FOOTNOTES:

Works on toxicology were written at a much earlier date: the Θηριακά and Αλεξιφάρμᾶκα, of Nicander, ca. B.C. 135; θeπερὶ δηλητηρίων φαρμάκων, of Dioscorides, ca. A.D. 50; the treatises, “De Venenis,” of Petrus de Abbano (ca. A.D. 1250), first printed Mantua, 1472; of Arnoldus da Villanova (ca. A.D. 1300), first printed (sine loc. et an.) ca. 1470; of Santes de Ardoynis, Venice, 1492, and of F. Ponzetti, Venice, 1492, are among the earliest. Works on toxicology are not considered in this Introduction, the historical sketch of that science being reserved for a later volume.

“The applicant was not a member either of the American Medical Association or of the Erie County Medical Society, at the time of his alleged deviation from the formulas prescribed by these conventional rules. He was under no legal obligation to observe them, and had neither actual nor constructive notice of their existence. Those who were members of the society could not lawfully be expelled for antecedent deviation from the code (Fawcett v. Charles, 13 Wend., 477). Much less could such deviation be alleged, as cause for exclusion, against one who had never agreed to be bound by it, and as to whom it was not merely an inoperative but an unknown law.

“As the relator demanded admission to the enjoyment of a franchise to which he was presumptively entitled, his exclusion could be justified only by facts repelling the presumption that he was duly qualified for admission, or by extraneous facts, showing that, if his application was granted, there were then subsisting causes, making ‘a clear case’ for immediate expulsion (Ex parte Paine, 1 Hill, 665).

“The burden was upon the appellant to establish affirmatively the existence of such present cause for expulsion. The society waived the right of making a return and taking a formal issue on the claim of the relator, to be determined as matter of fact by a jury, under the direction of the court; but submitted its objections in the form of affidavits, which failed to establish cause either for exclusion or expulsion.

“The only specific fact alleged in the opposing affidavits, as ground of objection, was the publication by the relator of a professional advertisement, which was inserted in one or more of the Buffalo journals in May, 1855, and discontinued in January, 1857, more than two years before his application was presented. It is charged that the printing of this notice was an empiricism, and in conflict with the code of ethics adopted by the Erie County Medical Society.

“There is nothing in the terms of the advertisement from which any inference can justly be drawn against the relator, in respect either to his personal character or his professional skill. There is no suggestion, in the affidavits, that any of the statements of fact contained in the notice are untrue, and there is nothing in its contents inconsistent with perfect good faith on the part of the relator. It refers to the treatment of bronchitis, asthma, and consumption, as a special department of the profession to which he had directed his particular attention; and it alludes to his use of the method recently introduced, of medicated inhalation, through an instrument appropriate to that purpose, in aid of such general treatment as experience had proved to be beneficial in that class of diseases. It is not denied that the relator possessed peculiar skill in this department of the profession; and the case discloses the fact that the method of auxiliary treatment, introduced by him in the county of Erie, was not only successful in his own practice, but was adopted, with beneficial results, by members of the county society of high professional standing, and that it was accepted by a large proportion of the physicians of Western New York. If, at the time this remedy was introduced, he had been a member of the County Society or of the American Medical Association, he would not have been at liberty to direct attention, through the medium of the public journals, to the benefits resulting from its use. This would, perhaps, have been unfortunate for those who were suffering, in that vicinity, from this particular class of diseases; but it is undoubtedly true that the suppression of such an advertisement would have been more considerate toward his professional brethren, and more in accordance with the rules of delicacy and good taste. But an error, in this respect, by one who had no notice of the society regulation is not cause for disfranchisement. The act of the relator was neither immoral nor illegal. It was no violation of the by-laws; for, as to him, they were wholly inoperative. It was no present cause for exclusion; for the publication of the objectionable notice had been discontinued for more than two years. When he applied for admission, he proposed to become bound by the by-laws; and this the society refused to permit, for the sole cause that he had not observed them before they became rules of conduct for him. ‘Where there is no law, there is no transgression.’ The relator, therefore, had been guilty of no legal wrong which could bar his claim to the franchise.”

