_ - Bold text displayed as: =bold= - - - - - GOLDEN RULES - - OF - - MEDICAL EVIDENCE. - - BY - - STANLEY B. ATKINSON, - M.A., M.B., B.Sc. - - _of the Inner Temple, Barrister-at-Law; - a Justice of the Peace for the County - of London; Hon. Sec. of the - Medico-Legal Society_ - (_London_). - - - _“GOLDEN RULES” SERIES. No. XVI._ - - - Bristol: - JOHN WRIGHT & CO. - London: - SIMPKIN, MARSHALL, HAMILTON, KENT & CO., LTD. - - - - - PREFACE. - - -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. - - STANLEY B. ATKINSON, - - _10, Adelphi Terrace, W.C._ - - - - - INDEX. - - PAGE - - Alleged drowning, uncertainty concerning, 47 - - — overlaying, uncertainty concerning, 47 - - — still-birth, uncertainty concerning, 47 - - - Blood-circulation preceding sudden death, 48 - - - Civil actions, the fees in, 44 - - Common witnesses of facts, 8 - - Coroner’s court, constitution of, 8 - - — — the fees in, 39 - - Criminal proceedings, the fees in, 41 - - - Dead, the examination of, 21 - - Deglutition and peristalsis preceding sudden death, 48 - - Drawing up a medico-legal report, 24 - - - Evidence, classes of, 8 - - — given before entering court, 10 - - — in court after being sworn, 30 - - — in court before being sworn, 28 - - Examination of the dead, 21 - - — of the living and the dying, 18 - - — of the living, dying, and dead, 17 - - Expert witnesses, 9 - - - Fees, the rules as to, 39 - - - Hearsay testimony, when receivable, 50 - - - Limitations imposed by inadequacy of knowledge, 46 - - Limitations to medico-legal evidence, 45 - - Living and dying, the examination of, 18 - - - Manner, the, of giving medical evidence, 30 - - Matter, the, to be given in medical evidence, 33 - - Medical certificates, when not to be given, 11 - - — evidence, the manner of giving, 30 - - — — the matter to be given, 33 - - Medico-legal report, the manner of, 24 - - — — the matter of, 26 - - - Neuromuscular action and sudden death, 49 - - - _Post-mortem_ evidence, limitations of, 47 - - Precautions under suspicious circumstances, 52 - - Preparation of evidence, 14 - - Preparing and giving evidence, 10 - - - Respiration preceding sudden death, 48 - - Rules as to fees, 39 - - — of evidence, limitations imposed by, 45 - - - Slow poisoning, if suspected, how to act, 52 - - Stepping stones of medical evidence, 57 - - Sudden death, vital activities preceding, 48 - - Suicide, threatened or attempted, 54 - - - To escape attending as witness, 13 - - - Vital activities preceding sudden death, 48 - - - Witness, to escape attending as, 13 - - Witnesses, classes of, 8 - - - - - _Golden Rules of Medical Evidence._ - - -Every legally qualified and registered medical practitioner in actual -practice in or near the place where the death in question happened, -by the Coroners Act, 1887, may be summoned by the Coroner to give -medical evidence as to the cause of that death. Thus medical men may -be compelled to practise medical jurisprudence if called upon so to -do. With the growth of knowledge and exact observation, the weight -which is attached to medical evidence has increased proportionately. -It is still true, however, that “the exercise of a sound judgment, -which is of far more value in medico-legal matters than all the -substance of all the ancient _medicina forensis_, must be our guide.” - -The =Coroner’s Court= differs from other tribunals in that, -primarily, it conducts an enquiry to which there are no formal -parties. The evidence received by this Court is on that account much -less bound by technical rules. - - - CLASSES OF MEDICAL EVIDENCE AND WITNESSES. - -_The evidence of_ - -=I. Common witnesses of Facts which they have observed.= They -state the minor premiss of the forensic argument. Those who can -describe technical matters which they have seen are _skilled common -witnesses_: medical men usually appear in court as skilled witnesses. -Job’s “I shall see for myself, and my own eyes shall behold, and not -another,” indicates the correct attitude of a common witness of fact. - - -_The testimony of_ - -=II. Expert witnesses concerning their Opinions.