Importance of Med

Journal of Criminal Law and Criminology
Volume 23
Article 3
Issue 5 January--February
Winter 1933
Role of Medical Science in the Administration of

Criminal Justice
Oscar T. Schultz
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Oscar T. Schultz, Role of Medical Science in the Administration of Criminal Justice, 23 Am. Inst. Crim. L. & Criminology 736
(1932-1933)
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THE ROLE OF MEDICAL SCIENCE IN THE 1
ADMINISTRATION OF CRIMINAL JUSTICE
2
OscAR T. SCHULTZ
Introduction
Law and medicine come in contact with each other in an im-
portant field in which information that scientific medicine is in posi-
tion to furnish should be made available to and utilized by law in
the administration of criminal justice. Some of this same body of
medical information enters also into the administration of civil jus-
tice. Malpractice and claims for accident insurance, personal in-
jury, and workmen's compensation need only to be mentioned to
emphasize the importance of medical opinion in this field of law. But
the medical aspects of the administration of criminal justice far out-
weigh those that enter in civil actions. Since the administration of
criminal justice involves a controversy between the state and the al-
leged criminal offender, medicine owes an obligation to society, and it
is the duty, rather than the privilege, of medicine to meet this obliga-
tion as competently as possible. Anything that will make for a better
'This article attempts to present in abbreviated form the results of a study
of the present status and possible future development of legal medicine in the
United States. This study was made for the committee on medicolegal prob-
lems of the National Research Council, Washington, D. C. The members of
this committee are: Dr. Ludwig Hektoen, director of the John McCormick
Institute for Infectious Diseases, Chicago, chairman; Dr. Adolph Meyer, pro-
fessor of psychiatry in the Johns Hopkins University and psychiatrist-in-chief
to the Johns Hopkins Hospital, Baltimore; Dr. Howard T.. Karsner, professor
of pathology, Western Reserve University, Cleveland; Dr. William H. Wood-
ward, director of the Bureau of Legal Medicine and Legislation of the Amer-
ican Medical Association, Chicago; Mr. John H. Wigmore, dean emeritus of
the School of Law of Northwestern University, Chicago;-and Mr. Roscoe W.
Pound, dean of the Harvard Law School, Cambridge. The complete study has
been published as Bulletin No. 87 of the National Research Council. This
study, like three preceding ones made under the auspices of the commttee on
medicolegal problems of the National Research Council, has been made pos-
sible through a grant made to the committee by the General Education Board
of New York City. The previous studies have been the following: The
Coroner and the Medical Examiner, by Oscar T. Schultz and E. M. Morgan.
With a Supplement on Medical Testimony, by E. M. Morgan. Bulletin 64,
National Research Council, 1928. A Survey of the Law Concerning Dead
Human Bodies, by George H. Weinmann. Bulletin 73, National Research Coun-
cil, 1929. A Compendium of the Statute Law of Coroners and Medical Ex-
aminers in the United States, by George II. Weinmann. Bulletin 83, National
Research Council, 1931.
2M. D., Director of Laboratories. St. Francis Hospital, Evanston, Ill.
ROLE OF MEDICAL SCIENCE 737
application of medical science to the administration of criminal justice

will be equally applicable to the administration of civil justice.
In the contemplation of this common field of law and medicine,
whose relations to both law and medicine are evident from its title
of legal medicine, the viewpoints of the two professions are naturally
different. The subject matter, the training, the aims, and the
philosophy of the two professions are different, and it is therefore
not to be wondered at that the angles of view of law and medicine
diverge in the contemplation of - a field common to both. The di-
vergence finds its most extreme expression in the statements of some
medical writers who decry every application of legal technic and
procedure, because it may hamper the presentation of medical opinion,
and in the opinions of those members of the bar who profess to find
nothing of value in medicine as applied to justice because of the con-
troversial character of medical. testimony as usually presented. It
must be the aim of the leaders of the professions of law and medicine
to overcome the tendency that would make of legal medicine merely
a gainful occupation for the professional partisan expert medical
witness or a procedure whose main purpose is the gaining of a
legal victory by an attorney. It must be their aim to make of legal
medicine a field more thoroughly tilled in common by both profes-
sions, in order that the two together may render to society the highest
possible type of service in the administration of justice.
What Is Legal Medicine?

The term, legal medicine, seems almost to define itself, and is
used so freely as to suggest that the concept of its subject matter is
quite clear. But if the legal medicine of certain foreign countries is
compared with that of the United States,- it will be found that the
term covers both a different content of subject matter and a differ-
ent mode of applying the subject matter to the needs of justice.
TIorst Oertel, 3 professor of pathology in McGill University,
Montreal, has written "The term 'legal medicine' is employed with
different meanings. The most common definition is that it is the
application of expert medical knowledge to the needs of law or
justice. In this definition is embraced, not only criminal law, but
the application to all kinds of insurance (life and accident), em-
ployees' compensation acts, soldiers' rehabilitations, and other civil
3
Oertel, Horst: The Academic Position of Legal Medicine in Canadian
Universities. Methods and Problems of Medical Education. Ninth Series.
The Rockefeller Foundation. New York, N. Y., 1928. P. 23.
OSCAR T. SCHULTZ
procedures. A second rarer definition applies the term to the social

and legal position and relations of the physician himself, that is,
his rights, duties, obligations, and responsibilities to the community
and to his fellow practitioners, and how the laws of the country
affect him in the pursuit of his professional practice."
It is the legal medicine of the second of these definitions that
has received the greater attention in this country. This is the law
of medicine. It emphasizes the aspect of legal medicine that relates
to the practice of medicine. It makes up the major portion of the
content of what is taught in schools of law and in schools of medicine
as medical jurisprudence.
It is with the legal medicine of Oertel's first definition that this
article deals. This is the medicine of law. It emphasizes the aspect
of legal medicine that relates to the utilization by law of medical
science in the interest of society. It is an aspect of legal medicine
that has received scant attention in this country, either in its prac-
tical application to the needs of justice or in its development as a
university discipline.
It might help to focus attention upon the differences between
these two aspects of legal medicine if the term medical jurisprudence
were limited to the law of medicine, and the term forensic medicine
to the medicine of law. The former should be taught by lawyers to
students in the schools of both law and medicine with perhaps the
greater attention in the law school, since it is the law that must
define and interpret "the social and legal position and relations of
the physician himself." Forensic medicine, in the restricted sense,
should be taught by physicians to the students of both law and
medicine, with the greater attention in the medical school, since it is
medical science that must be applied to the needs of .justice. Neither
the legal nor medical aspect of either subdivision. of legal medicine
should be isolated from the other. And especially he who proposes
to become expert in either subdivision must have the opportunity
of training in both the legal and medical aspects.
Position, Content and Aims of Forensic Medicine

What legal medicine is and how it aims to aid society in the
administration of justice has been well told by Knud Sand,4 pro-
4
Sand, Knud: Origin, Development, and Status of. Legal Medicine in
Modem Times, Status of Legal Medicine in Denmark, and Description of
Institute of Legal Medicine, Copenhagen. Methods and Problems of Medical
Education. Ninth Series. The Rockefeller Foundation, New York, N. Y.,
1928. P. 349.
ROLE OF MEDICAL SCIENCE
fessor of legal medicine and director of the Institute of Legal Medi-

cine in the University of Copenhagen. After tracing the use made
of medicine in the earliest systems of judicial procedure, he sketches
the important and rapid development of the medical sciences that
occurred in the nineteenth century and their relation to law in these
words: "Pathological anatomy developed from the continued and
repeated observations derived from post-mortem studies. Toxicology
rose with analytical chemistry. Psychiatry was organized out of the
chaos of problems involved in the ever-present problem of responsi-
bility. And meanwhile law itself made rapid strides forward, draw-
ing into its confines an ever increasing multitude of medical facts
and methods." - He then mentions a number of medical scientists,
whose names are outstanding in the medicine of the nineteenth cen-
tury and whose work brought to light many facts that have been
utilized by law, and continues: "It is owing to these men, their
contemporaries and followers, that legal medicine obtained a firm
footing and now constitutes a well-founded and well-organized entity,
which has become a normal discipline in most universities all over
the world and has also asserted its firm position by the acquisition
of institutes of research and by the establishment of government
offices through which its service is secured."
In his discussion of the content of legal medicine, Sand asks a
question and proceeds to answer it. "What field of medical knowl-
edge enters especially into the service of law? This question is
answered most fully when the social and medical events which dic-
tate the address of the law to medical science for enlightenment and
assistance are considered.
"These events necessarily are those mental or bodily manifesta-
tions which are affected by civil or criminal law; . . - For the
purpose of dealing with these questions the medical adviser uses an
insight derived from his knowledge of all branches of medicine
Still, there are certain branches of medicine that will prove to be
needed most frequently.
"Very often indeed the necessity arises in civil as well as in
criminal law for a psycho-pathological investigation for the purpose
of deciding the mental status of certain individuals and their legal
accountability. The vast field of legal psychiatry .has developed out
of these conditions. . . . Bodily injuries will call for investiga-
tions of live persons and in post-mortems.
. . The judgment of lesions is supported by pathological
anatomy. . . . This field of medicolegal work constitutes by far
OSCAR T. SCHULTZ
the more ponderous of all, particularly because of its bearings on

