SURGEONS IN ACTING AS WITNESSES.

19

certain spots found upon his clothes, or upon a knife belonging to him, due to effused blood or to other causes? Whether any, and what statements were made by the dying man, and what were the precise circumstances under which they were made? It need hardly be observed that questions of this nature are rarely noticed, except in a cursory manner, by chemists and surgeons; and a medical man is not likely to acquire the means of answering them by intuition. On the other hand, regarding ourselves as living in a civilized state, in which the detection and punishment of crimes against life and property are indispensable to the security of all, it is impossible to overrate their importance. Unless a witness is able to return answers to these questions when a public necessity occurs, a guilty man may escape punishment, or an innocent man may be condemned. A witness may thus most seriously injure his own reputation; for it is certain that his qualifications as a physician, surgeon, or general practitioner, however great, will not shield him from general reprobation.

Thus, then, it is obvious that the duties of a medical jurist are of a highly responsible nature and of great importance to society, while the cases which call them into exercise are of purely accidental occurrence. A medical practitioner who thinks himself secure in the most retired corner of the kingdom, is liable to find himself suddenly summoned as a witness on a trial, to answer questions which perhaps during a long period of practice he had been led to regard as unimportant. Under the circumstances it is scarcely possible that he can avoid exposing his deficiencies, and the final question will be, Have you ever attended to or thought of these subjects before? A negative answer to this question, while it commonly brings with it public censure, will in most instances lead to the acquittal of the accused in spite of strong presumptions of guilt. The truth of this picture will be felt and acknowledged by those who have been a few years engaged in practice. The records of our courts of law contain many unfortunate exposures, which might have been easily avoided had the witnesses only availed themselves of the opportunities afforded to them while students of acquiring a knowledge of the subject; but they had unreflectingly acted on the principle, that medical jurisprudence was a dry, dull, and useless study, and that the practice of it. was remote and speculative. This feeling is, however, fast disappearing. Those who have been compelled by circumstances to give their attention to it have, in subsequent cases, taken care to prepare themselves for the ordeal through which every medical witness must pass.

Some medical men who have treated legal medicine with indifference have ventured to act as witnesses, thinking that the subjects on which they were likely to be examined were so little known to judge and counsel that even hazardous or rash statements would escape observation; such witnesses, however, have often found to their cost that they were laboring under a delusion. Various circumstances have led to the acquisition of much medico-legal knowledge by lawyers, especially in relation to questions connected with wounds, child-murder, and poisoning; and they are not slow in detecting and exposing a mere pretender who attempts to shelter himself by vague or evasive statements and technical language. Another fact must be borne in mind:-there are few counsel engaged in any civil or criminal case of importance who do not take care to fortify themselves, under medical advice, with a full knowledge of the views of standard medical writers on the subject in dispute; and with these works before them, and with their proverbial acuteness, he must indeed be a clever witness who can succeed in passing off an erroneous or evasive answer to a medico-legal question.

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MEDICAL CONTRASTED WITH

It is a frequent charge against members of the medical profession that they are the worst witnesses on matters of fact and opinion. This is an unmerited censure. Those who are ready to make this charge overlook the number, complexity and difficulty of the questions that are put to medical men compared with those put to other witnesses. They also forget that medical men are much more frequently summoned as witnesses than the members of other learned professions. Their evidence obtains much greater publicity, and is necessarily exposed to a wider circle of criticism. The fact is, that good and bad witnesses are to be met with in every profession, and under equal conditions there is no reason to suppose that one would furnish a greater number of incompetent witnesses than another. It is certainly the fault of medical men that they are not always prepared for the questions which are likely to arise in a case on which they know they will be required to give evidence. This want of preparation frequently applies to facts as well as to opinions. Thus, in reference to a case on which a charge of murder or manslaughter may be ultimately founded, a medical man who is called in omits to observe many circumstances, because at the time they appear to him to have little importance, although at the subsequent trial he may find, to his dismay, that they actually become the turning-points of innocence or guilt. Medical observation as a result of professional habits is, on these occasions, in general confined to only one set of circumstances-the recognition and treatment of accident or disease; but medico-legal observation should take a much wider range than this, and should be directed to all the surrounding facts and incidents of a case. The essential difference in the two kinds of practice is, that circumstances which are of no interest in a medical or surgical point of view, are often of the greatest value and importance in legal medicine. It is obvious that if they are not observed by a medical witness when he is first summoned to the injured person, whether dying or dead, it will be out of his power to meet many of the questions which must arise in the progress of the case. The non-observance of these facts is a serious evil, and often carries with it, although unjustly, an imputation of professional ignorance. The first duty, therefore, of a medical jurist is to cultivate a faculty of minute observation of medical and moral circumstances. This, combined with a general knowledge of what the law requires as evidence, will enable him to meet satisfactorily the scientific questions that may be necessary for the elucidation of a case. The exercise of this faculty is by no means inconsistent with the performance of his duties as a surgeon. A learned judge on one occasion remarked that "a medical man, when he sees a dead body, should notice everything." Undoubtedly he should observe everything which could throw a light upon the production of wounds or other injuries found upon it. It should not be left to policemen to say whether there were any marks of blood on the dress or on the hands of the deceased, or on the furniture in the room. The dress of the deceased, as well as the body, should be always closely examined on the spot by the medical man. It may stimulate the attention of a medical practitioner in reference to these inquiries if he is informed that one art of counsel defending persons charged with murder or manslaughter consists in endeavoring to discover what the witness omitted to do. Although sometimes the omission may be really of no medical importance whatever, yet it is usually placed before the jury in such a strong light that the accused obtains the benefit of a doubt. The omission may be attributed to professional ignorance, or, what is worse, to bias-a determination to find proofs of guilt

