UVE E I) I C-A-X, J-CEISFEUDENCE. 
T H E 
ANNUAL ADDRESS 
BEFORE THE 
MASSACHUSETTS MEDICAL SOCIETY, 
JUNE 3, 1868. 
By HENRY GRAFTON CLARK, M.D. 
BOSTON: 
DAVID CLAPP & SON—334 WASHINGTON STREET. 
1868. MEDICAL JTJEISPErtJDEHCE. 
THE 
ANNUAL ADDRESS 
BEFORE THE 
MASSACHUSETTS MEDICAL SOCIETY, 
JUNE 3, 186JL 
By HENRY GRAFTON CLARK, M.D. 
FELLOW OF THE SOCIETY AND SURGEON OF THE MASS. GENERALJ 
BOSTON: 
DAVID CLAPP & SON—334 WASHINGTON STREET. 
1868. At an Adjourned Meeting of the Mass. Medical Society, held Oct. 3,1860, it 
was 
Resolved, “ That the Massachusetts Medical Society hereby declares that it 
does not consider itself as having endorsed or censured the opinions in former 
published Annual Discourses, nor will it hold itself responsible for any opinions 
or sentiments advanced in any future similar discourses.” 
Resolved, “ That the Committee on Publication be directed to print a state- 
ment to that effect at the commencement of each Annual Discourse which may 
hereafter be published.” ADDRESS. 
Mr. President and Gentlemen : 
For the first time in the history of the Massachu- 
setts Medical Society its Fellows are assembled with- 
in the walls of an edifice* which has been erected 
for purposes, and is hereafter to be devoted to 
objects, entirely in harmony with those for which the 
Society itself was organized; namely, the treatment 
of disease and the advancement of the cause of 
medical education. 
Permit me, then, to congratulate you on the auspi- 
cious circumstances under which we this day meet; 
and, in the name of the Trustees of the Massachu- 
setts General Hospital—who, I know, will excuse 
me for the liberty—to whose liberality and enter- 
prise we are indebted for this spacious and conveni- 
ent amphitheatre, and in behalf of my colleagues and 
myself, its Physicians and Surgeons, to extend to you 
now, as we shall at all times be happy to do, a most 
cordial welcome. 
* The new operating theatre of the Massachusetts General Hospital. 4 
INTRODUCTORY. 
For it is indeed most fitting that this structure— 
the necessary and healthy outgrowth of an institu- 
tion which, on the fourth of July next, enters upon 
its second half-century — should be thus honored 
at its inauguration by the presence of an Associa- 
tion, to the members of which it is so greatly in- 
debted for what it has accomplished in the past, 
and for all that it may hope to achieve in the 
future. 
It would be ungracious, while we thus welcome 
you to this our new theatre, should I omit all expres- 
sion of passing regret that we have taken our final 
leave of the classic old place endeared to us by so 
many interesting recollections, and which has been 
for so many years intimately associated, in the 
minds of most of us, with the history and progress 
of the surgery and surgeons of New England and of 
the country. 
But there is one event in this retrospect which, 
more than any other of the eight thousand opera- 
tions which have been performed in that thea- 
tre, will keep the memory of it forever green. I 
mean of course the final demonstration of the pro- 
perties of Sulphuric Ether, the simple report of 
which I have extracted from vol. 30, p. 446, of the 
Surgical Records of the Hospital. It is as follows : 
“ The patient, Alice Mohan, was carried to the ope- 
rating theatre at 11 o’clock. Mr. Morton’s prepara- 
tion Avas exhibited. In three minutes the patient 
was under its influence completely. The artery was 
compressed by Hr. J. M. Warren and the thigh am- 
putated by Dr. Hayward. With regard to the influ- INTRODUCTORY. 
5 
ence of the preparation inhaled, the patient asserts 
that she was entirely insensible until the last ligature 
was tied.” Thus quietly but perfectly was that great 
discovery verified and demonstrated, for which, in 
the words of Sir Benjamin Brodie, all physicians and 
surgeons have been looking in vain from the days of 
Hippocrates to the present time. 
Salient beyond almost all others the great fact will 
forever remain to us ; and, like the bow of the Cove- 
nant, will safely span, with its many-hued radiance, 
that yet unknown and unmeasurable space from that 
earliest*recorded time when “the Lord God caused a 
deep sleep to fall upon Adam, and he slept; and he 
took one of his ribs, and closed up the flesh thereof; ” 
to the period of the fulfilment of that sublimer pro- 
mise and that diviner hope of man, “ Neither 
shall there be any more pain ” ! 