sudden death and its causes.
"The medicolegal expert will find it necessary to give
his most serious attention to general laboratory work. . . . The
subject of pharmacology, with its bearings on toxicology, is of great
importance."
Surgery, obstetrics, and pediatrics are mentioned as branches of
clinical medicine that may be required when the occasion demands.
Fundamental medical sciences not included in the above excerpts,
but that may be of the greatest importance in medicolegal investiga-
tions are anatomy, bacteriology, immunology, and physiology.
What is the aim or purpose of such a science of legal medicine
as has been outlined? Sand says, "Its main purpose is to demon-
strate the right manner in which the special knowledge and skill of
a doctor may enter into the service of the courts. . . . It is,
a unified discipline, which teaches the use of the doctor's fund of
medical knowledge from a definite point of view and for a definite
purpose." How does legal medicine carry out its purpose? "Legal
medicine is not merely a theoretical science, but a field of eminently
practical activity. . . . Certain principles affect the work of the
medical expert in the medicolegal practices. . . The doctor is a
medical man, not a jurist. He is the expert adviser who, as such,
investigates certain facts, clarifies them, and,. in explaining them,
guides and assists the courts."
One point brought out incidentally in the above quotations from
Sand deserves further emphasis. This is that the seriice of legal
medicine is to the courts, and that it is not particularly concerned
with the contentions of the prosecution or plaintiff on the one hand
or of the defendant on the other. The service of legal medicine,
as envisaged by Sand, is nonpartisan and impartial, just as the court
is nonpartisan and impartial.
It is the aim of the following pages to inquire into the manner
of utilization of medical science in the administration of justice in the
United States, and into the extent to which expert, nonpartisan med-
icolegal service is available to our courts, in the light of such a
science of legal medicine as has been described. This will reveal the
extent to which legal medicine in the United States "constitutes a
well-founded and well-organized entity," the extent to which it "has
become a normal discipline" in our universities, and the extent to
which it has "asserted its firm position by the acquisition of institutes
of research and by the establishment of government offices through
which its service is secured." The situation in this country may

then be contrasted with that in countries where expert nonpartisan
medicolegal science is made available to the courts through govern-
mental and university institutes of legal medicine. Upon the basis of
this contrast it is possible to offer suggestions that should lead to
future improvement in the status of legal medicine in the United
States and to a more intelligent administration of justice.
The Application of Medical Science to Law in the United States

In the United States the practical application of medical science
in the interests of criminal justice occurs along three different lines.
(1) The most common application is in the investigation of
deaths into whose causation there enters a suspicion of criminal vio-
lence. It is the purpose of such investigations to determine as ac-
curately as possible the cause and manner of death. 'Not only must
the causation of death by the supposed injury be established in sci-
entific manner, but other causes of death must be excluded, if the
findings relating to the supposed violent cause are to have full weight.
The investigation of death and its causes requires the skill and tech-
nical experience of the trained pathologist. Many poisons produce
no changes that can be certainly detected by the eye of the most
skilled pathologist. In such cases the poison itself must be detected,
and it must be found to be present in a quantity that would make it
a probable cause of death. Poisons and their action, detection and
quantitative estimation constitute the fieldof toxicology. The proof
that a detected substance is the alleged poison may require the use
of some of the experimental technical procedures of the pharma-
cologist or physiologist. The determination of the cause of death,
and what is more important, the exclusion of nonviolent causes of
death, may require the aid of bacteriologic, histologic, or immunologic
investigations.
The investigation of supposedly violent deaths occurs usually
through the office of coroner. In some states the justice of the peace
may function as a coroner, and in a few eastern jurisdictions the
office of coroner -hasbeen replaced by that of medical examiner. How
well these agencies perform their important duties will be discussed
later.
(2) One of the most important problems with which the ad-
ministration of justice has to deal is the determination of the inetital
responsibility of a person accused of an alleged criminal act. The
investigation of the mental state and the determination of mental
742 OSCAR T. SCHULTZ
abnormality is the work of the skilled psychiatrist. In some locali-

ties provision has been made for making psychiatric examination
and opinion available to the agencies of justice. In general, however,
this important branch of medical knowledge is applied through paid
experts working under a system that will receive mention shortly.
(3) The third line of application of medicine is in the evalua-
tion of clues and circumstantial evidence, and in the apprehension
and identification of suspected criminals and important witnesses.
This important field of police science, which is but poorly developed
in this country, must make use not only of medical science, but of
many other pure and applied sciences and technical arts.
Expert Testimony and the Hypothetical Question

Before inquiring into the actual use made of medical science by
the agencies of justice, it may be well to discuss briefly the method of
presenting medical facts and opinions, although most members of the
legal profession are familiar with this aspect of the subject. Maguire 5
has pointed out that there are three main methods by which facts,
or opinions based upon facts, that are beyond the ken and experi-
ence of the average layman may be presented to courts. The first
attaches to the tribunal an expert or corps of experts as an integral
part of the tribunal. This is theoretically an ideal procedure, but
objections to its practical application will occur to every one. This
method is not in use in the United States.
A second method of procedure is that under which the court
selects an expert or experts to act as friend or adviser of the court.
Like the first method, it has the great advantage that the expert
opinion is nonpartisan and unbiased. Like the first, it also has the
disadvantage that the judge on the bench, however learned he may be
in matters of the law, may have difficulty in determining actual ex-
pertness in technical or scientific fields other than his own.
The right of a trial court to select its own experts seems to be
an inherent one under the common law, but upon this point there
appears to be some difference of opinion. Thus Maguire 6 has said,
"The appointment of disinterested experts as advisers to the court
seems unworkable where juries are finally respofisible for solution
of factual questions, nor is this way of acquiring information beyond
reproach even when the judge handles facts as well as law." Wood-
5Maguire, John M.: Expert Testimony. Encyclopaedia of the Social Sci-
ences. Vol. 6, p. 13. The Macmillan Co., New York, N. Y., 1931.
6
Maguire, John M. Loc. cit.
ward," on the other hand, has written "The weight of legal opinion
is, I believe, to the effect that the judge has the right to call in ex-
pert witnesses on his own account and of his own selection, if he has
the means of doing so. The trouble is that some courts have not the
means, and others are timid about exercising their rights."
While the weight of legal opinion may be that the court has the
right to appoint its own experts, this right seems to be questioned
from time to time and to form the basis of appeal to a higher court.
In 19208 and again in 1930, 9 the Ohio Supreme Court upheld the
right of a lower court to select its own medical experts in personal
injury cases. In Alcorn v. Cincinnati Traction Company,' the same
high court affirmed the right of the lower court to appoint its own
accountant in a suit involving an accounting for taxes under a public
utility franchise. These were civil actions in which the appeal ques-
tioned the trial court's inherent right under the common law to name
its own experts.
In some states the right of the lower court to call its own ex-
perts in criminal actions has been enacted into statute law. Such
statutes do not in any way interfere with the right of either defense
or prosecution to place on the stand as many experts of its own
choosing as either side may desire. In 1910 the Supreme Court of
Michigan11 declared unconstitutional a statute providing for judicially
appointed experts in criminal homicide cases. The higher court held
that it was not a proper function of the court to select witness and
that the testimony of the official expert of the court would receive
undue credit. The Supreme Court of North Carolina 2 in 1916 sus-
tained a trial judge who appointed an expert in a murder trial. In
1930 the Supreme Court of Wisconsin's upheld a statute similar to
the one previously declared unconstitutional in Michigan.
It is not necessary for the purpose of this discussion to attempt
to seek out every court decision that may have a bearing upon the
right of a court to appoint disinterested experts as advisers to the
court. The purpose of the references cited has been merely to indicate
7Woodward, William C.: Director, Bureau of Legal Medicine and Legis-
lation, American Medical Association, Chicago: Communication to Dr. Ludvig
Hektoen, Chairman, Committee on Medicolegal Problems, National Research
Council. Jan. 30, 1932.
sFeldcamp v; Cincinnati Traction Company, 20 Ohio Law Rep., p. 316.
9S. S. Kresge Company v. Trester, 123 0. S. 383; 175 N. E. 611.
10Alcorn v. Cincinnati Traction Company, 22 Ohio Law Rep. 319; 25 'N.
P. (x. s.) 523.
"People v. Dickerson, 164 Mich. 148.
'12State v. Home, 171 N. C. 787.
aJessnerv. State, 231 N. W. 634.
that this right has been made the basis of appeal and that the right
appears to be upheld in most jurisdictions. Granted that the court has
the right to appoint an expert as adviser to the court, the objections
to this procedure are that, as Woodward has said, the court may
not have the means to avail itself of its right and that nonpartisan
advice of the proper degree of expertness may not be available under
present conditions.
The third method of presenting expert opinion has been termed
by Maguire14 the "contentious" or "combative" method. Although
these words are used seriously and without quotation marks in the
original, they fitly express the chief defects of this system, which is
the one in common use in this country. The experts are retained by
one side or the other. The fact that expert medical testimony is to
be used by one side usually results in the employment of experts on
the other side to combat the testimony of the opposing side. Since
the experts of one side or the other of a legal controversy are par-
tisans of the side employing them, their testimony is open to the
suspicion of bias. Although the expert may try to be thoroughly
impartial, the restriction to which he is subjected by legal technicali-
ties and the knowledge that his testimony will be combated by the
opponents almost inevitably leads him to contend for the correctness
of his opinion. Sheer weight of numbers of experts often appears
to be relied upon to determine an issue.. The result is often a
"battle of experts" that is a credit neither to medicine nor law. In
every large city there are what might be termed "professional" med-
ical experts who are not held in very high esteem by their colleagues
of the medical profession or by the leaders of the bar.
The presentation of expert testimony under the system that pre-
vails in the United States is often hedged about with technicalities
of legal procedure that prove irksome to the intelligent physician who
honestly attempts to state an opinion in nonpartisan manner. When
a medical writer 5 sarcastically entitles the opening chapter of a book
upon the subject of expert testimony "Technicalities-and More of
Them" and begins that chapter with "Technicalities are the life of
trade-legal trade, at least. Which means that they may have noth-
ing in common with the old term, justice," lawyers may be inclined
to forgive him on the ground that he does not fully understand the
necessity for legal technicalities.
Of such technicalities the hypothetical question is theoretically
14Maguire, John M. Loc. cit.
15Williams, Edward H. The Doctor in Court. The Williams and Wilkins
Co. Baltimore, Md., 1930.
one of the most logical and scientific. It is the hypothetical question