= They state the -major premiss of the syllogism, whose conclusion is found in -the verdict of the jury. All expert witnesses should be skilled -witnesses. Experts sometimes become common witnesses when examined -as to exhibits produced in court. The weakness of expert testimony -is, in practice, its _ex parte_ nature. Medical men called to give -evidence as to fact, must beware of being unconsciously drawn into -offering expert testimony. - - - - - I. PREPARING AND GIVING EVIDENCE. - - - =A. BEFORE ENTERING COURT.= - -Notify directly to the Coroner all deaths, the certificate of the -cause of which you are unable to sign (persons found dead—whose death -was caused or hastened by accident or injury—who have died without -recent medical attendance—who, although attended by a registered -medical practitioner during the last illness, have died in such a -manner or at such a time, that the medical man is unable to assign a -cause of natural death, or for some good reason declines to certify -the cause). - -Most of the cases in which you give medical evidence are those in -which you have declined to sign a certificate of the cause of death. - -There are also those cases in which the relatives object to your -treatment, and those in which the registrar refers your certificate -to the Coroner. - -The fact that the account for professional services rendered is -likely to be unpaid is =not= a good reason for refusing to sign a -death certificate. - -=Decline to give medical certificates= to police-constables or to -solicitors’ clerks gratuitously, and without authority being shown. - -Demand a formal interview by appointment during professional hours -with a responsible superior; otherwise you may receive no fees. - -Volunteer no private information, and express no opinion in public, -concerning medico-legal causes with which you are not personally -concerned; otherwise you may be _sub-pœna’d_ to support your views. -If you know facts which will aid the execution of justice, give a -=hint to the police= either yourself or by a medical friend. - -Give information _viva voce_ or in letters marked “private.” Never -write an unofficial opinion. “Do right, and don’t write—then fear -nothing.” - -Should you receive threatening letters, demanding blackmail, or -otherwise without reasonable cause, at once put them into a good -solicitor’s hands. “Let this action be a lesson for all men to stand -boldly forward—to stand on their character—and not, by compromising -a present difficulty, to accumulate imputations on their honour.” -Associate yourself permanently with a Medical Defence Society. - -Unless in self-protection, or at the request of patients, do not -appear in court without having been properly served with a formal -_sub-pœna_. - -Do not fail to attend after receiving a formally served _sub-pœna_, -on peril of contempt of court and an action for resulting damages -on the part of the litigant calling you as a witness. You need not -afford a _precis_ of your evidence. “He [or they] must be satisfied -with impromptu answers.” When in doubt or difficulty, seek at once -the best legal advice possible. - - - TO ESCAPE ATTENDING AS A WITNESS: - -=In Coroners’ Courts.= Written certificates are usually accepted in -Coroners’ Courts from members of hospital staffs and from general -practitioners concerning the absence from ill-health of witnesses or -jurymen; the nature of the illness need not be specified. In higher -Courts personal attendance and evidence upon oath are necessary. - -=In Civil Courts.= If an appeal to the solicitor fails, you may -state that your memory of the events in question is vague, and when -prompted you may find that the facts as known to you are quite -hostile to his client’s claim. - -You may decline to offer “=expert opinions=”—a direct interference -with the facts and circumstances of the case alone =qualifies= you as -a common skilled witness who is bound to give evidence if required so -to do. - - - THE PREPARATION OF EVIDENCE. - -“More mistakes are made, many more, by not looking than by not -knowing.” You must be ready to meet an =exhaustive interrogation= in -Court: hence it is essential