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· I am compelled to demur to the very more difficult. The most absolute imhigh estimate which Mr. Stephen has partiality would be required to enable placed on the value of cross-examination a witness to execute with complete sucin this respect; and, lest I should seem cess the task of opening the eyes of layto speak rashly, I will give a specific men to the exact position of scientific and foreible instance of the correctness inquiry on many points of toxicology : of my view. On the trial of Smethurst but the present system excludes the posone of the most important questions sibility of even a tolerable approach to was as to the possibility or otherwise of fairness in any case which is of sufficient Miss Bankes's symptoms having been interest to provoke a contest. The laws caused by dysentery. Looking back on of human nature inexorably forbid us to the hubbub of contradictions which hope that, with such numerous excuses arose on this point, it is difficult to for forming opinions in a crotchety or realize the fact - which, nevertheless, theoretical manner as are furnished by assuredly is a fact—that the whole mat- medico-legal questions, the average mediter really lay in a nutshell.
cal witness will ever hold the balance tion on this point was, Does English true against the pressure of material dysentery ever cause a totality of symp- interest and the temptation of profestoms such as Miss Bankes suffered from, sional rivalry. There is a cynical inOne witness declared that he had seen sincerity in pretending to expect any many cases of dysentery in this country such result, which deserves grave repropresenting severe symptoms and ending
It is certain that, until means fatally. The circumstance which I de- shall be provided for obtaining scientific sire to point out is this—that it never evidence which has been formed apart occurred to counsel to inquire, in cross- from the injurious pressure of interested examination of this witness, (a) whether considerations, we are only making behis fatal cases had not uniformly oc
lieve to elicit the truth so far as it can curred in persons who had previously be decided on scientific grounds. visited a tropical country and suffered 5. Passing by some minor functions from dysentery there ; and (6) whether which medicine might perform for the there was reason to believe that Miss state, we come now to the most imBankes had ever resided within the portant and the most miserably neglected tropics, or contracted tropical disease ? of all—the assistance which medical The least learned person can see that advice should give to the state authothat was a great blunder; yet it was pre- rities in questions as to mental unsoundcisely what might be expected from a ness. The present condition of things layman dealing with the intricacies of in this country, with regard to the science.
forensic aspect of lunacy, is one which But the crowning offence against our posterity will look back upon with justice and common sense, in the recep- incredulous wonder and disgust. It is tion of medical testimony on trials, con- confessed by every psychologist who is sists in allowing and indeed requiring it worth his salt that our knowledge of to be given ex parte, the universal practice mental pathology is still in its infancy : in this country. Experience has abun- at the same time it is known to every dantly proved that by such a method of observer of the progress of medical taking skilled evidence (whether medical, science that we have now entered upon or engineering, or of any other kind) a path which must lead to great and nothing but a mass of contradiction wilí valuable discoveries in the future, and be obtained ; but the worth of medical has already led to some which are very testimony is especially damaged by it, important. In short, our mental science because medical problems are is in a peculiarly developmental state ; siderably farther removed than others that is, in a state which of all others from the scope of ordinary education, renders it difficult for a layman to disand their interpretation is proportionably eriminate between that which is solid
fact, based on competent experience, and already referred to in another relation, that which is mere opinion. Here, are especially important in connexion more than ever, do we suffer under an with questions of mental unsoundness. intolerable grievance in the fact that It is the simple truth that without a impartiality in the scientific advisers of special and scientific knowledge of them the state is not merely unprovided for, it is a hopeless undertaking, even for but is rendered very nearly impossible. one who has had large experience of Whether the question be one of signing mental diseases, to attempt to convey to a certificate for the removal of a patient laymen the true state of science on many to an asylum, or of informing the Master questions in lunacy. But at present the in Lunacy or a jury as to the capability possession of such knowledge hardly of an individual to manage his own enters at all into the popular conception affairs, matters stand in such a way that of the necessary qualifications of a the slightest introduction of a hostile witness in lunacy, and certainly it is element in the shape of conflicting inte- not every medical man who has acrest at once causes the parties to enlist quired it. It is this kind of ignorance, medical evidence on their respective sides ; more than any other, that conduces to and this is done with a skill which it is the occurrence of scandals like the chimerical to suppose that the medical Townley and Windham affairs. body could have the tact and firmness II. I come now to the practical part to resist. At least, if some resist, others of my paper, in which I hope to show will certainly comply, and these by no that the great evils which disfigure our means the least honourable members of present administration of state medithe profession. The practice of signing cine, and which are far too gigantic to certificates for the committal of patients be remedied by any unaided efforts on to houses of restraint is a very important the part of the medical profession, might matter, because it is in constant opera- be removed in great measure, if a helption, and because it has been made the ing hand were reached to us from ground of all kinds of suspicion against without. the candour and honesty of medical Here is a great mass of work the practitioners. The public has a chronic general characters of which are similar quarrel with "mad-doctors," as the pages in all its branches; the central feature of many a sensation novel will testify. of all the functions which I have reIt is obvious that nothing would so ferred to being the reduction of high completely relieve the public mind of scientific mysteries to terms of popular uncomfortable feelings on this score as intelligibility. At present it is perthe knowledge that all matters of certi- formed in a scattered and disjointed ficate-signing would be performed by an way,—by persons in most cases without official unconnected with the patient or special knowledge either of the scientific his friends, and at the same time quali- facts or of the true way of making fied by his superior knowledge and ex- them intelligible by and useful to the perience to make the certificate a really state,--and under the disabling pressure valuable report, instead of what it too of circumstances which render imparoften is at present a hazy, incoherent, tiality almost impossible. It would and nearly useless document, suggestive seem certain that any effective principle (to the Commissioners in Lunacy) of of reform must include the consolidation little else than the reflection that “these of these functions, the strict limitation doctors are themselves the strangest of the power to exercise them to men psychological study which could be who should be able to give proofs of found.