But the world does not yet know, nor will it, until 
the true history of the use of Ether hi this case comes 
to be written, how near to a lost opportunity this 
was ; nor how much it was indebted for its triumph- 
ant success (I believe I violate no confidence in say- 
ing so) to the sagacity, the adroitness, and the ener- 
getic remonstrances, against the obstructive etiquette 
and red-tape which imperilled everything, of the then 
junior, and now senior, surgeon of the Hospital, 
I)r. Henry J. Bigelow. 
I feel that I am already anticipated, in your 
thoughts, when I pronounce in your hearing, and 
in this connection, the everywhere well-known and 
time-honored names of James Jackson, and John 
Collins Warren ; who may truly be said to have 6 
RETROSPECTIVE. 
been, not only the founders of the Massachusetts 
General Hospital, but its creators ; to whose fore- 
sight, sagacity, and enterprise—to whose magnetic 
and dominating personal influence—to whose high 
professional attainments—to whose unwearied foster- 
ing care and skilful administration—it is indebted for 
the high rank it so early acquired, and the reputation 
it has since maintained. 
With a personal assiduity that never tired—with 
a single-hearted devotion to the hospital and to its 
inmates, which yet never forgot the interests of medi- 
cal education—they walked its wards, and dispensed, 
each in his chosen department, during a prolonged 
term of service, for the benefit of those under their 
charge, the highest resources and appliances of the 
arts of medicine and surgery; and thus, by their 
teachings and example, fitly taught and trained those 
who followed their footsteps, listened to their teach- 
ings, and witnessed their operations. 
Upon the sons of both we all know how worthily 
their mantles fell: one of them,* alas ! for us too 
early snatched from our justly exalted hopes and ex- 
pectations ; the other,j* spared to us until, as it seems 
but yesterday, he too, in the meridian of his days and 
usefulness—his accustomed instruments scarcely laid 
aside from his latest operation, and as calmly as if he 
had not seen the angel of death advancing straight 
upon his path; never faltering or failing in the per- 
formance of his every duty—was at last compelled 
to yield, and sank down to that sleep from which there 
is no waking. 
* Dr James Jackson, Jr. 
f Dr. J. Mason Warren. RETROSPECTIVE. 
7 
Although I am conscious that the moments of the 
brief hour—for the distinguished honor of occupying 
which I am afraid I am indebted to your overestimate 
of my ability to interest you—are rapidly passing 
away, I cannot forbear to remind you, even at some 
personal peril, of the various orators who have pre- 
ceded me. I need but speak their names to recall to 
your recollection the subjects of their discourses ; or 
the titles of them, to bring, in bodily presence before 
you, the familiar faces and forms of their authors. 
As the progress of time, and the succeeding pro- 
cession of more recent events, are day by day and 
year by year removing into the increasing obscurity 
of forgetfulness the things which are past, it is well 
sometimes to look back and thus revive the memory 
of them. This retrospect, however useful and inter- 
esting, is not to him who is to stand in this place, for 
the time being as your orator, always very reassur- 
ing. It is nevertheless quite suggestive—stimulating 
him to make the effort to follow, even at ever so 
humble a distance, such distinguished precedents, and 
at the same time awakening him fully to the con- 
sciousness of his temerity in making the attempt, and 
warning of its very possible failure. 
For myself, the best remembered, and to my mind 
that most worthy of remembrance because of its 
originality, its truthfulness, and its utility, was the one 
that I first had the pleasure to hear—that of Profes- 
sor Jacob Bigelow, upon Self-limited Diseases : a 
paper, which it is safe to say, has accomplished more 
in enlightening the medical profession and reforming 
its practices in regard to the subjects of which it 8 
RETROSPECTIVE 
treated, than any and all other treatises, however 
long, which have ever been written. 
The paperof Dr. John Ware, on Delirium Tremens, 
proved not only the self-limited nature of the disease, 
but also the entire inutility of all remedies in arrest- 
ing the course of it, or of even abating its symptoms. 
Once remarking to me, as I well remember, that if 
opium, the then fashionable remedy, was given in 
sufficient doses to enforce sleep the patient would 
never awake again; he added also the statement that, 
in his opinion, if the disease was uncomplicated and 
its progress not interfered with by treatment, re- 
covery from it should be generally expected. And 
although, since its discovery, Ether has frequently 
proved the efficient means of cutting short the attack 
in the milder cases which occur in a certain class of 
subjects, experience has fully confirmed the general 
soundness of his opmions as then announced. His 
address, upon The Duties and Objects of the Medical 
Profession, was, as were all his writings, full of his 
habitual practical wisdom. 