that a careful clinical or _post-mortem_ -examination should be made, with the aid of all reasonable modern -apparatus, and that what is known professionally concerning the -matters in hand should be revised from modern text-books: your -knowledge of pathology must be up-to-date. “You must know a thing -before you suspect it, and you must suspect a thing before you find -it.” - -=Remember= you are not a partisan: value accuracy of observation and -of statement as you do your professional reputation. - -You must be prepared to =explain facts and conclusions clearly= to a -body of laymen. - -=Beware= of mistaking a previously formed inference for a -recollection of actual fact—assumed conclusions sometimes -fallaciously suggest the real cause. “The chambermaid, in the -background, made out as much of the letter as she could, and -invented the rest; believing it all from that time forth as a -positive piece of evidence.” _Stat pro ratione voluntas_ is a fallacy -to be guarded against. - -Welcome, and even suggest, =conferences= which will avoid subsequent -public differences in medical opinions. - -Decide what exhibits and sketches you will hand in. Label, initial, -and number them. If they are returned to you after the trial, -preserve them for possible future use (e.g., pathological specimens). - -Previous to the trial keep all notes and exhibits =under lock and -key=. - -=Remember= medico-legal evidence is subject to certain -=limitations=—your “facts” may be absolute, or probable, or merely -possible (see p. 45). - -=Refresh the memory= from your clinical or other notes just before -giving evidence rather than when in the witness box. - -Any =notes read in the witness box= are open to the inspection of the -Court. They must have been made by you at the time of the event in -question, or immediately thereafter. - -All clinical notes and personal memoranda should be destroyed upon -the death of a medical practitioner, who should see that his Will -contains such a direction. - - - MEDICO-LEGAL EXAMINATION OF THE LIVING, THE DYING, AND THE DEAD. - -“The best memory is a record =made at the time=.” - -=Make a note on the spot= as to the person examined, the place, the -date, and hour of the commencement of the examination. Daylight -should be chosen. - -If possible, choose a time such that you can complete the enquiry at -one sitting, as it may be final. - -Where criminal charges may arise, =associate the police= (and, when -necessary, the relieving officer) with the case at once. If called -by a police-constable, do not fail to note down his number (from his -collar). - -=Decline= to perform technical processes which are probably beyond -your skill: thus the Coroner will usually secure the permission of -the County Council for analyses in suspected poison cases. - -=Exclude lawyers and curious laymen=, but invite another medical man, -especially if your own previous actions may be in question. - -Whatever you discover must be =kept secret= until you give evidence -in court. As a matter of courtesy, the Coroner may be informed -privately, before the inquest is held, of any unexpected or grave -results; do not, however, inform press men. - - - MEDICAL EXAMINATION OF THE LIVING AND OF THE DYING, FOR THE PURPOSE - OF EVIDENCE. - -All persons examined physically =must be informed= of, and =consent= -to, the purpose and possible legal consequences. - -Never take directions from a third person (e.g., police, magistrate, -employer). - -If a =further examination= may be necessary (e.g., under an -anæsthetic), that fact should be stated. - -=Witnesses= should be present, especially in the case of the -examination of females. - -=Do not send written certificates= to third persons as to the result -of the examination, unless (1) In an open envelope, having read the -certificate to the patient who takes it to its destination; (2) After -having received the written consent of the patient so to do. - -The payment of the fee by a third person does not absolve from the -rule of professional secrecy. - -The symptoms and =feelings of a patient= are sometimes admitted as -(hearsay) testimony