NEW-YORK MEDICAL AND PHYSICAL JOURNAL. JANUARY, FEBRUARY, AND MARCH, 1828. ART. I. Annual Address delivered before the Medical Society of MR. VICE-PRESIDENT, AND GENTLEMEN OF THE SOCIETY, THE honourable office to which I have been called by your Amidst the multiplicity of subjects that present themselves with those branches of medicine to which I have particularly devoted myself, enables me to speak of it with more freedom, it will not be deemed unworthy of your notice, as it embraces not only the interests of the profession, but of the community in general: I refer to the subject of MEDICAL EVIDENCE in courts of justice. Besides the ordinary, but responsible and most interesting duty of attending the sick, the physician and surgeon is often called upon to exercise other functions. His opinion is often desired on cases of sudden death-of grievous bodily or mental injury-or on the nature of particular diseases and affections. This indeed was the natural result of a regard to the interests of society. As the importance of equal laws became more fully recognised, and the necessity of distributing impartial justice was more fully understood, it would soon suggest itself to the legislator, that whenever evidence was required, it should be of the most unexceptionable and decisive kind. When the controversy originated in mercantile disputes, the opinions of merchants were of course sought for and depended on; and their customs and usages have become a part of the statutes of various countries. So also when unexpected death followed from known or supposed injury-when the suspicion of violence entered into the list of causes, it was natural, that sooner or later, those should be called upon to examine and testify, whose ordinary studies and pursuits best enabled them to decide. We find that it is now nearly three centuries since a formal enactment in a European code recognised this principle. The emperor Charles the Fifth, the most powerful and probably the most talented monarch of his day, in the celebrated criminal code framed by him at Ratisbon, in 1532, ordained, that the opinion of medical men should be taken in every case where death had been occasioned by violent means, such as child-murder, poisoning, wounds, hanging, drowning, and the like. France and other continental countries soon followed this example, and improved upon its directions. In England, the country from which we derive our laws, no formal statu tory provision on this subject is, I believe, to be found; but custom has sanctioned what the necessity of the case rendered imperious-an appeal to medical testimony. Yet it cannot be denied, that this appeal is still avoided as often as public sentiment will permit, and even when legally ordered, its proper objects are often thwarted or imperfectly accomplished. The principle, however, is recognised, and must often be acted upon both there and in this country. It then becomes a most interesting question, how it should be best performed for the furtherance of the ends of justice-in punishing the guilty and rescuing the innocent-how the obstacles to its proper knowledge shall be best obviated—and how the difficulties that attend its execution may be lessened or removed. In cases of violent death, and these are the most important, as well as the most common, in which professional witnesses are summoned, their duties may be considered under two divisions-first, before the coroner's inquest, and secondly, before the court and jury that is to try the supposed criminal. In other words, the facts that are to govern, are elicited before the former, while before the latter, these facts are to be stated and opinions are to be advanced, which frequently decide the fate of the accusation. This is the ordinary mode of judicial proceeding, though of course it is often necessary to pronounce an opinion even before the coroner's jury, but with the important distinction, that its merits and weight are there seldom canvassed. The office of coroner is a very ancient and certainly a very important one. It enters into the very essence of his duties, and those of the jury whom he summons, to view the body. He is to inquire into the causes which have produced the supposed violent termination of life; and if the injury be manifest, to ascertain its nature and the probable instrument used to effect it. In the discharge of this function, he may summon any medical man before him as a witness. That he should do it, in every case which admits of the slightest doubt, would seem equally proper and just. Here, however, a discretion is often exercised, the result of which proves in jurious-sometimes by permitting a guilty person to escape, but more frequently by introducing a degree of carelessness and hurry in those investigations which are attended by physicians. In some countries this discretionary power is destroyed. In Austria, though a despotic country, a highly laudable care is exercised by the government over its subjects. All bodies found in suspicious circumstances, are required to be examined, reports are demanded from the medical inspectors, and to aid them in their duties, a code of regulations has been prepared and circulated throughout the empire, according to which all are to proceed.* This, indeed, is as it should be. None but medical men can be supposed sufficiently capable of judging decisively of the nature of the case. They are best qualified to separate ac cidental circumstances from those indicative of violence, and they can best explain and illustrate the variety of natural causes, which, in doubtful situations, have led to suspicion. Returning, however, to the consideration of those instances where medical evidence is legally demanded, it remains to consider the powers and duties of the professional witness. It should be understood that he is to satisfy himself as to the cause of death. He is to proceed to a dissection, if he entertains the slightest doubt; and he has a right to demand this, or, as an alternative, to deny his testimony.† At the present day, physicians at least, need not be told that an external view alone of the body is perfectly nugatory; that it can lead to no certain deductions, and that a jury is quite as competent to form an opinion upon it as the best * Quarterly Journal of Foreign Medicine and Surgery, 1. p. 40. + London Medical Repository, 24. 578. It has been doubted, whether in point of law, it is imperative on a coroner to have the body opened.— This, however, is of little practical importance, when we know he cannot prevent it, if demanded by competent persons, viz. medical witnesses. His jury is sworn "diligently to inquire and true presentment make," how and in what manner the deceased came to his death.-Medico-Chirurgical Review, 6. 562. instructed practitioner. If it be the duty of judicial officers to obtain in all cases, the best evidence in their power, surely the necessity of medico-legal dissections will not be denied.* The duties required cannot be satisfactorily or conscientiously discharged without competent knowledge. An acquaintance with anatomy is indispensably necessary, and peculiarly so in those interesting cases, where it is necessary to distinguish the effects of disease or violence from ordinary appearances. Unless well grounded in that science, the phenomena that follows natural death may be mistaken for the effects of poison; and in illustration of this, I need only refer to the changes induced by perforation of the stomach, and the variety observed in the vascularity of that organ.— Anatomy, then, both physiological and pathological, must be applied to the case. Nor is this always sufficient. If the question of poisoning be agitated, chemistry is required to lend its aid. None, I presume, will question the correctness of these remarks. Let us not then hesitate to make the proper application. The members of our profession in every part of the * I copy the following note of the editor of the Edinburgh Medical and Surgical Journal, from its intimate bearing on the subject. It will be understood as applied to Great Britain. "We cannot omit this opportunity of expressing our disapprobation of the conduct of coroners, who presume to interrupt the medical practitioner, called upon to examine the cause of death under suspicious circumstances; and of informing practitioners in general that, as soon as the body is delivered over to them for that purpose, they are to proceed deliberately with their examination until they be satisfied. Upon this subject, we quote with great satisfaction, the opinion of the enlightened judge who now presides over the criminal court of this division of the empire. Dr. Cleghorn, of Glasgow, having been examined in a trial for poison, the Lord Justice Clerk, after highly complimenting the learned professor on his luminous evidence, took occasion to impress strongly on all magistrates and public officers present, the absolute necessity of having the body of the deceased opened and examined by a medical man, in every case of suspicious death."—Edinburgh M. & S. J. 14. 468. |