Of all the good lessons taught us by Dr. James 
Jackson, the universally beloved Nestor of the pro- 
fession, none will be longer or more appreciatingly 
remembered than those classically simple but wise 
words of advice to a young physician. And although, 
having arrived at an age prolonged far beyond the 
ordinary term of human life, the laws of which none 
knew better, he has forever passed away, 
“ Calmly, as to a night’s repose, 
Or flowers at set of sun,” 
we shall never forget liis venerable and benignant <|!lose beyond the darkness of the cloud 
Which for so long has hid him from our eyes, 
Like Enoch’s chariot of golden fire, 
In lOditfar him the glorious sunshine lies! RETROSPECTIVE. 
9 
form, as he lived and walked among us ; nor should 
we too much grieve that a life so perfect and complete 
in all its years has at last rounded to its close; for we 
know that, 
close beyond the shadow of the cloud, 
Which, envious, rapt him from our mortal eyes, 
Like a winged chariot of flaming fire, 
In wait for him th' eternal sunshine lies! 
But I have no need to attempt words of eulogy when 
they have already been so fitly said by his learned, 
eloquent, and venerable compeer *— and said and 
sung so well by one whom we always delight to hear 
and to honor—his kinsman and his friend; f by one 
who, as a true poet, has interpreted for us, in living 
and burning words, the sentiments and emotions we 
had not the power to speak or express, and which 
but for him would have remained forever unspoken 
and unexpressed. 
The hereditary standard of his professional fame 
we know will suffer no abatement during the life of 
him, who has in every way, personally and profes- 
sionally, so well sustained his honored name ; and 
about whom Dr. John Ware years ago very pithily 
said, there was nothing morbid but his modesty. 
Of the several discourses upon the Condition, Pros- 
pects, and Duties of the Medical Profession, and on 
related subjects, which have been pronounced suc- 
cessively by Drs Reynolds, Ware, Wyman, Shattuck, 
and Wakefield, it only need be said, that they each, 
* Dr. Jacob Bigelow, 
f Dr. Oliver W. Holmes. 10 
RETROSPECTIVE. 
according as it has pleased them, have so thoroughly 
explored the field, spreading out before us its ample 
stores of knowledge—and these all have been so 
well analyzed by Dr. Morrill Wyman in his excellent 
address on Certainty in Medicine—that gleaners after 
them will find a harvest of but scanty sheaves. 
That of Dr. Edward Reynolds, our Magnus Apollo, 
will be well remembered for the honestly indignant 
and hearty attack which he made upon the false doc- 
trines and the delusive theories of Hahnemann and 
the Homoeopaths. I believe that he has since thought 
it not to have been practically effective. That was 
the naturally-to-be-expected result of fighting a folly 
and a phantom! 
Dr. J. Mason Warren, in his resume of the progress 
of surgery for the last thirty years, has given us a 
compact, and so far as was practicable within the 
ordinary limits of the annual address, a complete ac- 
count of the principal improvements which have been 
introduced into the theory and practice of the art, 
during that period, both here and abroad; and in his 
Surgical Observations, a work completed during the 
last months of his life, he has given us many of his 
own cases as illustrative of his opinions, and of his 
most important surgical operations. 
A most life-like and interesting notice, with a 
sketch of his more salient characteristics, published 
shortly after his death, by his classmate and friend 
the Professor of Anatomy in Harvard College, together 
with the very just and discriminating resolutions in 
regard to him drawn up by Dr, Henry J. Bigelow, RETROSPECTIVE. 
11 
for his colleagues at the Hospital, have rendered any- 
thing I could further add superfluous. 
Dr. Cotting, in his address before the Society, ap- 
pears to have faithfully followed the advice of our 
late lamented president, Dr. Augustus A. Gould, in 
his admirable address upon the study of natural sci- 
ence—the letter and spirit of which he had himself 
so thoroughly carried out—although he has interro- 
gated nature in some of her least attractive moods. 
Whether, according to Dr. Cotting, disease was a 
part of the original plan of creation; whether it was 
the result of a radical change in a plan originally 
perfect; or whether, if so, the change is to be at- 
tributed to divine or human intervention, are questions 
which, as the greater includes the less, may perhaps 
be settled when the Theologians have agreed among 
themselves with regard to the mooted question of the 
Divine origin of evil. Dr. Cotting has, however, cer- 
tainly shown himself, as viewing them from his own 
standpoint, a most competent advocate of his an- 
nounced opinions. 