that may prove most annoying to the medical witness and that has
come in for unflattering comment by physicians. Although a medical
writer1 has criticized what he terms the "absurdities" of the hypo-
thetical question, it is not to medical authors but to legal authorities
that one must turn for the use of such words as "obstructive and
nauseous," "thoroughly disgusted," and "cumbersome" in discussions
17
of the hypothetical question. It is Wigmore who wrote. "Its (re-
ferring to the hypothetical question) abuses have become so ob-
structive and nauseous that no remedy short of extirpation will suf-
8
fice." And it was Morgan who wrote, ". . . the misuse and
abuse of the hypothetical question by counsel, . . . has done
much to make court and jury, as well as the medical profession,
thoroughly disgusted with the whole matter!' And it was Maguire'
who wrote, "The so-called hypothetical question is only too often a
necessity and a very cumbersome one; it can rob an examination of
intelligibility if framed without the firm mental grasp essential to
terse description of decisive factors." The reform of procedural
technic is a matter for the attention of the legal profession. But a
more thorough and impartial application of medical science to the
needs of law should be the concern of everyone interested in a better
administration of criminal justice.
The Office of Coroner
An inquiry into the manner in which medicine is applied to

justice under existing conditions should probably begin with con-
sideration of the office of coroner. The use of medical science by
this office is or should be a, matter of routine in its every day duties.
This is recognized by the requirement of some jurisdictions that the
coroner be a physician and in others by the attachment to the coroner's
office of one or more coroner's physicians, or autopsy surgeons, or
pathologists. The office is an almost universal one in the American
system of county government. Even in those jurisdictions where the
IGWhite, William A. Insanity and the Criminal Law. The Macmillan Co.,
New York, N. Y., 1923.
1
7Wigmore, John H.: A Treatise on the Anglo-American System of Evi-
dence in Trials at Common Law. Sec. 686. 2nd Ed. Little, Brown & Co.,
Boston, Mass., 1923.
18
Morgan, E. M.: Medical Testimony. Supplement to The Coroner and
the Medical Examiner, by Oscar T. Schultz and E. M. Morgan. Bulletin 64,
National Research Council. Washington, D. C., 1928.
19Maguire, John M. Loc. cit.
OSCAR T. SCHULTZ
office does not exist under its usual title, its duties remain to be per-
formed and are constantly called into action.
The origin and early history of the coroner's office and the
transplantation of the English office of rural county coroner to
America have been discussed elsewhere. The ancient and honorable
past of the office is interesting, but veneration for the things of
antiquity should not blind us to the fact that contemporary civiliza-
tion, and especially the congestion of large populations into urban
and suburban areas, have introduced factors that were unknown when
the office was established in our original colonies. The duties of the
office have increased, they have assumed a different character, and
they, as well as the startling advances in medicine during the past
century, demand an exceptionally high type of medical service.
Concerning the character of the duties actually performed by
the office of coroner in any populous jurisdiction, neither layman nor
lawyer nor doctor seems to have any very clear conception. Every-
one will be quick to admit the necessity for some impartial and gov-
ernmental agency for the investigation of deaths due to criminal
homicide. But such deaths are a minimal, and in actual numbers an
insignificant fraction of the cases actually investigated by the coroner's
office. The lawyer, the doctor, and the criminologist will have no
difficulty in assigning to the coroner the investigations of deaths pre-
sumably due to suicide or abortion, because the dividing line between
such deaths and those due to criminal homicide may need to be
determined by official investigation. The lawyer will add deaths due
to other forms of violence, namely casualty, since there may enter
into such deaths questions of negligence or criminal responsibility.
The statutes of all the states quite universally assign to the coroner's
office the investigation of all deaths due to the vaiious forms of
violence noted, but the statutes of a number of states sharply limit
the extent of the investigation that the coroner may make in the
various kinds of violent deaths.
Does the investigation of violent deaths constitute the sum total
of the activities of the coroner's office? Every physician knows that
it does not. He comes in contact with many deaths, to which others
than the physician give little thought, that require action by someone
other than himself. The authority to furnish a certificate of death,
which is a prerequisite to disposal of the body, is limited to legally
qualified practitioners of medicine. If death is sudden, or if the
person, having been ill for a longer time, has not been seen profes-
sionally by a physician, and the latter finds the patient dead or dying
upon arrival, the physician is not in position to furnish a legal cer-