“In the first place I doubt much whether the defendant below, after retaining the plaintiff as a physician and accepting his services as such, could call upon him in the first instance to prove a regular license. In other like cases, the presumption is against the defendant. It is so as between attorney and client, in a suit for services performed under a retainer. Pearce v. Whale, 7 Donl. & Ryl., 512, 515, per Bayley, Judge; 5 Barn. v. Cress., 38, S. C. There, if the objection sound in the fact that the plaintiff was never admitted, or that his admission has become inoperative, it lies with the defendant to show it. Id., and see Berryman v. Wise, 44 T. R., 566. and other cases; 1 Phil. Ev., 227, Cowen v. Hill’s ed. Besides, the contrary would be doing great violence to the presumption that no man will transgress the command of a positive law.” See also Thompson v. Sayre (1 Denio, N. Y., 75), where this principle seems to have been assumed as correct without question upon the strength of the decision quoted above. A similar doctrine appears to have been enunciated in the State of Illinois in Chicago v. Wood, 24 Ill. App., 42; and Williams v. People, 20 Ill. App., 92. It may be sound, and undoubtedly the English cases cited in Macpherson v. Cheadell, supra, tend to support it. But in a case in which the physician’s right to practise is denied, the safe course will be for him to have a duly authenticated copy of his license ready to be offered in evidence. The general rule is that the burden is on the plaintiff to show all the facts which make up his right of recovery. See Bliss v. Brainard, 41 N. H., 256; Salomon v. Dreschler, 4 Minn., 278; Kane v. Johnston, 9 Bosw., N. Y. Superior Ct., 154.

And see, also, Raynor v. State, 62 Wis., 289; Wendel v. State, id., 300.

As to how far the decision of an inspector appointed by a board of health is regarded by the law as quasi-judicial, and therefore conclusive, see Underwood v. Green, 42 N. Y., 140; Raymond v. Fish, 51 Conn., 80. Health officers who were guilty of gross negligence in removing infected persons from a city in stormy weather, and putting them in an unprotected and unsafe structure, so that such persons died from the exposure, have been held liable. Aaron v. Broiles, 64 Tex., 316.

The latest and most complete statute laws creating or regulating health boards are: England, 38 and 39 Victoria, chap. 55; United States (National Board of Health), 20 Stat. L., 484, suppl. to U. S. Rev. Stats., chap. 202, passed March 3d, 1889; Mass., chap. 79, Mass. Rev. Stats.; Pa., Laws of 1885, chap. 56; New York (State Board of Health), 2 N. Y. Rev. Stats., 1195; Local Boards, id., 1191-1193, chap. 270, Laws of 1885. The statutes of New Jersey are considered in Lozier v. Newark, 19 Vr., 453. In Missouri the power to license physicians is conferred upon the State Board of Health, and the Supreme Court of that State has held that the act of that board in granting or refusing a license is discretionary and its action in such a matter will not be enforced by a writ of mandamus (State v. Gregory, 83 Mo., 123); and a similar doctrine prevails in Minnesota, State v. State Med. Board, 32 Minn., 324. The latest and best work on the general subject of the organization and powers of boards of health is Parker & Worthington’s “Public Health and Safety,” M. Bender, publisher, Albany, N. Y., 1892.

It is proper, although not necessary, that upon cross-examination the witness should be asked as to his fee; that is, as to whether he expects to receive any additional fee besides that of an ordinary witness, and it has been held that where the expert witness testified that he was to receive a fee which was contingent upon the case, he was disqualified from testifying. Pollock v. Gregory, 9 Bosworth, N. Y. Superior Ct. Rep., 121-124.

A medical expert is sometimes confronted upon the witness-stand by long quotations from well known medical text-books, and he is asked whether the doctrines, opinions, etc., there laid down are sound. Especially is this done when such doctrines and opinions are in apparent discord with his evidence as he gives it. In such cases as this, however honest, however intelligent and non-partisan the witness may be (except as any opinion on one side or the other of a disputed question may be considered partisan), he is placed in a very difficult position. If the citations and questions are from well-known authors, and he is a modest man, as most men of learning are, it will be difficult for him to deny that such authorities as these have great weight, even more weight than his experience, skill, and knowledge entitle him to claim. On the other hand, if he takes the bold course and sticks to his opinion, he is cried down the winds by counsel in summing him up, as a man of gall, boldness, audacity and egotism. His course is difficult whichever way he turns, but modesty as well as honesty is usually the best policy. Perhaps the best thing for such a witness to do under such circumstances is to do as once did the great mental alienist Dr. John P. Gray, when, having given an opinion on a question of insanity, he was cross-examined as to the different theories from time to time prevalent as to what insanity was, and having stated what theories were then the accepted ones, he was confronted by counsel on his cross-examination with the question: “What do you think of Dr. John P. Gray as an authority on that question?” and then with his own writings, quite extensive, of many years before, in which he had advocated theories apparently different from those which he had professed upon the witness-stand. Placed in this position, the distinguished gentleman simply replied: “It is true I cherished those theories at that time, but I lived to learn better,” thus substantially disarming any criticism that could be made of him in his capacity as a witness in that case.

1. Causes of death; especially in cases of homicide, suicide, accident, etc., including poisoning.

2. Causes, nature, and extent of personal injuries, by violence, accidents, explosions, railway disasters, collision between vessels, etc.

3. Birth of infants; was infant born dead or alive; if dead, was death the result of natural causes or of internal violence; age of infant at the time of birth or death. Also causes of alleged sterility or pregnancy; time pregnancy has existed; also cases of alleged impotency.