Dr. Luther V. Bell’s thoroughly practical discourse 
on Ventilation was an advance in a most useful di- 
rection ; and equally demonstrative of the philosophi- 
cal qualities and the inventive mechanical knowledge 
for which he was so distinguished. It is to be regret- 
ted that such doctrines as those enunciated by Dr. 
Bell, and by another of your orators, Dr. Morrill 
Wyman, have not had a larger influence on those 
who are usually entrusted with the construction 
especially of our public buildings, and who, in such a 
self-complacent way, assume the exclusive use of the 12 
RETROSPECTIVE. 
term practical as applied to themselves, to the exclu- 
sion of professional men whose opinions they affect 
to hold in contempt. 
Of Dr. Holmes’s Currents and Counter-Currents 
in Medical Science, .wThat shall I say] but that the 
play and sparkle of its brilliant words and expres- 
sions, that so rapidly chased and displaced each other, 
as the completed sentences fell upon the eager and 
listening ears of his auditors, were but the attractive 
surface-ripplings of a vigorous under-current of a 
strong common sense, and of truths, to make the 
doses of which palatable, in the opinion at least of 
some of his brethren, needed all his skilful manipula- 
tion. For, in truth, when one’s faith in his own pre- 
conceived notions is so shaken by the winds of doubt, 
the pill must indeed be well gilded, in order that it 
may be comfortably taken. But time, which brings 
its convictions, as well as its revenges, I believe has 
satisfied most of us that if many of the drugs as 
commonly used were thrown into the sea, it would be 
as much “ better for us as it would be worse for the 
fishes!” 
The discourse of Dr. William J. Walker, upon 
Compound and Complicated Fractures, and that of 
Dr. George Hayward, upon Diseases of the Joints, 
constitute the only remaining addresses upon surgical 
subjects. That of Dr. Walker was a masterly and 
exhaustive exposition of doctrines which were con- 
siderably in advance of the surgery of the day; and 
in the discussion of which he proved himself to be as 
profound and careful an observer of the reparative 
processes of nature, as we all knew him to-be skilful MEDICAL JURISPRUDENCE. 
13 
in the practical operations of surgery. His retire- 
ment from the profession at the high tide of his 
opportunities for usefulness was an event to be re- 
gretted. 
There are other discourses which might have been 
touched upon, had not this sketch, imperfect as it is, 
perhaps already detained you too long; but there is 
one more, that of Professor D. Humphreys Storer, 
upon Medical Jurisprudence, to which you will I know 
permit me to allude, because, after reading it lately, 
its subject has suggested itself as one to which the 
attention of the Society might again be profitably 
directed. 
In the hope simply of supplementing the address 
of Dr. Storer, in some untouched points, I ask your 
indulgence during the remainder of our time to some 
suggestions in regard to the desirableness of a more 
extended study of Medical Jurisprudence, and to 
some reasons why its study should be more closely 
connected with that of General Sanitary Law. 
From the earliest times to the present day, Medi- 
cal Jurisprudence, especially when inclusive of Sani- 
tary Law, has been more or less a subject of interest 
and of action to legislators and physicians. In the 
Laws of Moses, in the Code Napoleon, and in fre- 
quent intermediate legislation, the principles so long 
ago enunciated in the old Latin motto, Salus populi 
suprema lex, have been constantly and duly recog- 
nized. 
According to Fodere, excepting sanitary laws 
which were derived from or suggested by the Mosaic 
Code, Legal Medicine was limited to a knowledge 14 
MEDICAL JURISPRUDENCE. 
and practice of the art of reporting “ en justice,” that 
is, in aid of justice ; which report is defined by Orfila 
to be an instrument or document drawn up by one 
or many individuals (doctors of medicine, surgeons, 
health officers, chemists, sages-femmes, etc.), at the 
request of the judicial or administrative authority, 
and under oath to state certain facts, to detail them 
with care, and to deduce the consequences. 
Fodere tells us that the body of Julius Caesar 
was exposed, all bloody as it was, to the eyes of the 
public; they examined his twenty-three wounds ; 
and one only was judged to be mortal by one named 
Antistius, who dabbled in medicine ; and it was that 
which had penetrated the chest, between the first 
and second rib. 
In the age of Charles V. and Francis I. of France, 
an ordinance was passed requiring the courts to call 
physicians to their aid in cases which they could not 
otherwise understand. 
