MEDICO-LEGAL.

E. S. M'KEE, M.D.

Medical Jurisprudence.

The medico legal jurist may be a lawer, a physician, a chemist, a toxicologist, a microscopist, a pharmacist, a bacteriologist, a pathologist, a surgeon, an embalmer of the dead, one skilled in the use of light, of electricity, of radium, of the spectroscope, of all those aids that science lends to the investigation of crime as to its commission. No matter what the problem or the question is, medical jurisprudence is that science that has the whole domain of investigation in charge, and she welcomes to the solution aid from all sources of intelligent investigation and inquiry that light which is or should be the object of all inquiry in cases belonging to this domain of forensic medicine.

Before anyone should be allowed to testify in a court of justice as an expert or be allowed to give an opinion he should be shown to have had actual knowledge of and experience in the matter in question.

No lawyer or medico-legal jurist should be allowed to give evidence until he is shown to have the knowledge of or experience in the special subject of the inquiry.

Because he is a lawyer of eminence he should not be allowed to give an opinion upon questions purely medical without he is shown to have the knowledge and have had the experience therein.

No physician should as such be allowed to testify on any question, even if called a medical question, until he is shown to have the knowledge and the actual experience in and contact with the subject of inquiry.

For example, a physician as such should not be allowed to testify as an expert in a case of insanity until he is shown by knowledge or experience to be competent to know what he is saying.

A physician as such should not be allowed to give an opinion as to any subject with which he is familiar from actual experience and personal knowledge.

In the case of Patrick, for example, Drs. Loomis, Williams and another were allowed to give an opinion that in the embalming process, by the right brachial artery, the fluid did not and could not

enter the lungs, and neither of them were shown to have any knowledge of the subject or that they had ever embalmed a body.

A microscopist, whether he was a physician or not, should be confined to his subject, unless shown to have knowledge and experience in the subject he testifies about.

Any specialist should be confined to the subject of which he has superior knowledge and experience, and not be allowed to testify outside, as to the subject he is not proven to have had experience and knowledge in.

This rule should apply to all experts in all cases.-Medico-Legal Journal.

Criminal Responsibility of the Insane.

Dr. F. E. Daniel, editor of the Texas Medical Journal, "Recollections of a Rebel Surgeon," and vice-chairman of the section on Psychology, Medico-Legal Society of New York, discusses this subject in his journal, familiarly known as the "Red Back." He says that there is a widespread and growing conviction that the reform of the criminal law is a pressing necessity. The inefficiency of our penal statutes is due to the fact that they are made by men who, for the most part, make no pretensions to scientific knowledge and are notoriously averse to being advised. The unwise practice in some States of paying legislators is in a measure responsible for this. Such pay is not calculated to command a high order of law-making talent. That the jurisprudence of insanity is far behind the present status of medical science on this subject is very generally admitted. It belongs to a past age, and survives in jurisprudence to-day. What other course than that of medical science should our lawmakers follow in legislating upon a subject better understood by physicians than by any other class of investigators? There are fortyfour forms of insanity known to alienists.

From the standpoint of the medical jurist the jurisprudence of insanity is defective in at least three particulars:

1. The defendant in a murder trial bas not the benefit of a diagnosis by the light of modern science, because recent discoveries and conclusions of medical science are not comprehended in the existing system. The laws have not been made to conform thereto, nor do the courts permit

the text-books, the standard authorities, to be quoted in support of alleged insanity. 2. The law leaves to the determination of a jury, often of unenlightened men, metaphysical questions that baffle the ablest scientific minds, to-wit, the existence or non-existence of insanity, the degree of impairment of free will, and the extent of responsibility of a person adjudged insane by medical experts.

3. The courts do not exercise proper discrimination in allowing medical men to pose as experts.

There should be a medical court in every State, paid by the State, to whom should be left the adjudication of all points of medicine in its relation to law, just as we have courts of law to settle all legal points. Trial by jury is a relic or barbarous ages, and has degenerated in a large number of cases into a travesty of justice. If accused of a crime I had rather trust my fate to the toss up of a penny than to stand trial by a jury to whom is given the determination of questions so far beyond their comprehension.

Our penal system is based upon the ancient law, "an eye for an eye and a tooth for a tooth." Vengeance seems to be the chlef end-retaliation rather than justice. Our system of jurisprudence should not only be humane, it should be intelligent. The protection of society, the deterring of criminals, and the lessening of crime are the ostensible objects of capital punishment. It is a demonstrated failure. The ends can be secured by means less revolting.