their possessing the special knowledge Information on all questions of lunacy required, and the remuneration of such can only be usefully given to the state persons in a way which would render by men who have mastered the laws of them independent of the favour of evidence. These laws, which I have private individuals. There are many
persons, doubtless, who will be ready science and medical police in this country, at once to declare that any such scheme from a want of any proper organization is Utopian, and its execution impossible. on the part of those on whom their I believe they are mistaken, and that maintenance and extension depends. the real Utopianism consists in thinking The principal feature of Mr. Rumsey's that the kind of machinery at present scheme is the appointment of district in vogue can effectually solve the ever- officers of health, who shall take cognimultiplying difficulties presented by the zance of all questions of vital statistics, relations of medical science to the state. of sanitary police, and of forensic mediAlready the amount of work done for cine, which arise within their juristhe state by medical men (quite ex- diction, who shall possess a special clusive of the medical service of the educational qualification guaranteeing army and navy, which does not come their fitness for their office, and who under the head of state medicine proper) shall be sufficiently remunerated by is very considerable, and it is yearly the state, and expressly debarred from increasing. The powers wielded by the private practice. To the hands of such Privy Council—the present representa- officers the following duties should be tive of the old Board of Health-enable committed :--A. The scientific registrait to set on foot inquiries which must tion of births, of deaths and their causes, terminate sooner or later in a great and of the amount and kind of sickness development of the application of sani- occurring in their district. B. The intary science, and of vital statistics, to spection of vaccination.
C. The exathe prevention of disease. The appoint- mination of articles of food and drink, ment of inspectors of vaccination may
with a view to the detection of adulterbe looked on as one important recent ations. D. The preparation of scientific indication of this tendency; the special evidence in all cases of sudden and viomissions of inquiry into the origin of lent deaths, and in all cases of alleged particular epidemics of disease which personal incompetence—whether moral, have from time to time been sent out is mental, or physical—for the fulfilment another. The institution of officers of of public or family duties, or of labour health was a great stride in the same contracts, and to detect malingerers. direction. Obviously there must be in To this scheme must be added its the future a great deal of costly work natural complement, the list of suggesdone for the state by the medical pro- tions for a special examination in the fession; it seems worth while, there- qualifications for these duties, which fore, to inquire whether it were not candidates for the new offices would be better for humanity, and ultimately even required to have passed. “It can hardly for humanity's pocket, to include in one be questioned,” says Mr. Rumsey, in a department, paid and guaranteed efficient valuable paper which, by his kindness, by the state, the various officers whose I have had the opportunity of reading, services advancing civilization will in- “that none of the ordinary medical evitably require? That such an idea is degrees or diplomas—whether from not altogether chimerical has been shown “ Universities or from Medical Colleges by Mr. H. W. Rumsey in a series of "—distinctly express and embody the able papers 1 read before the Social “special qualifications required. Nor Science Association, in which that “ do any of the courses of instruction, gentleman took as his text the scan- through which medical students are dalous inefficiency of our
obliged to pass, provide adequately for "returns
of birth and death, and “the acquirement of that exact knowwhich contain many forcible illustra- "ledge of particular subjects which such tions of the deplorable condition of vital " officers ought to possess." This is
1 "Public Health : the Right Use of Records 1 “A Proposal for the Institution of Degrees founded on Local Facts." By Henry Wild- in Civil or State Medicine in the Universities bore Rumsey. J. W. Parker & Son. "1860. of the United Kingdom."
literally true. If Government were ever the process of reformation is commenced to adopt the above or any similar scheme, the better for us all. It may well be it must necessarily insist on a quali- that the scheme above propounded fication of its candidates which would (which is merely introduced here as the compel the addition of special items to work of an able man who has had the the curricula of the colleges, and to the courage to think this question resolutely programme of the examiners of even out) will be found to require great mothe most exigeante University. To say difications before it could be practically the least, it would be necessary to add, adopted. For details I must refer the even to the most stringent medical reader to Mr. Rumsey's pamphlet itself; examinations known, another in the suffice it to say that, with regard to one physical sciences, a searching practical most important matter, the probable examination in the diagnosis
of mental expense of such a scheme, he adduces affections in actual patients), and, figures which seem to prove that this finally, an examination on the laws of might be rendered moderate, indeed evidence both by papers and also vivá quite insignificant, in proportion to the voce—the latter being conducted by a advantages which the state would gain. barrister of standing.