Up to this time*—I translate from Fodere—phy- 
sicians and surgeons had been called, indifferently, to 
report to the courts ; but in 1606, Henry IV. gave 
letters-patent to his physician-in-chief, by which he 
conferred on him the right to name two surgeons in 
each city, and one in each considerable town, to make 
the official reports of the wounded, killed, mutilated, 
etc., to the exclusion of other surgeons. This law, it 
must be observed, as the surgeons in those days were 
very inferior as a class to the physicians, excluded 
from this service to the State nearly all of those who 
were best qualified for it. As a necessary result of 
this state of affairs, the science of Legal Medicine, MEDICAL JURISPRUDENCE. 
15 
imperfectly as it was then understood, fell into disre- 
pute ; in fact the functions of the law already refer- 
red to assigned to them duties which might have 
been perhaps quite as appropriately required of coro- 
ners as of medical jurists. 
Paul Zacchias, whose precepts on Legal Medicine 
were printed in 1621, at Rome, and the renowned 
surgeon Ambroise Pare, the first writer on the sub- 
ject, fifty years later in the same century, seem each 
to have collated and arranged in a codified form all 
that was previously known of the science—Pare’s 
work especially becoming and remaining the sole 
authority as a text-book for more than a century. 
But from this period, it was not until near the begin- 
ning of the eighteenth century that any systematic 
and comprehensive treatise upon the subject was 
written, or that, either in France, England, or Ger- 
many, it was deemed of sufficient importance to 
establish for it a professorship. Indeed, Dr. Taylor, 
speaking on this subject, says, that in John Hunter’s 
time Medical Jurisprudence was unknown. But 
Fodere’s book, entitled “ Les lois eclairees par les 
physiques, ou Traite de medecine legale et d'hygiene 
publique,” proves that he at least comprehended the 
interest and importance of the subject; and he was 
far in advance of his time. 
Orfila divides the science of Medical Jurisprudence 
into two branches, defining them as follows : “ All 
which tends to preserve the public health, to favor 
the vigor of the population, to insure life and liberty 
to the citizen, appertains to medical police or public 
hygiene : also the examinations of the air, water, and 16 
MEDICAL JURISPRUDENCE. 
localities, of food and drinks, of habitations, of pri- 
sons, of epidemics, of epizootics, etc. etc., belong 
to the domain of that science. Legal Medicine, on 
the contrary, occupies itself with causes carried be- 
fore the tribunals and the courts of justice.” 
Mahon agrees with Fodere, in defining Legal 
Medicine in such a way that it includes public hy- 
giene also, viz., as an art which applies the know- 
ledge and principles of the diverse principal and 
accessory branches of medicine, to the composition, 
illustration, and interpretation of the laws. 
The two best books of our time, which have pre- 
ceded the very elaborate work of Dr. A. S. Taylor, 
are by American authors, although I think both were 
first published abroad ; Ur. Beck’s, on the general 
subject, and Dr. Bay’s treatise, as yet unrivalled, on 
the Medical Jurisprudence of Insanity. Dr. Taylor’s 
definition of Medical Jurisprudence, which I give as 
that of the most approved modern authority, although 
it does not expressly include, as you will observe, the 
law of public hygiene, and although no reference 
is made to it in his work, as in the works of Fodere, 
Mahon, and as it is recognized in the famous Code 
of Napoleon, is yet perhaps one of the best that can 
be given. It is as follows : “ Medical Jurisprudence, 
or, as it is sometimes called, Forensic, Legal, or 
State Medicine, may be defined to be that science 
which teaches the application of every branch of 
medical knowledge to the purposes of the law: 
hence, its limits are, on the one hand, the require- 
ments of the law, and on the other, the whole range 
of medicine. Anatomy, physiology, medicine, sur- MEDICAL JURISPRUDENCE. 
17 
gery, chemistry, physics, and botany, lend them aid 
as necessity arises ; and, in some cases, all these 
branches of science are required to enable a court 
of law to arrive at a proper conclusion on contested 
questions affecting life and property.” 
Having thus noticed the very various methods of 
defining the bounds, and of pursuing the study of 
the science of Medical Jurisprudence, let us consider 
whether that definition which is the most compre- 
hensive is not also the simplest as well as the best; 
and whether, with Fodere and Orfila, admitting the 
natural division of so extensive a subject into the 
two branches of Legal Medicine and Sanitary Law, 
we shall not agree that both may be very properly 
included in the larger department of Medical Juris- 
prudence. 