I am well aware that the hope of instituting radical changes in a system so universal and so long established is Utopian. But were everybody content with the existing condition of things there would be no progress in any department of human activity-in law, medicine, art, science, literature, finance or commerce. No errors would be corrected or evils eradicated. Hence, when human life so often depends on rules of court based upon an antiquated conception of insanity, it is needful to insist that the voice of science shall be heard, and that the great truths revealed by the laborious investigation and experimentation, truths vital to the dearest interests of mankind, shall be utilized in medical and criminal jurisprudence. Our system needs to be remodeled, made more comprehensive, and adapted to the changed

condition of the knowledge of insanity and to the demands of an advanced civilization.

Consent to Operation.

The Supreme Court of Illinois has had this subject before it recently in the case of Pratt vs. Davis. The results of this trial emphasizes the necessity of surgeons having a clear understanding of their legal liabilities in undertaking important operations and the prudence of requiring explicit consent of the patient or his legal representatives before beginning an operation. The decision covers three points of much interest to surgeons.

1. What is sufficient consent to an operation?

2. How much is implied in consent once given?

3. What is the privilege and duty of the surgeon in emergencies arising in the course of an operation undertaken with previously obtained consent?

The case in question was as follows: Patient, married, aged forty, had suffered from epileptic seizures for fifteen years, came with her husband to a sanitarium for treatment. There was found laceration of the womb and other conditions which required surgical interference. She was operated on for these conditions and sent home, but was not improved. She was then told to come back to the sanitarium for further operation. The surgeon then removed her womb without expressly telling her that he was going to do so or gaining her consent or that of her husband, though the latter was implied. The patient was no better, but rather grew worse, and later was adjudged insane and sent to an asylum. Suit for damages was instituted for removing the uterus without consent, and a verdict for three thousand dollars given. The Supreme Court affirmed the decision of the appellate court. The decision of the court on the third point is of importance, for it tends to put the duty of the surgeon in the course of an operation already undertaken in a clearer light. It is the duty and legal right of the surgeon, in the presence of unexpected complications arising in the course of an operation, to use his highest skill and judgment, even if the consent of the patient or his representatives cannot be obtained. It is also the right and duty of the surgeon to act in accordance

with the best teachings of surgery in emergencies in which consent cannot be obtained, even to the extent of performing operations.

The State Fails to Convict.

The case of Ohio vs. F. H. Seeley, the rupture specialist, was tried before a jury at Columbus on January 23.

The defendant acknowledged that many of the statements made in his advertisements were not true; that he never treated the Czar of Russia, nor the Pope's physician, nor Sir Frederick Treves, as claimed in his advertisements. He further acknowl. edged that he had never been abroad, nor was he at that time, as claimed, in Columbus in order to testify as an expert for a railroad. The attorneys for the State forced him to admit that such statements were made with the idea of securing business.

The evidence in the case showed that he charged $20 for fitting a truss for a case of hernia, and he admitted that the charge of $20 for a $3 truss was made in order that he might secure $17 for his expert services.

The jury, in spite of his admission, held that the $20 represented the price of the truss only, and that he charged no fee for services, and hence he was acquitted of the charge.

To a physician it would not seem difficult to regard a price of $20 for a truss that was probably worth that much per dozen, as a fee for services. It would be just as reasonable for an unregistered doctor to make a professional visit free and charge $2 for three pills which he might leave for the patient.-Ohio Medical Journal.

Waiver of Privileged Communication
by Heir.

In the case of Sibley vs. Morse, Supreme Court of Michigan, a physician was called to testify as to the mental condition of testator at the time two codicils were drawn to his will. On cross-examination the physician was asked as to his having treated testator for urethritis. Excluded on objection. The contention was then raised that testator's son as heirs at-law might waive the statue protecting the patient from the discovery of facts learned by the physician while treating him. But whether the heir can, against the protest

of legal representatives (as executors, etc.), waive the right, the court does not decide, on the ground that it was not necessary to do so in this case. It says, however, that there is authority for sup porting the contention that he may. (Thompson vs. Ish, 99 Mo. 160.) The reason given why it was unnecessary to decide the question here was that in any view of the case the testimony in question was too remote to be of any value in determining the mental condition of the testator a number of years later, and no error was committed in its exclusion which prejudiced the rights of the con

testant.

Successful Soothing Syrups.

The Journal of the American Medical Association for February 9, 1907, reports the following:

Death of a child of ten months from Mrs. Winslow's soothing syrup, reported by Dr. John E. Campbell, South St. Paul, Minn. The death of a child from Rex cough syrup is reported by Dr. Thos. C. Buxton, Decatur, Ill., coroner of Macon County. Dr. J. Elliott Dorn, Brooklyn, reports the death of a child from Monell's teething syrup. Dr. Jesse R. Cooper, New Castle, Pa., reports the death of the twin children of Joseph Minolich, of that place, from opium poisoning, the result of taking "Kopp's Baby's Friend." The father was agent for the preparation.