tificate of death. The responsibility for certifying the cause of death
must be assumed by some agency of government. That agency is
usually the coroner's office. In some jurisdictions, if the death is
not presumably due to violence, the local registrar of vital statistics
may assume the responsibility of issuing the death certificate. But
the vital statistics office is an office of record, and has neither the
facilities nor the personnel to determine a cause of death except by
guess. Unfortunately the authority of the coroner in determining
the cause of death in such cases is usually also so limited that he too
can do little more than guess at the cause of death. In spite of the
poor definition of authority to determine the cause of death in such
cases, non-violent deaths make up half or more than half of the cases
referred to coroners for investigation and certification.
Many 'physicians would go further and would like to refer to
the coroner's office deaths in which the physician has not been able
to make an antemorten diagnosis, although he has been in attendance
before death. The investigation of the cause of death in such cases
is not a proper duty of the coroner. Society has not yet advanced
to the stage of working with vital statistics in which causes of death
are established or confirmed by scientific postmortem examination.
And many physicians have not yet reached the stage of wishing to
have their antemortem diagnoses confirmed or disproved by such
examination. We are still too concerned with the fact of death
of a relative, to wish to have an accurate health record of our fore-
bears or to leave such a record to our descendants. Until that time
comes the coroner's office is not an agency for establishing the cause
of death, if a physician has been in attendance and if there have been
no circumstances to lead him to suspect foul play.
The accompanying table, which is taken from the complete re-
port upon which this article is based, gives for three coroner's
offices and for three medical examiner's offices the total deaths in
the jurisdiction, the number and percentage of those deaths referred
to the coroner or medical examiner, and the distribution of the re-
ferred deaths in various categories. The coroner's office of Cook
County, Illinois, will be left out of consideration for the time being,
because of the unusual distribution of its statistics.
In the remaining offices of coroner and medical examiner, it will
be noted that from 12.0 to 20.9 per cent of all the deaths that bc-
curred in the jurisdictions were referred to the governmental agency
of the coroner or medical examiner for investigation. The average
.-. 'o c ,-. 0
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was 17.7 percent, surely a figure large enough to indicate the im-
portance of these agencies in the investigation of causes of death.
Deaths supposedly due to criminal homicide constituted only 1.6 to
6.5 per cent of all deaths investigated, with an average of 3.4 per cent.
Numerically, the homicidal deaths make up a very small part of the
work of the coroner or medical examiner; criminologically, their im-
portance is out of all proportion to their number. Suicidal deaths
varied from 5.4 to 9.5 per cent, with an average of 81 per cent.
Deaths due to casualty were 30.3 to 40.7 per cent, and averaged 34.7
per cent. All of these forms of violent death combined averaged
46.0 per cent for the five jurisdictions and varied from 39,6 to 56.7
per cent. Deaths due to abortion, which are listed separately in the
statistics of the offices, may be disregarded since they averaged less
than 1.0 per cent.
That the investigation of violent deaths is not the main function
of the office of coroner is apparent from the figures for deaths that
were ascribed' upon investigation to natural causes. These varied
from 42.5 per-cent to 59A per cent and averaged 50.4 per cent. This
group of deaths investigated by the coroner or medical examiner
made up almost 10.0 per cent of all the deaths in the various com-
munities.,
Study of the statistics of other coroner's offices will reveal much
the same distribution of work as is evident in the tabulation here-
with presented. The unique character of the figures for Cook County,
Illinois, is due to purely local factors. The state's attorney's office
of the county, acting as legal adviser to the coroner, some three or
four years ago ruled that the coroner had jurisdiction only in deaths
supposedly due to violence, and that deaths due to unknown but
presumably not violent causes must be referred to the registrar of
vital statistics. This conflict of authority of the two offices has been
removed by a recent act of the legislature. It may be of some
interest to the citizens of Cook County to know that at the time the
figures given herewith were prepared the county had achieved the
unenviable position of leading the entire country in the number of
death certificates listed as unsatisfactory or not acceptable by the
division of vital statistics of the federal census bureau.
The character of the work of the coroner's office being such as
the foregoing figures have shown it to be, what is its quality? The
coroner's office has been the subject of impartial study in a number
of localities. Here there need be mentioned only Cleveland; New
York City just prior to the change to the medical examiner system;
Chicago, San Francisco, and New Orleans in an earlier 2 survey made

by the committee on medicolegal problems of the National Research
Council; and Chicago, Philadelphia, and Cincinnati in the present
study. All of these investigations, as well as others made elsewhere,
have been unanimous in the conclusion that the average coroner's
office does poorly work that is of great importance to society. Every
lawyer who has been present at a coroner's inquest knows what a
futile proceeding this can be. Many a prosecutor knows how diffi-
cult has been the preparation of a case after the coroner's inquest
has finished its work. It would probably take a trained pathologist
to determine how far the medical work of the average coroner's
office falls short of the scientific accuracy that it should have. If the
coroner's physician is competent, he is usually hampered by inade-
quate facilities.
The reasons for the failure of the coroner's office are not far-
to seek. Leaving out of consideration entirely the fitness or ability
of the individual coroner, the chief causes of poor functioning are
the political, politically obscure, and elective character of the office;
the short tenure of office; the lack of qualifications required of the
coroner in most jurisdictions; the poor definition of the authority of
the coroner in the statutes relating to the office; and the failure of
society to realize the importance of the duties of the office. The
coroner is usually a party politician. The obscurity of the office,
with its relative paucity in political spoils, does not usually entice
even the more robust type of party politician. The short tenure of
office is not conducive to the development of the technical legal
and medical staff that the office should have, if it is properly to carry
out its functions. If the coroner happens to be a physician or is
required to be a physician, he may manifest interest in the medical
duties of the office, but he is usually not trained in the one branch
of medicine, namely pathology, which is the foundation of medicolegal
work. He is apt to be merely the political type of doctor, who is no
great improvement over the layman type of politician. In most
states, the statutes relating to the office are the original ones that
established the office. They have not been revised to meet the
changed conditions of contemporary life. The body of society can-
not be expected to have an appreciation of the importance of the
duties of the office until lawyers, physicians, students of government
20Schultz, Oscar T., and Morgan, E. M. The Coroner and the Medical
Examiner. Bulletin 64, National Research Council, Washington, D. C., 1928.
and other professionals have become conversant with the functions of

the office and with the way in which they should be performed.
Drastic reform of the office of coroner is necessary if the office
is to become the medicolegal agency that it should be. Those who
have given most thought to the matter believe that the only real
reform is the radical step of abolition of the office of coroner. If
the office is abolished, it is necessary to transfer the important magis-
terial and legal functions of the coroner to the prosecutor's office,
which is much better qualified to perform them. Many of the an-
tiquated statutes relating to the coroner impose upon this official a
number of extraneous minor duties, that are a relic of the old days
when the coroner was a sort of under sheriff and extra bailiff; if
there is still any need of these duties, they must be transferred to
other already existing agencies. The important medical duties are
vested in an official known as a medical examiner. The latter is an
appointive official, who serves either under a long term appointment
and is usually repeatedly reappointed, or continuously and indefinitely
under civil service. In a subsequent section the manner of function-
ing of the medical examiner system wil be briefly discussed.
The Ofice of Medical Examiner

Massachusetts, the second oldest of the original colonies, was the
first of the states that later made up the federal union to decide that
the coroner system failed adequately to perform the duties imposed
upon it. By an act of the legislature, the coroner's office was abolished
throughout the state in 1877. Two salaried appointive medical ex-
aminers were provided for the county of Suffolk, in which Boston
is situated. For the rest of the state the law provided that the
county commissioners might name as many medical examiners, work-
ing under a fee system, as might be necessary.
At the time that the Massachusetts medical examiner act became
effective, its provisions were such as best met then existing conditions.
In the light of later developments, improvements that might be made
in the Massachusetts law have become apparent. The single medical
examiner's office of New York City handles well a volume of work
much greater than that of the two medical examiners of Suffolk
County. Automobile transportation and improved highways would
make it possible to consolidate the large number of outlying medical
examiner districts into a much smaller number, served perhaps 'by
part-time or full-time, appointive, salaried examiners. Such a redis-
tricting should disregard county lines. A properly supported single
OSCAR T. SCHULTZ
examiner's office in Boston could become the scientific medicolegal

center to which the problems of the outlying medical examiners could
be submitted for scientific solution.
In due time other New England states followed the lead of
Massachusetts and replaced the coroner by the medical examiner,
Maine being the last of this group of states to make the change. In
most of these other jurisdictions, the medical examiner laws differ in
some respects from those of Massachusetts. The differences are not
always to the advantage of better functioning. In Connecticut the
office of coroner is retained. The coroner, who must be a qualified
lawyer, is appointed by the governor and functions chiefly in the
holding of inquests. The coroner appoints the medical examiner. In
Rhode Island, coroners appointed by the town councils still function
in the holding of inquests if the medical examiner or attorney-gen-
eral deems an inquest necessary. Medical examiners are appointed
by the governor for a period of six years. In New Hampshire the
medical examiner is known as a medical referee. Maine abolished
the office of coroner in 1929. In Vermont, there are neither coroners
nor medical examiners. Justices of the peace or municipal or city
judges may hold inquests.
The legislature of the state of New York abolished the office of
coroner in New York City in 1915. In 1918 a single medical ex-
aminer, appointed under civil service, took over the duties of the
several coroners of the jurisdictions that entered into the formation
of the greater city. The original chief medical examiner has served
continuously since 1918.
In 1927, the legislature of New Jersey made the adoption of the
medical examiner system optional with the two counties of the first
class. The change was immediately made in Essex County, in which
Newark is situated. The physician, who had served for two and a
half years as county physician and coroner before this change be-
came effective, has served continuously as medical examiner since the
change was made. The New Jersey law, which is quoted by Wein-
mann, 21 is the best statute thus far drawn and may serve as a model
to other jurisdictions.
The table that is included in this article presents the statistical
summaries for the medical examiner offices of New York City, Suf-
folk County, Massachusetts, and Essex County, New Jersey. These
three offices investigated from 12.0 to 19.7 per cent of all the deaths
2lWeinmann, George H.: A Compendium of the Statute Law of Coroners
and Medical Examiners in the United States. Bulletin 83, National Research
Council, Washington, D. C., 1931. P. 218.
that occurred in their respective jurisdictions, the average being 17.0

per cent. Necropsies, which reflect the scientific spirit and the med-
icolegal value of the agency if properly performed, were done in
19.2 to 48.4 per cent of all the deaths investigated; the average was
29.2 per cent. Not only do these agencies do a larger volume of
work relative to the population of their jurisdictions than do coroners'
offices, but their work is much better done as measured by the criteria
that apply to scientific work. The medical examiners and their as-
sistant medical examiners have served continuously for relatively long
periods of 'years. Well trained in the beginning, their training has
become of increasing value to the public that they serve, through
added experience in medicolegal work. The cooperative relations
between these medical examiners and other agencies of justice are
much closer than obtain in most coroner jurisdictions. If any
criticism is to be made against these three medical examiner offices,
it is that lack of support and failure to understand the importance
to society of the work done do not enable the medical examiner to
employ all the necessary medical sciences to the fullest extent, and
do not permit these agencies to become the centers for the dissemina-
tion of medico-legal knowledge that they might become.
Psychiatric Court Service