I come back to the opinion which The adoption of any plan which would forms the groundwork of this paper, involve even these changes obviously that medical advisers of the state canpresents many serious educational diffi- not be taken with advantage at hapculties; and, in addition to this, it is hazard from the mass of general praecertain that the practical obstacles to titioners, pure surgeons and pure phyany legislation tending to interfere with sicians, who are devoting themselves to the vested interests which protect the the business of curing individual patients present class of death-registrars and the I believe that absorption in ordinary present autocracy of vestries in sanitary practice is a fatal bar to the acquisition matters would be immense. It is also of that kind of knowledge and that skill possible that a certain amount of oppo- in communicating it which is indispensition might be offered by a portion of sable. And I would urge with especial the medical profession to any measure force the propriety of placing the man which took out of their hands such of science, from whom the state requires employment as is furnished by the information, in a position of indepenrequirements of coroners' inquests and dence. The few remaining words which assize trials, or the possible reversion, I have to say will be devoted to the in some cases, of a vestry appointment consideration of an evil, already touched as officers of health ; but I believe that upon, which offers the most pointed the feeling of opposition would be but example of the mischiefs arising from temporary in this case, and that the a neglect of this precaution. sense of relief to themselves and benefit The practice of receiving scientific to the community would quickly recon- evidence of an ex parte character is a discile the rank and file of the profession grace to our judicial processes. When, to an exclusion from duties for which on a criminal trial for instance, the questhey have had no opportunity of quali- tion of the prisoner's mental soundness fying themselves. I acknowledge to the becomes of importance, it is a gross full all the difficulties which stand in scandal that the jury should be left to the way of any plan of organization. form their momentous decision from a But the mere statement of these diffi- haphazard balancing of two extreme culties, if we care to undertake it, statements of the scientific facts proforces us to a consideration of the pounded by two witnesses (or sets of actual state of things from which no witnesses) whose pecuniary and profesintelligent person can rise without the sional interests are bourd up respectively feeling that at any cost reforms will with the prosecution and with the de have to be made, and that the sooner fence. It is quite possible that the best expression of the fullest science on par- should sift the facts and hear any other ticular questions would necessarily be evidence which might be offered on the less clear and decided than could be scientific questions. The commission wished. But that is no reason why we would then come to as definite an should deliberately accept such a version opinion as was possible under the cirof the scientific facts of a case as must, cumstances, and would embody this in from the method in which it has been a report to the court, which should be extorted, be nearly worthless. The idea taken to be final as regards the scientific that any effective check upon the abuses questions. of scientific authority thus occasioned It would be difficult to believe that a can be effectively imposed by counsel in scientific commission, chosen with these the cross-examinations is ludicrous. Here elaborate safeguards for its impartiality, and there an exceptionally able lawyer, would be more likely to be crotchety than like Sir A. Cockburn, prompted in his a common jury of small shopkeepers. questions by exceptionally able medical On the contrary, it would be an imadvisers, will succeed in dispelling a possibility that half a dozen men, each cloud of sophistries such as those by of the scientific rank which is here prewhich the plain and straightforward supposed, and entirely independent of. medical faets of Palmer's case were at- the others as regards authority, should tempted to be disguised; but it would allow such perverse and baseless theories be a great mistake to take this hard-won as those which frequently astonish and piece of success as any specimen of the impress a jury of half-educated laymen average result to be expected from the to have any weight with them at all. application of cross-examination in the Nor would such a body be afraid to conevent of contradictions arising in medical fess the true state of the case should it evidence.
happen, in a particular instance, that The remedy which, sooner or later, I science could give no definite answer to am convinced will have to be applied, the inquiries addressed to it by the is the institution of scientific coinmis- state. sioners as adjuncts to the ordinary Defend it as you will, the present apparatus of the courts, before whom, system of allowing a knot of confused, and not before a common jury, the bewildered, and often half-terrified laystrictly scientific questions shall be men to give the final decision on matters argued—the general question in respect of science, which in fact they now do, to the legal charge being subsequently is simply monstrous. It has been atdetermined as at present. Supposing tempted to excuse the existing state of some such scheme as that which has things the argument that it is not been above proposed for district officers abstract truth, but the highest probability, of health to have been carried out, these that the jury are instructed to discover, officers might be employed as commis- and that consequently they need not sioners in the followingway: The officer trouble about the actual right or wrong for the particular district would ex officio of scientific opinion, but must simply collect all the scientific evidence by per- judge what is the prevailing voice of the sonal observation and interrogation on science of the day on the question in the spot, with the assistance of any ordi- hand. But that is precisely what they nary medical attendant professionally cannot discover, save by a lucky accident, cognisant of the facts. The whole mass under the present system. The prevailof scientific facts would then be placed ing voice of science is not represented before the commission, which should by any balance struck, by unscientific consist of a certain limited number of persons, between the extreme views held experts selected in rotation from the by the learned on either side : such hapdistrict officers of health of the kingdom; hazard guesswork often results in an and this body, with the assistance of opinion which has really no relation to the counsel for prosecution and defence, the points in dispute. Nothing but the