MEDICO-LEGAL OBSERVATION.

21

when the facts might be innocently explained by a want of experience on the part of the witness in dealing with cases of this nature.

If we except medical experts, who are selected according to their experience in different branches of the profession, medical men have no option respecting medico-legal practice; for the cases which give rise to medico-legal questions are always more or less connected with the practice of medicine and surgery. Thus before any inquiry is instituted by a magistrate or coroner, and before any suspicious circumstances have come to light, a medical man may be summoned to a person dying from the effects of a wound, or from the secret administration of poison. The dying person may make to him a declaration or statement as to the circumstances under which the wound was inflicted or the poison administered: he may also mention the names of the person or persons concerned in the assault or the administration. This dying declaration or statement, according to the circumstances under which it was made, may become of material importance in the prosecution of a party charged with murder or manslaughter. It is therefore proper that a practitioner should observe and make notes of the exact condition of the patient;-whether, when he makes the statement, he is under the conviction or belief that he is about to die. It has been thought that it was also necessary to prove that the wounded man had lost all hope of recovery: but, as a judge has justly remarked, it is very difficult, if not impossible, to say on these occasions, when, if ever, the feeling of hope completely deserts a man. Again, a man may express an opinion that he shall "not recover," but this is not sufficient. The law admits these declarations, not because recovery is impossible, but because the person making the statement has in his mind at the time of making it a full conviction of approaching death. It is therefore the duty of the medical attendant on these occasions, to see how far the person making the statement believes that his death is impending or nearly approaching. This belief is considered in law to be equivalent to the obligation of an oath.

Hence, when the case is likely to prove fatal, the medical man should warn the patient, in the presence of his relatives or friends, of his dangerous condition. If the wound or poison is not likely to prove rapidly fatal, the attendance of a magistrate to take down the statement in due legal form would relieve the medical man of all responsibility. Should any statement, however, be made to him under these circumstances, it is his duty to make, on the spot, a note of the words actually used. There should be no paraphrase or translation of them, but they should be the very words of the dying man. It is not for the witness, but for the court, to interpret what is thus stated. A medical man on these occasions should not render himself officious in extracting information. He may receive that which is voluntarily uttered, and, either immediately or on the earliest possible opportunity, write down the statement as it was made. Any question should be simply confined to the purpose of explaining what may appear to be ambiguous or contradictory in the declaration. itself.

In reference to persons who have died from the effects of wounds, poison or other violent causes, the initiatory proceedings connected with the inquiry usually take place in the court of the coroner; and unless the medical man in attendance is supposed to be implicated, by maltreatment or otherwise, in the death of the person, the duty of making an examination of the dead body devolves upon him. He may not have seen the person while living; and in this case it will be necessary that he should give his attention to those circumstances which may be of importance in the future inquiry. He should note, as far as it can be ascertained:-1. The exact time of

22

DYING DECLARATIONS.

