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A MANUAL OF
MEDICAL JURISPRUDENCE AND TOXICOLOGY.
PART I. MEDICAL JURISPRUDENCE,
Importance of the subject of Medical Jurisprudence-Ordinary and Expert Witness-The Coroner's Physician-Relations of the Medical Profession to the Coroner in Cases of Sudden Death, etc.
MEDICAL JURISPRUDENCE, or Forensic Medicine, or Legal Medicine, as the subject is often also called, may be broadly defined as medicine in relation to Law. Although a subject of very wide scope and much practical importance, it is, nevertheless, usually neglected by the students of medicine. It is very desirable, however, that every physician should have some knowledge of medical jurisprudence. The physician should know what the Commonwealth expects of him and has a right to demand of him in his professional capacity, and he should know his own rights as a medical expert. Every physician, during the course of his professional career, may be called upon to give testimony in cases of rape, foeticide, infanticide, death from poison and from other causes.
Witnesses, however, are of two kinds. One is a witness in the ordinary acceptation of the term, who testifies simply to matters of fact of which he has personal knowl
edge. The other is a witness, who likewise testifies to matters of fact, but concerning which he has special professional expert knowledge, such as the ordinary witness cannot, from the nature of the case, be expected to have. A person, for example, happens to be walking in the street. He sees a boy run over by a street car, or a man plunge a dirk into another; or the shot of a pistol is heard and a man is seen to fall. This person is a witness in the ordinary acceptation of the term. That is to say, he is liable by the law of the Commonwealth to be at any time subpoenaed to testify in court to these facts. Such subpoena, when served, the witness must obey. Every citizen may be called upon to testify to matters of fact of which he has personal knowledge. The medical expert witness, however, is of a kind different from the ordinary witness. He is called upon by the prosecution or defence to give an opinion or testimony as to facts concerning which he is especially qualified to express an opinion on account of his professional training. His knowledge of the particular facts of a case, however, will depend entirely as to whether he sees proper to make himself acquainted with them or not. No law can compel, for example, a physician to examine the contents of a stomach, with the view of determining whether they contain a poison, if he refuses to do so. The physician can excuse himself on the ground that he does not feel competent to make the chemical analysis, or that the necessities of his practice do not give him sufficient time to make such analysis, or that giving testimony in court at the time of the trial may interfere with other professional engagements, etc. The physician may give any such reasons he pleases for refusing to undertake a medico-legal investigation, and no law can compel him to do so.
The Gardner Sanitarium
Ordinarily it would be unwise for a young physician not to avail himself of an opportunity of giving testimony in court, since it undoubtedly leads indirectly to a great deal of practice and professional preferment generally. If the physician does accept this responsibility, it is important that he should know exactly what his duties will be to the Commonwealth under these circumstances, and also what he may expect from the Commonwealth.
Coroner's Physicians.-Usually in every large city there are appointed by the coroner one or more "coroner's" physicians, whose duty it is to make all medico-legal examinations, or a police magistrate or some such official has the power to appoint a physician to conduct the same. It is obvious that the more attention any one physician gives to this kind of professional work, the better qualified will he be for performing it; in Philadelphia the coroner usually appoints one physician as coroner's physician, though frequently he is allowed one or more assistants.
The compensation of the coroner's physician and assistants might either be by the fee system or by salary. The latter is much preferable, for, if the emolument of the office depends upon the number of post-mortem examinations made, these examinations might be increased needlessly. At the present time in this city the coroner's physician and assistant are salaried. Apart, however, from the case of the regularly-appointed and salaried coroner's physician, any physician may be called upon by the Commonwealth or the defendant, in murder cases, for example, to give testimony. It is not only desirable, but most important under such circumstances, that if the physician agrees to give his time to the Commonwealth or the defence, the matter of compensation should be
first definitely fixed. If a physician be subpoenaed as an ordinary witness, which summons he must obey, and, having given his evidence in court, the Commonwealth or the defence endeavors to obtain an expert expression of opinion upon the facts testified to in addition to the testimony as to the mere facts themselves, the physician is justified in refusing to answer. If, for example, a physician happened to see a man stabbed, and is subpoenaed as an ordinary witness to testify as to the facts, he must answer questions bearing directly upon such facts as he observed. But should the judge, prosecuting attorney, or defence ask a physician who has been so subpoenaed strictly professional questions which an ordinary witness, such as a laboring man, could not possibly answer, and which he alone can answer on account of his being specially qualified, the physician in justice to himself should refuse to answer them. The court has no more right to take advantage of the physician's professional knowledge and skill in extorting evidence without proper compensation than it would have to take his property; his knowledge is his property, his capital.'
Relations of the Medical Profession to the Coroner.— While in a general way it is always proper that every law-abiding citizen should contribute to the Commonwealth anything that lies in his power, whatever his profession may be, by which the ends of justice will be attained, it is only right that he should be sufficiently compensated by the Commonwealth for so doing.
In cases of persons dying suddenly, from violence, or within twenty-four hours of the time a physician has been in attendance, the coroner is notified by the attending physician, members of the family, or some one interested in
1 Vide Webb vs. Page: 1st Carrington and Kerwin's Nisi Prius Reports, p. 23.
the case. As there is some difference of opinion among physicians and lawyers as to the interpretation of the law bearing upon such cases, it is well that the law should be stated. By the Act of Assembly, March 22, 1867, it is provided: “That it shall be the duty of the coroner of the city and county of Philadelphia to hold an inquest on the body of any deceased person who shall have died a violent death, or whose death shall be sudden; provided, that such sudden death be after an illness of less than twenty-four hours, and that no regular practising physician shall have been in attendance within said time, or that suspicious circumstances shall render the same necessary; which said suspicions shall first be sworn to by one or more citizens of said city." Such being the law, the attending physician may say that, while in cases of death from violence or occurring under suspicious circumstances, it is undoubtedly his duty to notify the coroner, this law cannot be so interpreted as to compel him to notify the coroner in cases of death from chronic disease, even though he may not have been in attendance within twenty-four hours of death.
Let us suppose that a physician, in accordance with that interpretation of the law, signs a death-certificate, assigning some chronic disease as the cause of death, not having seen the patient within twenty-four hours, or, perhaps, not within a week of death. It is not impossible that in such a case suspicions might be aroused after burial, the body might be exhumed, and a post-mortem examination might reveal poison as the true cause of death. An attending physician, under these circumstances, would certainly be subpoenaed to appear before the coroner to explain his action, even though he were not held for criminal prosecution.
It may be urged, however, if the attending physician