4. Rape, abortion, bastardy, pederasty, onanism, masochism, and many other matters relating to the sexual organs.

5. Malpractice cases, involving the degree of care and skill usual, and that used in the case under investigation, and involving delicate questions as to the propriety of the treatment adopted, etc.

1 Phillips Ev., p. 136; Starkie Ev., p. 40; Wharton Ev., s. 606; Greenleaf Ev., secs. 248, 237, 239; Taylor Ev., s. 916; Stephen, Dig. of Ev., art. 115; Rogers’ Expert Testimony, s. 45; Reynolds’ Theory of Evidence, s. 86.

It is to be noted that none of the cases which are cited as authority for the common-law rule as usually stated are really precedents to that extent. The cases of the Duchess of Kingston (supra); Lord William Russel (9 How. St. Tr., 602); Dr. Ratcliff (9 How. St. Tr., 582); Earl Ferrers (19 How. St. Tr., 886), and Rex v. Gibbons (supra), were all criminal prosecutions; and in Annesley v. Anglesea, Wilson v. Rastall, Broad v. Pitt, and Greenough v. Gaskell (supra), which were civil causes, the question of the privilege of a medical man was not really in dispute. It is well settled that communications between attorney and client are privileged, and yet Judge Pitt Taylor expresses some doubt whether the protection cannot be removed without the client’s consent in cases where the interests of criminal justice require the production of the evidence (Taylor Ev., s. 929). This intimation of a distinction between criminal and civil actions, even in the case of attorneys, suggests the possibility of a difference between those two classes of actions in the case of medical men. The cases cited establish authoritatively that in criminal prosecutions, at common law, confidential communications between medical man and patient are not privileged; but in civil causes, the opinions of the eminent judges seem to be obiter dicta. It is, however, established by other decisions that mere confidential relations do not prevent the disclosure of communications. (For the case of bankers, see Loyd v. Freshfield, 2 C. & P., 325; managers, Anderson v. British Bank of Columbia. 45 L. J. Ch., 449; clerks, Lee v. Burrell, 3 Camp., 337; Webb v. Smith, 1 C. & P., 337; stewards, Vaillant v. Dodemead, 2 Atk., 524; Earl of Falmouth v. Moss, 11 Price, 455; Pursuivant of Herald’s College, Slade v. Tucker, 49 L. J. Ch., 644.)

The opinions of so many eminent men, though strictly speaking obiter dicta, together with the uniform statements of text-writers based upon them, leave no room for reasonable doubt that independent of statute, in civil as well as criminal causes, communications between medical adviser and patient are not entitled to protection from disclosure in evidence.

These or similar reasons have prevailed in many States and Territories to bring about a statutory restriction on disclosures.

Under sec. 873, Code Civ. Pro., as amended by Law 1893, c. 721, the plaintiff in an action for personal injuries may be compelled to submit to a physician’s inspection. Cf. Page v. Page, 51 Mich., 88.

In Indiana, information as to abortion and criminal intimacy is protected in an action for criminal conversation. Harris v. Rupel, 14 Ind., 209. In Hewitt v. Prime, 21 Wend., 77 N. Y. (1839), in an action for seduction the testimony of a physician that he was asked for medicine to produce an abortion was admitted. It was stated that such testimony is not privileged, but there were other reasons for the judgment, and the case seems to be at variance with later decisions on that principle.

See also Briggs v. Briggs, 20 Mich., 34.

As to whether a physician may contradict his patient to prevent fraud, see infra, p. 111 et seq.

“Surgeon: One who applies the principles of the healing art to external diseases or injuries, or to internal injuries or malformations, requiring manual or instrumental intervention. One who practises surgery.”—Bouvier’s Law Dict., vol. ii., p. 698, q. v.

The amendment of 1891 allowed an express waiver of information, except confidential communications and such facts as would tend to disgrace the memory of the patient, by his personal representatives, or if the validity of the last will and testament of the patient is in question, by the executor or executors named in said will. Law 1891, c. 381.

The amendment of 1892 added the surviving husband, widow, heir at law, any of the next of kin or any other party in interest, in case the validity of the last will and testament of the patient is in question. Law 1892, c. 514. The present law contains the same provisions. Act 1893, c. 295.

See Adrereno v. Mut. Res. F. L. I. Co. (U. S. C. C. Mich.), 34 Fed. Rep., 870.

On the analogous case of an attorney as witness to a will, see Matter of Coleman. 111 N. Y., 220; and N. Y. Code Civ. Pro., s. 836, as amended Act 1893, c. 295.

In New York he is empowered by statute to employ not more than two competent surgeons to make post-mortem examinations and dissections and to testify to the same. N. Y. Laws of 1874, chap. 535, § 2.