It has always seemed to me remarkable that the 
subject of Legal Medicine, leaving out of the ac- 
count now that of Public Hygiene, should in most of 
the schools be made so subordinate and be rated of 
such small importance as compared with the other 
courses usually taught; being attached, apparently 
as a pendant, usually to the chair of Obstretrics, and 
sometimes to that of Chemistry. Now this appears 
to be reversing the convenient and proper order of 
things, and there does not seem to be the slightest pro- 
priety in thus making the greater subsidiary to the less. 
Notwithstanding the great changes and advances 
which have taken place with regard to the practice 
of the principles of Legal Medicine since the begin- 
ning of the present century, the services rendered by 
medical men as reporters, after the original manner 18 
MEDICAL JURISPRUDENCE. 
of its earlier methods, for the coroners at inquests, 
are still of the highest importance. 
In the case of alleged murder, for example: after 
the discovery of the corpus delicti, as it is called, and 
without which no trial can well go on at all, the first 
step in the case is to ascertain, by a post-mortem 
examination of the body, what is the cause of death. 
In many cases this is easy; in others, very diffi- 
cult ; and while a witness, especially a medical ex- 
pert, is not responsible for the consequences of his 
investigation, and has nothing to do but to observe 
carefully, and to report all the facts as he may find 
them, in the plainest and simplest way, avoiding as 
much as possible all technical expressions and pro- 
fessional phrases, giving at the close his general 
judgment and opinion on the same ; he will never be 
able entirely to divest himself of the reflection that 
the whole case, carrying with it the fate of the guilty 
party, but, what is of more consequence to the com- 
munity and to the course of justice, a righteous or 
unrighteous verdict, is dependent upon the manner 
in which he has discharged this duty. 
If the death has been occasioned by any obvious 
violence, such as that inflicted by heavy machinery, 
by falls from a great height, or from any large and 
patent external wounds, as in shooting or stabbing, 
his task is comparatively simple. But even here 
arise secondary questions, the determination of which 
is often quite as important, viz., whether the death be 
accidental, homicidal, or suicidal. The answer to 
these questions is sometimes beyond the power of the 
medical witness, and must be obtained from ctilla- MEDICAL JURISPRUDENCE. 
19 
teral evidence. Is the body supposed to be that of a 
drowned person ? In the absence of a full know- 
ledge of the circumstances of the drowning, it will 
be his duty to ascertain if it was alive and uninjured 
when it was immersed. 
In other cases, where there is no obvious cause of 
death, and there are no external appearances or 
circumstances to give any suggestion, the case will 
require a further and more careful investigation to 
determine it. In the absence of evidence to the con- 
trary, the death may of course be due to natural 
causes. Is it in this class % If not, and no fatal lesion 
is discovered, such as rupture of some of the ab- 
dominal organs, as the liver, spleen, or kidneys, all 
of which may occur without leaving any external 
trace of injury, he next inquires if it is from poison ? 
If so, what is the evidence which will determine its 
effects, and prove its character ? If we recur to death 
from violence, what are the distinctions between 
homicidal and suicidal wounds % If there are several 
wounds, which of them are necessarily mortal, and 
which of them are not % 
These are but a few of the questions to be decided, 
and only examples of the points to be examined in 
such investigations, and which it is evident require 
for their settlement, always, professional and scien- 
tific acquirements of the highest order. 
Such an inquiry implies that the investigator 
should be not only a physician, but a physiologist, a 
pathologist, a surgeon, and a chemist; and that he 
shall be able to reason accurately and well upon the 20 
MEDICAL JURISPRUDENCE. 
premises given, and to deduce therefrom conclu- 
sions which must be defensible as well as sound. 
In the natural division of the healing art into the 
three branches of medicine, surgery, and chemistry, 
we may easily find men who may be considered as 
experts, and be quoted as authorities in their respec- 
tive departments ; but as Fodere well remarks in sub- 
stance, that, as it is extremely rare that the same man 
has such universal knowledge, it is necessary some- 
times that the two should sustain and mutually aid 
each other; and that they should also call to their aid 
the pharmacien, the analytical chemist, or the lights of 
natural science, whenever a suitable occasion arises 
therefor. 
If we admire the skill and science of the anatomist 
who can recognize, dissect, and describe the most in- 
tricate structures of the human body, and explain 
their relations to each other ; how much more worthy 
of admiration is the comparative anatomist and mi- 
croscopist, who can, in aid of justice, from the charred 
and crumbling fragments of bones, rescued from the 
fiery furnace to which they had been consigned by 
the hand of crime, determine with certainty their 
character, and re-assemble them in their appropriate 
places in the skeleton of which they originally formed 
a part; of that wonderful triumph of chemical ana- 
lysis that can extract the mortal poison from the long 
buried cadaver, and demonstrate, to the satisfaction of 
a court of law, its presence therein! 