from a medical witness, especially where the -former is dead. =Letters= from a patient to a medical man containing -such statements are not allowed. - -A =confession= (which must be quite voluntary) or a =dying -declaration= (from the lips of a victim of homicide convinced -of impending death) made in the hearing of a medical man should -be noted down at once, word for word, and, in the absence of a -magistrate, signed by all persons present. Should death be imminent -after a criminal assault (which includes abortion), the medical man -should urge the victim to make such a dying declaration. - -If a patient is sent to gaol or an asylum, communicate at once, but -privately, with the medical officer should you know of any =mental or -physical abnormality=. - - - EXAMINATION OF THE DEAD. - -=Do not order the removal= of a dead body; leave that duty to the -police or to the Coroner’s officer. - -=Forbid=, however, any disturbance of a body to which you are called -until you have seen it and the circumstances. - -1. Where the Coroner orders “evidence touching the external -appearance of the body, and the cause of the death”: - -The body should be identified in your presence; if it cannot be -identified, special care must be taken with the inspection. A -photograph should be taken at once. - -The appearance of the corpse, both when clothed and when stripped, -must be noted. - -In all cases the probable time of the death must be estimated. - -The presence and nature of parasites must be recorded. - -Should the cause of death still =remain obscure= after a complete -inspection, the Coroner should be informed of the fact and requested -to order an anatomical _post-mortem_ examination of the body. - -2. Where the Coroner orders a =full post-mortem examination=, thus: - - “You are required to make or assist in making a _post-mortem_ - examination of the body, which shall comprise an examination of - the viscera of the head, chest, and abdomen, and, if necessary, an - analysis of the contents of the stomach, and report thereon at the - said inquest.” As to the analysis, see the Home Office Circular - (Jan. 7, 1903). - -The body must not be opened until the Coroner’s order has been -received; apart from inquests the =consent of relatives= must be -secured before a body is dissected. - -Wherever manslaughter or murder is suspected, the Coroner will order -a necropsy as a matter of course. - -If the deceased’s friends =charge you with negligence= in treatment, -you must not conduct the examination. - -Do not commence =until the body is cold=; do not delay until marked -putrefaction has set in. - -Have all necessary appliances at hand; having once started =do not -leave the room= until your final note has been made and signed. - -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 of the deceased. - -3. The result of an exhaustive external and internal _post-mortem_ -examination. - - -_a. The Manner of the Report_: - -Reports should be =short= and =distinct=; all unnecessary words -should be omitted. - -The paragraphs should be numbered: this facilitates reference. - -Names and figures must be written plainly, and underlined. - -=Technical terms= should be used only if the report is intended for -the use of a public authority; if used otherwise they should be -explained. - -=Beware= of writing “There is no ...” when you intend to report “I -can find no....” - -Exclude uncalled-for reasons, opinions, and comments. - -“Science is measurement.” Everything that can be, should be -=measured=. Anatomical and chronological order and exactness should -be aimed at. - -For immediate comparison, quote easily recognized English standards. - -“The _sometimes_ of the cautious is the _often_ of the sanguine, the -_always_ of the empiric, the _never_ of the sceptic: but the numbers -1, 10, 100, 1000 have but one meaning for all mankind.” - -In important cases the report should be type-written in duplicate and -signed, one copy being handed to the Court. - - -_b. The Matter of the Report_: - -The date and time of day of each examination, and the names of all -persons present