The office of coroner exists. When the need arises, it functions,
as a matter of routine and as best it may, with the facilities pro-
vided and under the laws governing it. Its mere existence is a recog-
nition of the need for the application of one subdivision of medicine
in the administration of justice. In the application of another division
of medicine, namely psychiatry, the need is not so well recognized.
In most states, there is no routine procedure for the application of
this branch of medicine. Yet the frequency with which psychiatry
is called into play in trials at law is evidence of the important place
that psychiatry should have in the administration of justice.
The advances and changes of opinion that have occurred in this
field of medicine, as they relate to our knowledge of mental ab-
normality and human behavior, might be almost compared with those
that followed the introduction of antiseptic procedures into surgery.
Law, as a body of precepts for the guidance and control of society,
appears to have remained unaware of the changes that have occurred
in psychiatric viewpoint. Perhaps this is because many opinions upon
psychiatric matters are still only matters of opinion and are not sus-
ceptible of absolute objective proof. This is all the more reason why
OSCAR T. SCHULTZ
the subject matter of psychiatry, when called in the scope of law,

should be presented impartially by an agency that is a part of gov-
ernment, as which its services would be available to the other parts
of government that have to do with the administration of justice.
What has been done in the way of developing agencies for the im-
partial presentation of psychiatric opinion is an indication that much
improvement is possible over the usual method of presenting psychi-
atric opinion by partisan medical expert testimony. As types of such
agencies the system of psychiatric examination of prisoners in Massa-
chusetts, the Medical Service of the Supreme Bench of Baltimore
County, and the Behavior Clinic of the Criminal Court of Cook
County may be presented.
The Massachusetts System

Under a law, which in its original form was enacted by the
commonwealth of Massachusetts in 1849, any person under com-
plaint or indictment may, at the time of sentence, or at any time
prior thereto, be committed to a state hospital as insane, or for
observation as to his mental condition. In order to obviate the neces-
sity of an observation commitment in all doubtful cases, a law was
passed in 1918 which authorizes any court to require the state De-
partment of Mental Diseases to assign a member of the staff of a
state hospital to make an examination of a person coming before
the court. In the foregoing laws, the obtaining of an opinion from
a psychiatrist of a state hospital is discretionary with the court. These
laws, however, provided a procedure by which expert testimony could
be obtained without cost to the court. A law passed in 1921 makes
psychiatric examination mandatory in certain cases. Clerks of court
must report to the Department of Mental Diseases all persons ac-
cused of capital crime, and all persons indicted or bound over for a
felony who have been previously indicted for any other offense more
than once. A still further advance was made by Massachusetts in
1924, by the passage of an act calling for the psychiatric examina-
tion, by the Department of Mental Diseases, of convicted prisoners
serving a sentence of more than thirty days in a house of correction
or jail, and of all prisoners in such institutions known to have served
a previous sentence.
The law of 1921 placed upon the clerk of the court the responsi-
bility of notifying the Department of Mental Diseases that there was
in the jurisdiction of the court a prisoner subject to psychiatric ex-
amination. The clerk frequently had no information relative to previ-
ous conviction or indictment of prisoners. It became obvious that

many prisoners indicted for felonies other than capital offenses were
not being reported for psychiatric examination. This defect in the
law was remedied by an amendment that became effective in 1927.
This requires the probation officer, who has a record of previous
indictments or convictions, to transmit his information to the clerk
of court.
Medical Service of .the Supreme Bench of Baltimore

In April, 1920, the general assembly of Maryland passed an act
creating the Medical Service of the Supreme Bench of Baltimore.
This act grew out of the volunteer service that had been rendered
to the local courts since 1917 by Dr. John R. Oliver, a psychiatrist.
The creation of this medical service was a recognition of the im-
portance of psychiatry in the administration of justice.
The primary function of the medical service is to make psy-
chiatric examinations of those in the jurisdiction of the Supreme
Bench and its agencies, the latter being the probation department
and the prisoners' aid association. Examinations are made also upon
the request of the state's attorney's office, of the various social service
agencies of Baltimore, and of the Board of Mental Hygiene of
Maryland. Examinations are also made of prisoners in the city
21 ,
jail. a
Behavior Clinic of the Criminal Court of Cook County

In April, 1931, the board of county commissioners of Cook
County, Illinois, established the Behavior Clinic of the Criminal Court
of Cook County. This agency for the application of psychiatry to
law grew out of the activities of members of the local bench who
realized the important service that psychiatry may render in the ad-
ministration of justice. The clinic was organized with the advice of
a committee of the Institute of Medicine of Chicago.
According to a statement of its director,2 2 "The clinic was or-
ganized to give advisory psychiatric service to the judges of the
Criminal Court. It was originally proposed to limit the work to
examination of persons who had been convicted, but not sentenced,
and who were-being considered for probation. As a matter of fact,
however, many of the examinations by the clinic have taken place
2-aSee Overholser Article in Sept.-Oct., 1932, JOURNAL OF CRIMINAL LAW.
22Hoffman, Dr. Harry R., Director, Behavior Clinic of the Criminal Court
of Cook County: Personal communication, Apr. 4, 1932.
before conviction and in some few cases even before indictment.

A psychiatric examination is available to the judges of the
Criminal Court. However, in some few instances judges of the
municipal court have referred cases for examination when the patient
was .being incarcerated in the county jail. A psychiatric examina-
tion may be available for any prisoner that the judge sees fit to have
examined. It is made upon the request of the court in the case of
specified prisoners. The results of the examination are sent at the
same time to the court, the prosecution and the defense."
From the director's report of the first six months' work of the
clinic, the following statement is taken: "The clinic is purely ad-
visory and is disinterested in the legal aspect of the case. It con-
cerns itself with the individual-his mental, physical and emotional
make-up--his environment, and the interaction of that individual
and that environment. In order to reach an evaluation of his make-
up the patient is given a four-fold type of examination: (1) A
thorough physical examination by the resident physician with special
attention to constitutional and neurological defects. (2) A psychp-
logical examination by the psychologist to ascertain his mental ability
and to determine what can be expected of him in the terms of social
and industrial adjustment. (3) A comprehensive. history of the
patient from relatives, friends, other agencies and individuals who
have had contact with him, to learn all the pertinent facts concern-
ing his family background, early life history, his experiences, and a
detailed study of his environment, in an effort to arrive at a more
thorough understanding of the patient in view of his background.
(4) A psychiatric examination by the psychiatrist: The psychiatrist
has two functions: to evaluate the personality manifestations of the
patient, and to coordinate all the findings and from them to make
a report to the judge for use in determining the disposition of the
accused."
The Massachusetts system of psychiatric examination of pris-
oners, the Medical Service of the Supreme Bench of" Baltimore, and
the Behavior Clinic of the Criminal Court of Cook County have been
described as types of agencies that furnish imparfial psychiatric opin-
ion to the courts. It is not pretended that these are the only agencies
of their kind. The Psychiatric Clinic of the Court o'fGeneral Ses-
sions of New York City was established in January, 1932. Other
similar agencies exist in other isolated localities. It would be difficult
to say just what there is in the United States that might be organ-
ized into psychiatric service for courts in general. A committee of
the American Bar Association has had this matter under investiga-
tion for two years. Its report should yield valuable information.
In the future organization of psychiatric court service, the es-
sential similarities and differences in the types of agencies described
should be kept in mind, in order that the type of organization best
fitted to the needs of a given jurisdiction may be devised. The agen-
cies described have done much to bring about a more intelligent dis-
position nf offenders. They have resulted in a saving of money. In
Massachusetts and Baltimore, expensive trials with their two groups
of opposing experts have -become almost unknown. The criminal
homicide trial that is a "battle" between two groups of contending
experts is a newspaper sensation and fills the front pages for days;
the much larger number of instances, in which the expense of trial
is saved or reduced through nonpartisan service, do not make sensa-
tional reading and do not find their way into the papers. The most
important similarity in the agencies described in their impartiality.
That this feature is recognized is evident in the frequency with which
the defense seeks the service of these agencies.
The service of the Massachusetts system is available to courts
throughout the state; the other two agencies function only in local
jurisdictions. In Massachusetts, the psychiatric examination of pris-
oners is a matter of routine. No question of the prisoner's sanity is
raised. The mere fact that a prisoner is accused of an offense of a
certain grade is enough to place the machinery in action. In Balti-
more and in Cook County, the examination is initiated by the request
of the court. The Massachusetts system and the Medical Service
of the Supreme Bench of Baltimore are permanent agencies. They
were established by legislative enactment, and can be discontinued
only through further legislative action. The Behavior Clinic of the
Criminal Court of Cook County is not necessarily permanent. It was
established by the action of a local governmental body, and may be
discontinued through action of that body.
Any discussion of the application of non-partisan psychiatry in
the administration of justice must fall far short of its purpose if it
does not make the lawyer and the social worker realize that the sci-
entific student of modern psychiatry, as opposed to the "professional"
partisan expert psychiatric witness, is not especially concerned in the
legal guilt or innocence of an accused. He believes that the participa-
tion of the accused in the alleged crime and his relation to the latter
should be legally established. But he furthermore believes that the
disposition to be made of the offender should be influenced by his
mental state, as determined by careful and thorough examination.