In connection with this branch of Legal Medicine, 
all those questions which relate to infanticide and 
criminal abortion are to be considered. These in- MEDICAL JURISPRUDENCE. 
21 
volve again many other considerations, such as can 
only be fully comprehended and expounded by an 
obstetrical expert, who can observe critically, and an- 
alyze skilfully, all the nice and intricate inquiries which 
relate to utero-gestation, the viability of infants, etc., 
and who are, by their especial training and studies, 
peculiarly fitted to give opinions in many matters 
which occupy the civil as well as the criminal courts. 
The questions of survivorship of mother or child, in 
cases of death during parturition ; of legitimacy and of 
hereditary rights as dependent upon a great variety of 
circumstances; are often practically decided upon 
opinions derived from the personal knowledge and 
experience of such witnesses. 
The subject of Suicide follows naturally in the shad- 
ow of that we have just discussed, and many of the 
points to be considered are of course identical with 
those which relate to murder. They are in some par- 
ticulars, however, more difficult of solution. Suicide, 
like murder, is usually a secret act, but, unlike that 
crime, is often concealed from every human being, while 
the murderer often involuntarily aids, by his sub- 
sequent acts, in his own pursuit and detection. There 
are, however, many exceptions to this rule: as suicides 
sometimes beforehand avow their intention, or leave 
behind them some written confession; even if they 
have not, in the last repentant agony of death, pro- 
claimed the cause, and explained the means by which, 
and the motives on account of which, the act has been 
committed. 
Insane suicides, who of course are wholly irrespon- 
sible and blameless for their acts, often do the deed 22 
MEDICAL JURISPRUDENCE. 
with a,deliberation, determination and secresy, which 
defy the sharpest vigilance of their custodians.. , To be 
sure, sometimes the act of suicide is the first evidence 
of insanity-—some writers and ;authorities, indeed, 
holding the belief that all suicides are insane acts ; 
but this, for many reasons which are deemed sufficient 
by those best qualified to judge, is not now the gene- 
rally received opinion. 
But a discussion of this single part of the subject 
of suicide opens the broader and more interesting 
field of the Medical Jurisprudence of Insanity—I say 
Jurisprudence in its wider sense, as distinguished from 
that narrower sense in which we discuss the subject 
of murder in its relations to the criminal law only, 
because, in this view, it is a subject which touches all 
classes of society. Insanity visits the palace as well as 
the hovel; it seizes indifferently upon the parent and 
the child, the husband and the wife, the scholar and the 
clown; is both accidental and hereditary; and, as 
shown by the laws enacted and the custodial and re- 
medial means adopted- for the care and treatment of 
the subjects of it, a matter worthy of the gravest con- 
sideration ; and therefore the propriety, necessity and 
humanity of making the medical treatment of the in- 
sane a profession by itself, have indeed for a long 
time been conceded. 
The questions of injuries to the person, such as as- 
saults and batteries—those relating to property—of 
competency to hold and bequeath property—are all 
interesting, and quite worthy of a discussion which 
must be denied them here. 
Life Insurance is one of the most important of these MEDICAL JURISPRUDENCE. 
23 
interests, and one which is daily and justly attracting 
to itself the attention of some of the best men in the 
profession, while those who have charge of the sub- 
ject are to be congratulated that their useful plans 
and acts have thus far been so ably seconded and sup- 
ported. 
Finally, the art of testifying in court usefully and 
properly is one which is of itself a study. Some great 
men make indifferent witnesses, while others of in- 
ferior capacity often testify very well. 
A medical witness should know beforehand, if he 
testifies as an expert, the principal points of the case 
upon trial; and he ought to be acquainted, not only 
with the facts which are supposed to favor the side 
upon which he is summoned, but also, if possible, the 
theory of that of the opposite party. While he ought 
to avoid any bias or partisanship, and, as a scientific 
witness, seek to elucidate the truth only, he will do 
well to remember, that, while he will be examined in- 
chief by questions which do not suggest their answers, 
upon the cross-examination almost all the questions 
will be what are called leading, and he will be in 
danger of being made to contradict himself, and to 
be enticed away from his real opinions. 
With regard to the point whether medical wit- 
nesses can be compelled to give opinions in cases 
with regard to which they have had no previous know- 
ledge, Lord Campbell decided that if ho.knew of any 
fact he might be compelled, but that he could not be 
compelled to give his attendance to speak to matters 
of opinion. Mr. Justice Maule says : There is a 
distinction between the case of a man who sees a 24 
PUBLIC HYGIENE. 
fact, and is called to prove it, and one who is called 
as an expert to give his opinion. The former is bound 
to do it; but the latter is under no such obligation; 
and the party who selects him must pay him. 