THE annual meeting of the Society of Medical Jurisprudence of New York elected the following officers: President (succeeding Dr. Carl Beck), Mortimer C. Addoms; Vice President, Dr. Robert A. Murray; Recording Secretary, Charles P. Laney; Corresponding Secretary, Alfred E. Ommen; Treasurer, John C. West. The medical members of the Board of Trustees elected were Drs. Carl Beck, Edward F. Brush, C. A. von Ramdohr and W. H. J. Speberg.

Gunpowder Stains.

An ointment of beta-naphtol, 10; sulphur, 45; lard, 24; and green soap, enough to make 100 parts, is useful in removing gunpowder not too deeply situated in the skin. It must be employed cautiously, however, to avoid a destructive dermatitis. -American Journal of Surgery.

vibrating tuning fork through air and bone are modified, and from these tests and with different tone tuning forks there has developed a means of differentiating the various forms of deafness, and furnishes one of the most instructive and interesting as well as one of the most important chapters in otology.

For testing the scale of hearing various other devices than tuning-forks are used, as the watch, speech, whisper, acoumeter and Galton whistle. Some use as many as nine or ten tuning-forks of different pitch in order to test the entire range of tones. Hartman thinks five tuning-forks sufficient, ranging from C of 128 vibrations per second to C4 of 2,048 vibrations. Politzer is of the opinion that three tuning forks are quite sufficient, using C, C1 and C, and thinks one can get quite an adequate idea of the entire scale with these, and rarely uses the lower or higher pitch forks, claiming that patients often mistake the feeling of the vibrations of the low-tone forks for the hearing of them, and thus leading more to confusion than enlightenment; and that it is impossible to use the high pitch forks and Galton whistle in unilateral deafness or in bilateral where it is not far advanced, on account of not being able to exclude these sounds from the normal ear.

Conta was the first to test the hearing through air with the tuning fork.

Bonnafont was the first to discover in nerve deafness that the perception for high tones is often lost while the low tones are well perceived, and this was confirmed by Lucae, who made some postmortem examinations on some cases observed during life. Lucae further observed that low-pitch tuning forks were faintly or not at all heard in conductive deafness where there was greatly decreased hearing of speech, while, on the other hand, they were fairly well heard in labyrinthine troubles.

Politzer proved by experiment on the cadaver that high tones are better transmitted than low tones in obstructions of the conductive apparatus.

From these and other experiments Bezold drew the conclusion that the conductive apparatus of the ear participated only in conducting the low-pitch sounds, and was not necessary for the conduction of the high tones.

Schwabach discovered that in obstruc

tions in the sound conductive apparatus from either in the external auditory canal or middle ear, that if a vibrating tuningfork of 128 or 256 vibrations per second be placed against the cranium, as on the mastoid, it would be heard longer than it would if the hearing was normal; and, furthermore, observed that in troubles of the auditory nerve that the duration of hearing the tuning forks was shorter than when the ear was in a normal condition.

The length of time is determined if you suspect middle ear troubles by placing the vibrating tuning-fork against the mastoid of the examiner's normal ear and when he ceases to hear it to transfer it to the patient's, and vice versa, if you suspect labyrinthine deafness.

Weber discovered that if a vibrating tuning fork of the same pitch be placed upon the cranium the sound was more distinctly heard in that ear in which the external auditory canal was closed by your finger, and clinical work demonstrated that in pathological conditions in the sound conductive apparatus that interferes with its function that the sound is better heard in that ear than in the normal one, or if both are involved it is heard better in the deafer ear, provided there is no involvement of the auditory nerve; but if the tuning-fork placed upon the median line of the cranium be heard louder and longer in the normal ear, it is suspicious that it is perceptive deafness.

Alt has suggested that, in order to tell whether there is trouble in the conductive or perceptive apparatus in unilateral deafness, you have them sing or hum with the mouth closed, and that the tones as in Weber's test will be heard louder in the affected ear if it is conductive deafness and less distinct in the affected ear if labyrinthine or perceptive deafness.

Heath states that if you place a watch against the mastoid and the watch is heard it is conductive deafness, and if not heard it is perceptive deafness; but this statement is too general, for you may have a beginning of nerve deafness and still hear the ticking of the watch. In the main, however, this statement is true, and the failure to hear the watch placed against the mastoid and the auditory canal closed to exclude the sound, is very suggestive that it is a nerve affection.

Rinne demonstrated that if a vibrating tuning fork of 128 or 256 vibrations be