The student of the law must determine to what degree such a con-
ception of the relation of psychiatry to the administration of jus-
tice can be fitted into our jury system. There can be little question
hut that this concept would result in a greater safeguarding of so-
ciety than does a procedure that establishes the relation of an accused
to an offense but frees him upon the grounds of temporary or im-
pulsive or emotional insanity.
Police Science
In this country the scientific policeman exists chiefly in the pages

of imaginative fiction. If he attempts or pretends to make use of
scientific methods in real life, he is apt to become an object of de-
rision whose prototype is the correspondence school detective of the
vaudeville stage and the revue skit. Most metropolitan policedepart-
ments have bureaus of identification and modus operandi records of
known criminals. Some are able to command the services of experts
in ballistics in investigations involving firearms. The police in the
larger cities may know those upon whom they may call for advice
upon handwriting and technical or manufacturing processes. But
any systematic application of medical and other sciences for the de-
tection and evaluation of clues or for the apprehension of suspects
is an unknown feature ofevery-day police practice. Laboratories of
police science, like those of continental Europe, Which are capable
of making use of every available scientific fact and*method whenever
necessary, are unknown in the United States.
The nearest approach to a laboratory of police science in this
country is the Scientific Crime Detection Laboratory of Chicago.
Organized through the benefactions of private citizens and supported
by and affiliated with a privately endowed university, it is not a part
of the governmental machinery, although it furnishes its services
gratis to the police agencies of Chicago and Cook County. It is an
object lesson of what government should do but fails to do, and will
probably continue to fail to do so long as the American system of
government is dominated by partisan politics. Former Commissioner
of Police Whalen, of New York City, outlined a comprehensive police
college, which included a school for detectives and a laboratory of
police science. But the scheme is still apparently in the outline stage
and still mostly on paper.
Medicolegal Institutes of Continental Europe

In the United States, with the exception of a few localities that
employ the medical examiner system, the application of medical sci-
ence to the needs of justice occurs through the poorly functioning
office of coroner in the immediate and fundamental investigation
involving problems of death, injury and disease. This office is part
of the governmental machinery for the administration of criminal
justice, but it acts more or less independently and its activities are
not well correlated with those of other elements of the machinery
of judicial administration. Matters relating to the behavior and the
mental state and responsibility of the individual are presented through
the testimony of contending, partisan experts, who are not a part of
any governmental agency, except in the comparatively few localities
where a psychiatric court service has been developed. As a result
of the American method of utilizing, or failing to utilize, medical
science in the administration of justice, forensic medicine has made
little headway in this country, either as a science of practical applica-
tion or as a university discipline.
The status of legal medicine in the United States may be con-
trasted with that of this branch of medicine in Europe. In conti-
nental Europe, the utilization of medical and other science in the ad-
ministration of justice occurs through the organization known as an
institute of legal medicine. Such institutes are an integral part of
the ministry of justice. Since the state also controls higher educa-
tion, the medicolegal institutes are also part of the university system.
The members of the staff have university rank, and the permanent
tenure of office and the social position that go with such rank in
Europe. The medical part of the organization functions not only in
the examination of the dead victims of crime for the purpose of de-
termining exactly the cause of death in every instance, but also in
lesser degrees of injury to the person, and in the psychiatric examina-
tion. of accused and of witnesses.
The director of the medicolegal institute, who generally has also
the university title of professor of legal medicine, is a man of renowfi
in the field of medical science. Usually his specialized training .has
been in pathology, but through the institute's staff organization, whose
members also have university rank, he is able to bring to bear upon
the investigation of any given case those other fundamental medical
sciences that are so essential for the accurate study of injury, dis-
ease and death. The organization of the medicolegal institute there-
fore has ample equipment and personnel for bacteriology, immunology,
OSCAR T. SCHULTZ
chemistry, toxicology, and general microscopy, as well as pathologic

anatomy and pathologic histology, any one or all of which may be
called into play in any medicolegal inquiry. The academic associa-
tion makes it possible to obtain aid from other university departments
in disciplines not usually or frequently required in the investigation
of cases brought to the attention of the institute. In addition to those
medical sciences that are so necessary in the investigation of injury
and death, the organization of the medicolegal institute makes pro-
vision also for the psychiatric examination and study frequently of
such importance in medicolegal cases. The division of psychiatry and
abnormal psychology is one of ever growing importance in foreign
medicolegal institutes. Criminal anthropology, anthropometry, and
methods of human identification are not neglected.
It must be evident that the institute of legal medicine, when de-
veloped to its highest possibilities, is an active institution that requires
expert direction and administration, a highly-trained personnel, and
equipment adequate for the work in hand. It is usually housed in
quarters whose size and character bespeak the importance and dignity
of legal medicine.
The institute has a two-fold function. As an agency of govern-
ment, it makes application of medical science to the needs of law
and justice. It does this in an impartial manner, through the highly
trained experts of its staff, and does it for the court rather than for
either party to a legal action. As a university agency, it engages
in research and investigation in the field of legal medicine. The pub-
lished work of the European medicolegal institutes is made available
to the world at large through three journals of legal medicine in Ger-
man, three in Italian, two in French, and one in Spanish. As a uni-
versity agency, it gives to undergraduate students of medicine such
fundamental knowledge of legal medicine as it is desirable that every
physician should have, and it trains graduate students for careers as
experts in legal medicine.
Functioning either as a part of the medicolegal institute or as a
separate organization within the ministry of justice, is the laboratory
of police science. In these laboratories, scientific facts and methods
are applied for the purpose of detecting crime, of evaluating and
preserving circumstantial evidence, and of identifying and appre-
hending suspects and important witnesses. The police laboratory
utilizes not only the fundamental medical sciences, but also all of the
natural sciences that can in any way aid in the solution of the prob-
lems presented by crime.
British Medicolegal Institutes

Great Britain presents an interesting transition from the highly
specialized, governmental university institutes of the continent to the
condition that prevails in the United States. The state of affairs, as
it relates to legal medicine in Great Britain, is interesting because
the empire presents within its own confines the two extremes, and
because these two extremes in the development of legal medicine are
dependent upon two different systems of legal procedure.
In England, which uses the coroner system, legal medicine oc-
cupies the same nondescript position that it has in this country. What
is known as medical jurisprudence, although a requirement for medical
licensure, is taught by part-time instructors of junior rank, and med-
icolegal institutes do not exist.
In Scotland, on the other hand, the French system of criminal
legal procedure prevails. Deaths due to suspected violence or to un-
known cause are investigated in private by a magisterial official, the
procurator-fiscal of the district. If medical examination is necessary,
such examination is made by a properly qualified physician appointed
to the case, or, in more populous centers, by a medicolegal examiner
serving permanently under appointment by the crown. This method
of procedure, as compared with the coroner system, has resulted in
a much higher development of forensic medicine in Scotland than in
England. A professorship of legal medicine was established in the
University of Edinburgh in 1807, at the University of Glasgow in
1839, and at Aberdeen University in 1857. From their very inception
these professorships have been on a full-time basis and have been
held by men eminent in the field of legal medicine. The departments
and institutes of legal medicine of the Scottish universities have at-
tained an eminence equal to that of the institutes of the continent.
Organizationof Institutes of Legal Medicine in the United States