thereat, should be stated. - -There must be a very sharp division made between: - -(a) =Information= received and from whom—this is hearsay. - -“Never believe what a patient says another doctor said.” - -Never sign a certificate to oblige another practitioner, without -personally examining the patient. - -(b) =Facts= found by personal examination or under personal -supervision. - -The results of a complete methodical external (anterior and -posterior) and internal investigation must be detailed; the condition -of the =diseased organs= may be recorded first, the =healthy organs= -being mentioned after, exhaustively. - -After entering all the pertinent facts, summarize the =main points=, -and conclude with the =probable cause= of the pathological conditions -found. - -=Sign= the report, affixing your medical qualifications and the -date; secure the signature of other medical men who may be present. -While in your care, keep the report under lock and key. - -Append any =sketches= or =photographs=, carefully numbered, which -elucidate the case. - -Retain an identical copy of the report for reference. - - - =B. WHEN IN COURT=, - - BEFORE BEING “SWORN.” - -All testimony given at this stage is null and void, and may render -the speaker liable to an action for defamation. Do not omit to be -“sworn” before speaking. - -Should you wish to object to giving evidence on the grounds: - - _a._ That your fee (for expenses and loss of time) has not been paid - by the solicitor calling you. - - _b._ That you are unwilling to pose as able to give “expert - opinions.” - - _c._ That you may possibly incriminate yourself:— - -this is the stage at which you should say so. - -There is now complete emancipation from “the insanitary oath.” For -the sake of public example you should decline to “kiss the Book” -unless you have brought a Testament with you. Insist on your right -either to affirm or to swear by the Scots method.[1] - - -AFTER BEING “SWORN.” - -Whatever you say in giving evidence will not render you open to an -action for slander. - -The privilege of a witness under examination is extended to a witness -making statements to a solicitor preparing his “proof.” - -State your full name and address. Then say, “I am a registered -medical practitioner”; your exact qualifications are immaterial. - - - GIVING MEDICAL EVIDENCE. - - (_Cf. Reports, p. 24._) - - - “There is matter in manner.” “Tell the truth, and make the truth - tell.” “Be the plainest man in the world in the witness box.” - “All trifles are not trifling.” “Pathology creates the doctor, as - distinct from the nurse.” - - -_The Manner._ - -Listen to the =whole question= before you attempt to reply: then -answer only what is asked. Make yourself understood. - -Don’t assume that the jury know all about the case. - -Speak audibly, slowly, deliberately, with an eye on the recording -clerk’s pen. - -Say =exactly= what you mean. - -Cultivate the power of expression and of repression. - -Be candid, courteous, dignified, and withal good humoured; =avoid= -appearing to be suspicious. - -Your =personal= disposition will count more with a jury than your -professional position; they will note looks, doubts, hesitations, -confidence, calmness, consideration, or precipitancy. - -Use =simple= and popular =terms=, otherwise you may be regarded as -speaking “either oracles or jargon.” Reserve technicalities for -cross-examination. The jury will think they understand “alcoholic -disease of the ...,” “bad disorder,” “black and blue,” “black-eye,” -“blood clot,” “blood poisoning,” “bowel,” “brain fever,” “bruise,” -“buoyant lungs,” “cancer,” “consumptive spots,” “coverings of the -brain,” “death stiffening,” “great vessel of the heart,” “gullet,” -“gut,” “hardened liver,” “hardening of valves,” “inflammation or -congestion of the ...,” “overloaded with fat,” “shrunken kidneys,” -“skull-cap,” “stroke,” “swallow,” “sweet-bread,” “windpipes.” - -Don’t worry about the =technical rules= of evidence; in the Coroner’s -Court they are seldom applied strictly. - -Insist on answering double-barrelled questions “=Yes= AND =No=” if -necessary. - -Do not argue