death, if known, and thus determine how long a period the person survived. 2. The attitude, position, and condition of the body. 3. The state of the dress. 4. All surrounding objects. Any bottles, paper-packets, weapons, or spilled liquids lying about should be collected and preserved, and their position with regard to the body of the deceased should be noted. 5. Any vomited matters near the deceased should be collected.—In making a post-mortem examination of the body the following additional points should be attended to. 6. The external appearance of the body, and whether the surface is livid or pallid. 7. The state of the countenance. 8. All marks of violence on the person, discomposure of the dress, marks of blood, etc. 9. The situation, form, and direction of all wounds. 10. The presence or absence of warmth in the legs, arms, abdomen, mouth, or armpits. 11. The presence of cadaveric rigidity in any part of the body. To give any value to the two last-mentioned characters, it is necessary for the practitioner to observe the nature of the floor on which the body is lying, whether the body is clothed or naked, young or old, fat or emaciated. These conditions create a difference, in respect to the cooling of the body and the access of rigidity. 12. If found dead-when was the deceased last seen living, or known to have been alive? 13. All circumstances leading to a suspicion of suicide or murder. 14. The time after death at which the inspection was made. 15. The state of the abdominal viscera. If the stomach and intestines are found inflamed, the seat of inflammation should be exactly specified; also all marks of softening, ulceration, effusion of blood, corrosion, or perforation. The stomach should be removed and placed in a separate vessel, a ligature being applied to each end. If cut open for examination at this period, this operation should be performed in a clean dish, and with such care that none of the contents are lost or are allowed to mix with the contents of the intestines. 16. The contents of the stomach, if this organ was opened during the inspection, should be collected in a clean graduated vessel :-notice a, the quantity; b, the odor tried by several persons; c, the color; d, acid or alka line reaction; e, presence of blood, mucus, or bile; f, presence of undigested food; and it may be as well to observe, that the presence of farinaceous matters (as bread) would be indicated by the addition of iodine water, if the contents were not alkaline-of fat, by warming; g, other special characters. 17. The contents of the duodenum should be separately collected, ligatures being applied to it. 18. The state of the large intestines, especially the rectum, and the condition of their contents. The discovery of hardened feces in the rectum would prove that purging had not existed shortly before death. 19. The state of the windpipe, throat, and gullet, and whether there are in these parts any foreign substances, or marks of inflammation and corrosion. This is of essential importance, as it throws a light upon a variety of questions which may arise respecting death by suffocation from mechanical causes, or the nature of a substance swallowed. 20. The state of the lungs and heart; morbid changes, etc. 21. The state of the brain and spinal marrow. 22. The condition of the womb, ovaries, and genital organs, as in the female poison has been sometimes introduced into the body by the vagina, or wounds have been inflicted internally. 23. The kidneys and the spleen should be submitted to examination. 24. The liver with the gall-bladder should be removed for chemical examination. 25. The urinary bladder, with any fluid contained in it, should be removed and placed in a separate jar.

Such are the points to which, in the greater number of cases of violent death, a medical jurist should give his attention. By means of these data, noted according to the particular case to which they are adapted,

EXHUMATION OF BODIES.

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he will in general be enabled, without difficulty, to determine the probable time of death, and the actual means by which death was brought about. He may thereby have it in his power, if the case be one of poisoning, to point out the dish or article of food which had contained the poison, and to throw light upon any disputed question of suicide or murder in relation to the deceased. Many cases of death from wounds or poison are rendered obscure, owing to these points not having been attended to in the first instance.

It is not necessary in this place to enter into any details respecting the mode of performing an inspection. A medical practitioner is supposed to have acquired a knowledge of this part of his duties during his study of anatomy; and any additional information which may be required will be found in the appropriate sections of this work. The only essential points, in addition to those above mentioned, are, 1. To examine all the important organs for marks of natural disease; and 2. To note down any unusual pathological appearances or abnormal deviations; although they may at the time appear to have no bearing on the cause of death. It is useful to bear in mind on these occasions that the body is inspected, not merely to show that a person has died from poison, but to prove that he has not died from any natural cause. Medical practitioners commonly give their attention exclusively to the first point; while lawyers, defending accused parties, very properly direct a most searching examination to the lastmentioned point, i. e., the healthy or unhealthy state of those organs which are essential to life. The usual causes of sudden death have their seats commonly in the brain, the heart and its great vessels, or in the lungs. Marks of effusion of blood, congestion, inflammation, suppuration, or a diseased condition of the valves of the heart, should be sought for and accurately noted. It has also been recommended that an examination of the spinal marrow should be made. If the cause of death is obscure after the general examination of the body, there is good reason for inspecting the condition of this organ. [In medico-legal cases, involving questions of life and death, the examination of the body cannot be too thorough and exhaustive; the omission of any one organ is a radical and sometimes a fatal defect. This was well illustrated in 1872 by two leading cases in the United States-that of Mrs. E. G. Wharton, charged with poisoning General Ketchum, and that of Dr. Paul Schoeppe, charged with poisoning Miss Steinnecke. In neither case was the post-mortem sufficiently complete.

In the first case, where the symptoms of the deceased were certainly more in accordance with disease than with tartar emetic (the alleged) poisoning, and where competent medical authority ascribed it to cerebrospinal meningitis, no examination of the spinal marrow was made. In the latter case, in which the symptoms were those of apoplexy and of uræmic poisoning, the kidneys and several other organs were overlooked. In certain obscure cases it may become necessary to institute a microscopic examination, especially of the brain and heart.]

Exhumation of Bodies.-Sometimes the inspection of a body is required to be made long after interment. So long as the coffin remains entire, there may be the expectation of discovering certain kinds of mineral poison in the organs; but decomposition may have advanced so far as to destroy all pathological evidence. The inspection in such cases is commonly confined to the abdominal viscera. The stomach is often found so thin and collapsed that the anterior and posterior walls appear to form only one coat. This organ should be removed, with the duodenum, and ligatures should be applied to each. The liver, kidneys, spleen and brain should