-The need for the development of legal medicine idl the United
States is patent and the possibilities are great. Development would
be best furthered by the establishment of medicolegal institutes sim-
ilar to those of Europe. The organization of such institutes, func-
tioning at the same time both as a part of the machinery of judicial
administration and as a university discipline, would certainly require
changes in governmental administration, would almost certainly 're-
quire enabling legislation, and would probably require changes in
methods of legal procedure.
It is not necessary, however, to await drastic changes in laws

that would permit the establishment of medicolegal institutes with
combined university and judicial administrative relationships. Great
improvement in the status of legal medicine in this country, with de-
cided advantage to the administration of justice, can be brought about
by coordination and correlation of existing medical knowledge. The
facts and methods of scientific medicine are as completely known in
this country as abroad. It remains only to make them available in the
administration of justice. That should be possible without any very
great changes in laws and methods of procedure. The development
that is possible in this country would not lead to complete, unified
agencies similar to the medicolegal institutes of Europe, but would
probably have to occur along two, and perhaps three, distinct lines.
These are, first, a more complete utilization of the fundamental medi-
cal sciences in the investigation of injury and death; second, the de-
velopment of a service that would make available to courts, in an
impartial manner, the best opinion relative to psychiatry and abnormal
psychology; and third, the application of scientific methods in police
work.
The more thorough application of medical science in the in-
vestigation of injury and death would occur through the office of
coroner or medical examiner. The medical examiner offices of New
York City, Suffolk County (Boston), Massachusetts, and Essex Coun-
ty (Newark), New Jersey, already do their work so well that it would
require only somewhat more liberal financial support, in order that
they might make daily use of the sciences of bacteriology, immunology,
toxicology, chemistry, pharmacology, and general microscopy in their
work. Under such conditions, the investigation of injury and death
would be as thorough and accurate as it is abroad. Modern trans-
portation and highways have overcome the handicaps of distance.
The medical examiner offices of Boston and Newark could readily
be amplified into agencies that would serve the entire state as well as
they serve their own communities. The volume of work of the chief
medical examiner of New York City is so great that a separate agency
would be necessary to serve the rest of the state.
In jurisdictions using the coroner system, the problem is more
difficult, but much could be done to further the work of judicial
administration by the establishment in each state of a centralized
medicolegal laboratory that would serve all the coroners of the state.
Full realization of the service that such a laboratory might render
would require reform of the coroner's office. The most thorough
reform would be the abolition of the coroner's office, and the sub-
division of the state into, relatively large examiner districts, each
in charge of a competent, nonpolitical medical examiner. The bound-
aries of examiner districts should disregard county limits and should
be determined by area, population, and transportation facilities. In
the past two decades government has learned the value of efficient
public health administration, sanitation and hygiene. Replacing the
elective coroner of a number of adjoining counties by a single dis-
trict medical examiner should bring about improvement in the admin-
istration of justice as great as that which has occurred in public
health administration.
Reform of the coroner's office to the extent of abolishing it en-
tirely appears to be something for a rather distant future to bring
about. In those states where the office is a constitutional one, con-
stitutional amendment would be necessary. In those states where
the office is not a constitutional one, it will also persist much longer
than it should, because it is obscure, because it receives little intelligent
thought or attention, because the importance of its duties is not rec-
'ognized, and because it is an elective office.- The very antiquity of
the office, to which are due some of its worst features, makes the
'office an object of veneration for some. I have in my files a letter
from a prominent attorney who favors the establishment of institutes
of legal medicine, but who opposes the abolition of the coroner's office
because "it is one of the oldest in our legal history."
If the office of coroner is to be retained, it should be modern-
ized. In most states the laws relating to the office were adopted at
the time of admission to statehood, and they have remained un-
changed in their essential features since that time. Those were the
days before trolley cars, automobiles, airplanes, electricity, home re-
frigeration, prohibition amendments, racketeering, and gang warfare
had *introduced many new hazards into life; and they were the days
before the condensation of population into large cities had compli-
cated the administration of government and the meting of justice.
Simply because our grandfathers lived in sparsely populated counties
of a few hundred inhabitants and had no very great need of coroners,
is no very good reason why counties with cities like Chicago or Phila-
delphia or New Orleans should continue to carry on with coroners
like those of our grandfathers' days. The duties and authority of
the coroner need to be brought down to date. If a state medicolegal
laboratory is to render the public service that it is capable of render-
OSCAR T. SCHULTZ
ing, the coroner system that is to use such a laboratory must have
the authority to use it and must know how to use it.
In those states where the state university dominates the educa-
tional system of the state and is an important element in the cultural
life of the citizens of the state, the centralized medicolegal laboratory
should be a part of the state university. In its university, the state
already has most of the facilities that would be required by a medico-
legal laboratory. Facilities already available and activities already
carried on need to be correlated, coordinated and developed in order
to make them available to the agencies of judicial administration.
Such a laboratory could also function as a laboratory of police sci-
ence, serving the police agencies of the state. Metropolitan police
departments would have to have their own bureaus of identification,
and should probably have their own laboratories of police science.
Psychiatric Court Service

In most jurisdictions the method of court procedure is so in-
fluenced by the contentious method of presenting expert testimony
that no other way may seem apparent. But the way has been pointed
out, and it needs only careful study to determine how that way may
be improved and may best be adapted to the needs of a particular
jurisdiction. The state-wide psychiatric examination of prisoners in
Massachusetts, the Medical Service of ,the Supreme Bench of Balti-
more, the Behavior Clinic of the Criminal Court of Cook County,
and the Psychiatric Clinic of the Court of General Sessions of New
York City have already been discussed as examples of agencies
through which psychiatry serves justice in an impartial manner.
The American Bar Association and the American Medical Asso-
ciation have officially placed themselves on record as favoring the
creation, in each state, of an agency like that here suggested. They
have applied to the proposed organization the name of criminologic
institute. The name is not so important as the service that the agency
should render.
Summary
The following summary is taken from Section VIII of the com-
plete report, Bulletin 87 of the National Research Coucil.
In the administration of criminal justice, certain aspects of medi-
cal science are of great importance and should receive more thorough
and constant application than they at present receive
Medical Science, Violent Death, and Nonfatal Violence

The determination of the cause of death, when a medicolegal
question is involved, is the work of the skilled pathologist. Those
whose duty it is to administer justice should be satisfied with nothing
less than the greatest accuracy obtainable. If the pathologist is to
do his work with the accuracy that should be required of him, he
must be in position to call to his aid, whenever necessary, the re-
sources of bacteriology, immunology, toxicology, chemistry, phar-
macology, and general microscopy.
No one person can be expected to be truly expert in all of these
highly technical lines, but the experienced pathologist should be able
to correlate and interpret for the court the information yielded by
these sciences.
In many cases of violence of a lesser degree than homicide, the
administration of justice should have the same scientific service at its
command.
Psychiatry and Crime
Determination of the mental responsibility of the accused and of
the reliability of important witnesses is the work of the skilled psy-
chiatrist. The opinion of the psychiatrist should be based upon care-
ful examination and study and should not be influenced -by the pay-
ment of a fee by either prosecution or defense.
Psychiatric opinion should therefore be unbiased and nonpartisan
and should be available to the administration of justice at any and
every stage of a criminal proceeding. Where it is available, such
nonpartisan service is frequently sought by the defense. A non-
partisan psychiatric service would not deny the right of defense or
prosecution to employ experts of their own selection.
Science and Crime Detection

The detection of crime and the apprehension of criminals may
at times require the application of pure and applied sciences in addi-
tion to the medical sciences.
Foreign Medicolegal Institutes and Judicial Administration

In most of the countries of Europe, in some of South America,
and in Egypt, the unification of the medical specialties for the needs
of justice occurs through highly efficient organizations or agencies
usually known as institutes of legal medicine. These have relations
to government, in the services that they render in the administration

of justice, and at the same time they have relations to the universi-
ties supported by the government, in that they are integral parts of
the university organization.
- In the United States there is as yet nothing even remotely com-
parable to the first-class medicolegal institutes of Europe, and there is
not, either in the universities or in the practical administration of
justice, any science of legal medicine in the broadest and truest sense.
The Office of Coroner or Medical Examiner as a Medicolegal Agency

Such use as is made of scientific medical procedures in the deter-
mination of causes of death occurs through the office of coroner or
the alternative office of medical examiner. It is in most instances
inadequate.
The use of scientific procedures by the coroner's office is inade-
quate because of the archaic character of the office, the failure to
modernize the laws relating to the office, and the political nature of
the office.
The office of medical examiner, which functions in a manner
vastly superior to that of the coroner's office, is hampered in its use of
scientific procedures by the failure of the public to realize the im-
portance to the public of the duties performed by the office, and by
the consequent failure to support the office financially in such a man-
ner as to permit it to use all the scientific aids that might be necessary.
Adaptation of the Foreign Medicolegal Institute to