If now, gentlemen, without pursuing this part of 
our subject further, we turn our attention, even brief- 
ly as we must, to the more important branch of it 
known as Public Hygiene, we cannot fail to observe 
how vast is the field, how abundant the promise of 
its harvest; and yet how comparatively few are its 
reapers! 
As Legal Medicine deals with individuals only, 
and not en masse, Sanitary Law deals with the 
masses of the community, and not with its individual 
members ; and it is therefore capable of being ad- 
ministered upon a grander scale, and of yielding 
correspondingly greater results. 
It takes cognizance of climates and localities ; of 
drainage, ventilation, and of habitations ; it looks to 
the safety of public buildings, of transportation by 
sea and land ; of pleasure-grounds ; of the markets ; 
and in fact of all those means and measures which 
are best calculated to secure for the people the great- 
est good to the greatest number. Considering human 
life as a fact, it counts the number of births, and, 
comparing them with the deaths, estimates the net 
gain to the population. - : 
It examines into the causes of the deterioration 
and destruction of human life; and contrives means 
and measures to avert, ameliorate, or postpone them. 
It brings within its purview, and recognizes as among 
its most appropriate functions, the duty of providing PUBLIC HYGIENE. 
25 
for the people the means of enjoying, to the fullest 
extent and for the longest possible time, that gift of 
life, which increases in value in a direct ratio, as it 
is multiplied by the number of times one life is con- 
tained in the whole mass of lives. Its proper admin- 
istration bears the same relation to the practice of 
Legal Medicine, as the preventive does to the cor- 
rectional police. 
Having already seen how many things are essential 
to a proper knowledge of Legal Medicine, it is evi- 
dent from this imperfect exposition of the functions 
and requirements of Sanitary Law, that its know- 
ledge implies attainments of a still higher kind; 
and in its administrators, qualities of the highest 
order. They must be familiar with climates and the 
history and laws of epidemics ; must know the laws of 
population as affecting human life in its masses; and 
must study the laws of life and death, not only with 
Bichat and the physiologists and philosophers, but 
with the geologists, the engineers, and the staticians. 
To administer it well, requires a capacity enlarged 
by experience; a judgment sharpened and broad- 
ened by the many-sided opportunities of general 
practice; and combined with the philanthropy of 
Howard the executive qualities of a good fighting 
general:—and finally, like our brethren, Professors 
Ordronneux and Storer Junior, to have studied law 
as well as medicine. 
Sanitary Laws which shall efficiently protect socie- 
ty against all the causes which endanger its safety 
can only be properly enforced by Medical Men, and 
by properly constituted Boards of Health ;—and the 26 
IN MEMORIAM. 
people of this State must therefore look to the mem- 
bers of the profession as represented and embodied 
in this Society, as their only competent guides ; who, 
if true to themselves, may thus rightfully assume the 
higher functions of expounders and illustrators, if 
not of legislators and executants of this great depart- 
ment of Medical Jurisprudence. 
Since the last meeting of the Society, twelve of its 
members have died ; six of them in Boston. Four 
of these, Dr. James Jackson, Dr. Henry H. Childs, 
Dr. John Homans, and Dr. J. Mason Warren, by a 
remarkable coincidence, almost within sight of the 
residences of each other—four men, I am sure, 
whose combined influence in the Society and in the 
profession cannot well be overestimated, and whose 
aggregated fame is not surpassed by any other equal 
number of its Fellows, living or dead. 
Of two of these I have already spoken,;—of the 
others, again with reverential hands we lift the funeral 
palls, to take one parting look, and refresh our 
memories with pleasant recollections of the strong 
and manly characteristics, and the indomitable energy 
and irrepressible activity of the one, exhibited in 
a long and useful life as a leader in the profession 
and an influential member of this Society; and, of 
the other, as an exemplification in his own person of 
all the qualities he so well described in his address, 
entitled The Character and Qualifications of the Good 27 
IN MEMORIAM. 
Physician. Let us, then, so emulate the example of 
these good men, that we may go not reluctantly, as 
“ to that leaden darkness, where men lie, 
Shut out from friends, in chambers all of stone, 
Waiting our summons from the awful sky,” 
but, like them, confidently and cheerfully, to our final 
rest. 
“ One cold, brief tread ; a sigh; and then—to dreams 
That shadow us with deep forgetfulmess.”