with Counsel; “disagree without being disagreeable.” “A -large experience is not all experience,” and what you call “a rare -case” may reflect upon your limited experience. - -An early “I =don’t= know” is better than a late “I =did not= know.” -If you “don’t know,” do not be trapped into guessing. Beware of -“argumentative figures.” - - -_The Matter._ - -If unable to decide as to the cause of death without a _post-mortem_ -examination, tell the jury so at once; the most experienced -pathologist will do so the most often. Thus you may tell them, by -way of apology, that any organ of the body may be ruptured without -external signs of injury being apparent. - -Distinguish =what you have been told= from what you have found by -personal examination. - -A knowledge of the facts differs from a knowledge of the records of -those facts. - -State what you =knew professionally= as to the health and the habits -of the deceased, but do not condescend to detail; it is sufficient to -say, “I treated him,” or “I prescribed;” you need not specify =how= -unless required so to do. - -Don’t offer any explanations unless directly asked; decline to give -“expert opinion” testimony unless you feel fully competent so to do. - -The jury value evidence by the exactness of statement of, and the -powers of observation evidenced by, a witness. Little benefit is -gained by cross-examining one who is obviously telling the plain -truth. - -Don’t exaggerate or estimate—“blessed are the pure in fact” in a law -court; in measurements and descriptions be accurate, quoting figures -where possible. - -You must answer =all questions= put to you, excepting such as would -tend to incriminate yourself; before you answer such questions, the -Coroner must warn you of the possible legal consequences if you -answer. - -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. - - J. WRIGHT & CO., PRINTERS, BRISTOL. - - - - - “GOLDEN RULES” SERIES. - -_Waistcoat Pocket Size, Cloth_, =1s.= _each._ - - - =I.= _9th Edition._ - -GOLDEN RULES OF SURGICAL PRACTICE. By E. HURRY FENWICK, F.R.C.S. - - - =II.= _5th Edition._ - -GOLDEN RULES OF GYNÆCOLOGY. By S. JERVOIS AARONS, M.D. - - - =III.= _5th Edition._ - -GOLDEN RULES OF OBSTETRIC PRACTICE. By W. E. FOTHERGILL, M.A., B.Sc., -M.D. - - - =IV.= _7th Edition. Enlarged & Entirely Re-written._ - -GOLDEN RULES OF MEDICAL PRACTICE. By LEWIS SMITH, M.D., M.R.C.S. - - - =V.= _4th Edition._ - -GOLDEN RULES OF PSYCHIATRY. By JAMES SHAW, M.D. - - - =VI.= _3rd Edition._ - -GOLDEN RULES OF PHYSIOLOGY. By I. WALKER HALL, M.B., Ch.B. -(Vict.), and J. ACWORTH MENZIES, M.D., C.M. (Edin.). - - - =VII.= _4th Edition._ - -GOLDEN RULES OF OPHTHALMIC PRACTICE. By GUSTAVUS HARTRIDGE, F.R.C.S. - - =VIII.= _3rd Edition._ - -GOLDEN RULES OF SKIN PRACTICE. By DAVID WALSH, M.D. Edin. - - - =IX.= _3rd Edition._ - -GOLDEN RULES OF AURAL AND NASAL PRACTICE. By PHILIP R. W. DE SANTI, -F.R.C.S. - - - =X.= _2nd Edition._ - -GOLDEN RULES OF HYGIENE. By F. J. WALDO, M.A., M.D. (Cantab.), D.P.H. - - - =XI.= - - _3rd Edition. Enlarged, Double Number_, =2/-=. - -GOLDEN RULES FOR DISEASES OF CHILDREN. By GEORGE CARPENTER, M.D. -(Lond.), M.R.C.P. - - - =XII.= _2nd Edition._ - -GOLDEN RULES OF REFRACTION. By ERNEST E. MADDOX, M.D., F.R.C.S. -(Edin.). - - - =XIII.= _2nd Edition._ - -GOLDEN RULES OF DENTAL SURGERY. By CHAS. W. GLASSINGTON, M.R.C.S., -L.D.S. (Edin.). - - - =XIV.= _2nd Edition._ - -GOLDEN RULES OF ANÆSTHESIA. By R. J. PROBYN WILLIAMS, M.D. - - - =XV.= _2nd Edition._ - -GOLDEN RULES OF SICK NURSING. By W. B. DRUMMOND, M.B., C.M., -F.R.C.P. (Edin.). - - _J. Wright & Co., Publishers, Bristol._ - - - - - Transcriber’s Notes - - pg 47 Added period after NECESSARY TO TEST - -*** END OF THE PROJECT GUTENBERG EBOOK GOLDEN RULES OF MEDICAL -EVIDENCE *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm -concept and trademark. Project Gutenberg is a registered trademark, -and may not be used if you charge for an eBook, except by following -the terms of the trademark license, including paying royalties for use -of the Project Gutenberg trademark. 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