American Conditions
The facts and methods of scientific medicine, that form the basis
of the work of foreign medicolegal institutes, are as well developed
in this country as they are abroad. Our backward state consists, not
in the lack of the necessary scientific knowledge, but in the failure so
to organize that knowledge as to make it fully useful in the adminis-
tration of justice.
Coordination of the facts and methods of the basic medical sci-
ences and of psychiatry and abnormal psychology might be brought
about in such manner as will make this important body of knowledge
practically useful to society in the administration of justice.
The more technical, basic laboratory sciences could be applied
through the office of medical examiner or coroner. The principles
of modern psychiatry and psychology could be applied through some
agency from which the agents of judicial administration might receive

unbiased and nonpartisan guidance.
Reform of the Office of Coroner

is necessary if this office is to perform in satisfactory manner its im-
portant function as the first agency to make application of medical
science in suspected violent deaths.
If the office of coroner is ever to make such use of science as it
should be required to use .in the public interest, drastic reform of
the office is necessary and the laws defining the duties and functions
of the office must be modernized to make the office fit modern con-
ditions. Sufficient information, based upon study of the functioning
of the office in different localities, is at hand to indicate that proper
functioning of the office, in matters entirely scientific in character, is
out of the question, so long as the coroner's office remains the obscure
political office that it is, and so long as it is required to operate under
the present statutes relating to it.
The organization of modern society and the complexity of the
problems of urban congestion of population require an agency more
efficient and more modern in its operation than an office administered
by a political official, who is, in essence, owing to the laws under
which he works, a combination of the country doctor of several gen-
erations ago and of the rural justice of the peace of the same period.
Proper reform of the office of coroner would lead to its complete
eradication and to the distribution of its duties among agencies better
qualified to perform those duties. Such agencies would include the
office of medical examiner for the medical duties. A mere change
in name from coroner to medical examiner, which has been proposed
in some quarters as a reform, would be a useless gesture, if the offi-
cial termed by legal fiat a medical examiner had to operate under the
laws that at present apply to the coroner.
If abolition of the coroner's office is not feasible, because the
office is a constitutional one and the state constitution cannot be readily
amended, or because of veneration for the things of antiquity, or
because of other reasons, the office could be modernized, first, by
making the coroner simply an elective administrative official, and by
creating for the office, as chief deputy coroner, a medical officer serv-
ing continuously under civil service, and by transferring the present
inquisitional duties of the office to the prosecutor's office or to so6e
other agency better qualified than is the coroner's office for the per-
formance of technical legal procedures. And secondly, the laws relat-
ing to the duties and authority of the office would have to be revised
in order that the duties and authority might be clearly and specifically
defined.
Adequate FinancialSupport Necessary for Scientific Work

But neither such a reformed coroner's office nor the alternative
office of medical examiner should be expected to perform its duties
in scientific manner unless the financial support of the office is such
as to enable it to use the necessary scientific procedures whenever
required in the interest of the public.
A budget that might theoretically be adequate for good scientific
performance of the medical duties of the office would be an item of
political extravagance, unless the medical duties are performed by a
trained official, it matters not whether he be medical examiner or
medical officer of the coroner, serving under civil service or long
time appointment.
Investigation of Nonviolent Deaths

The statistical table included in this report reveals that in the
jurisdictions studied, with the exception of Cook County, Illinois, from
12 to 21 per cent of all the deaths occurring in the jurisdiction are
referred to the coroner or medical examiner. Only 1.6 to 6.5 per
cent of these deaths are homicidal, and deaths due to all forms of
violence, including casualty, make up but 40 to 57 per cent of the
total. From 43 to 60 per cent of all the deaths referred to the coroner
or medical examiner result from natural causes. ,
Authority of Coroner in Nonviolent Deaths Not Clearly Defined

Although the coroner or medical examiner is called upon to as-
sume the responsibility for making out the death certificate in a group
of cases amounting approximately to from 7 to "10 per cent of all
the deaths in the jurisdiction, the functioning of the coroner in such
cases seems to be without very clear legal warrant in most states.
By a not too strict interpretation of the statutes he might be permitted
to view the bodies of those whose death is due to unknown causes
but not due to violence. But in practically every state the statutes
are so framed as to limit the coroner, in the use of "the only procedure
by which a cause of death may be accurately determined, namely, the
necropsy, to deaths due to violence. The laws relating to the medical
examiner define the duties and authority of this official much more
clearly.
Some agency of government is necessary for the investigation
of nonviolent deaths, when a licensed physician has not been in at-
tendance. Only through the careful scrutiny of such deaths can there
be any assurance that deaths due to unlawful means are not escaping
detection and that the vital statistics relating to death will not be
vitiated by a large factor of error.
That the registrar of vital statistics may authorize the issuance
of a death certificate in nonviolent deaths due to unknown causes is
no solution of the grave problem presented by such deaths. The vital
statistics bureau is an office of record, and has neither the authority
nor the personnel to determine causes of death. To give it the neces-
sary authority and personnel would be a duplication of governmental
machinery, and would result in the establishment of one agency, the
office of coroner or medical examiner, with authority limited to violent
deaths, and another whose functions would be limited to nonviolent
deaths of. unknown cause, some of which deaths might upon in-
vestigation prove to be due to unlawful means. All that would be
necessary for the solution of what might prove to be a serious prob-
lem, if coroners restricted themselves to the duties at present pre-
scribed by law, would be a clearer definition of the duties and au-
thority of the coroner in deaths resulting from unknown causes.
NonpartisanPsychiatricCourt Service
A nonpartisan psychiatric service for the guidance of courts,
prosecutors, and other agencies of justice has received even less at-
tention in thi§ country than has a scientifically conducted thanatologic
service. The psychiatric service made possible under the laws of Mas-
sachusetts, and the service rendered by an efficient medical examiner's
office indicate clearly that it is possible to make available to the agen-
cies of judicial administration the necessary facts and methods of
scientific medicine.
Need for Educational Propaganda

Before the possibilities for the future development of legal medi-
cine can become actualities, it will be necessary, for the medical pro-
fession to become educated to a realization of the service that it
should and must render to law, and for the legal profession to be-
come educated to a realization of the aid that it should and must
receive from medicine. It is futile to expect aid -from the lay pub-
lic, which must authorize changes in laws and must support the prac-
tical application of legal medicine to the needs of society, until the
two professions most vitally concerned shall have become cognizant
of their own share in the future development of legal medicine.

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Journal of Criminal Law and Criminology

Role of Medical Science in the Administration of

Follow this and additional works at: https://scholarlycommons.law.northwestern.edu/jclc

application of medical science to the administration of criminal justice

What Is Legal Medicine?

procedures. A second rarer definition applies the term to the social

Position, Content and Aims of Forensic Medicine

fessor of legal medicine and director of the Institute of Legal Medi-

the more ponderous of all, particularly because of its bearings on

which its service is secured." The situation in this country may

The Application of Medical Science to Law in the United States

abnormality is the work of the skilled psychiatrist. In some locali-

Expert Testimony and the Hypothetical Question

one of the most logical and scientific. It is the hypothetical question

The Office of Coroner

An inquiry into the manner in which medicine is applied to

upon arrival, the physician is not in position to furnish a legal cer-

.-. 'o c ,-. 0

Chicago, San Francisco, and New Orleans in an earlier 2 survey made

and other professionals have become conversant with the functions of

The Ofice of Medical Examiner

examiner's office in Boston could become the scientific medicolegal

that occurred in their respective jurisdictions, the average being 17.0

Psychiatric Court Service

the subject matter of psychiatry, when called in the scope of law,

The Massachusetts System

ous conviction or indictment of prisoners. It became obvious that

Medical Service of .the Supreme Bench of Baltimore

Behavior Clinic of the Criminal Court of Cook County

before conviction and in some few cases even before indictment.

mental state, as determined by careful and thorough examination.

In this country the scientific policeman exists chiefly in the pages

Medicolegal Institutes of Continental Europe

chemistry, toxicology, and general microscopy, as well as pathologic

British Medicolegal Institutes

Organizationof Institutes of Legal Medicine in the United States

It is not necessary, however, to await drastic changes in laws

Psychiatric Court Service

Medical Science, Violent Death, and Nonfatal Violence

Science and Crime Detection

Foreign Medicolegal Institutes and Judicial Administration

to government, in the services that they render in the administration

The Office of Coroner or Medical Examiner as a Medicolegal Agency

Adaptation of the Foreign Medicolegal Institute to

agency from which the agents of judicial administration might receive

Reform of the Office of Coroner

Adequate FinancialSupport Necessary for Scientific Work

Investigation of Nonviolent Deaths

Authority of Coroner in Nonviolent Deaths Not Clearly Defined

Need for Educational Propaganda

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