Reprinted from 
ANNALS 
OF 
SURGERY 
A MONTHLY REVIEW OF SURGICAL SCIENCE ANO PRACTICE 
EDITED BY 
L. & PILCHER. A.M., M.D.. ]. WILLIAM WHITE. M. D-. 
FREDERICK TREVES. F.R.CS., 
TABLE OF CONTENTS. 
ORIGINAL MEMOIRS. 
IV Melaao SurrntM n ... I.£,^ 
By Ciarln A. hw, MD 
EDITORIAL ARTICLES. 
I. nd BeMtn al Ex> 
IV. K^«e ue the Surgery of the GaB-Paa- 
INOEX OF SURGICAL PROGRESS. 
HydraphobKus, t*. ' 
Ha*» *"O >«<«New Methode/ 
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** BOOK REVIEWS 
IL Se/ZM. Surgical Ihaeetea ol 
IV. Vrawl Medical Electric 
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NECROLOGY. 
THE UNIVERSITY OF PENNSYLVANIA PRESS, 
PHILADELPHIA. PA 
1891. 
London: Bailie re, Tindall 4 Coa, ao King William Street, Strand. 
*' *Sao>9ie Number*jo Ceara. 
Ooe Gumea . Ymg 
JANUARY, 1893. 
Expert Examinations and Testimony in Railway Cases. 
By B. A. Watson, M. D., 
Jersey City. EXPERT EXAMINATIONS AND TESTIMONY IN RAIL- 
WAY CASES.1 
By B. A. WATSON, A. M. M. D. 
CONSULTING SURGEON TO THE BAYONNE HOSPITAL, SURGEON TO THE JERSEY 
CITY HOSPITAL, ETC. 
THE expert witness should never forget that he is employed 
for the purpose of aiding in securing justice; and, further- 
more he who interprets science honestly and truthfully 
will in the end receive the highest tributes of respect from his 
peers and best serve the interest of his cliental. 
Truth is mighty and brings us nearer to our God, while, 
2" He who tells a lie is not sensible how great a task he under- 
takes ; for he must be forced to invent twenty more to maintain 
that one." 
The further consideration of the duty suggests the following 
query: what is justice? 3"To give to every one his own." 
Furthermore, 4" Justice discards party, friendship, kindred and 
is always therefore represented as blind." 
The evil spirit-within the human breast-seems to whisper 
that the demands made on an expert witness are such, that it is 
impossible for him to maintain the high standard which we have 
prescribed. Let us briefly examine. Let us therefore take a 
retrospective view of this whole matter as presented in the light 
of history. The limits cf this article preclude the possibility of 
detailing individual reminiscences illustrating the various steps 
by which men have risen from obscurity to the highest pinnacle 
of fame. However, I shall venture to boldly assert that this 
desirable point has been universally attained by a fearless and 
strict adherence to the principles of justice. Let us nevertheless 
examine further into this matter and investigate the following 
JRead before the New York State Association of Railway Surgeons, November 
14, 1892. 2Pope. 3Aristotle. 4Addison. 2 
B. A. WATSON. 
question : What is required of the best educated surgeons before 
going on the stand as a medico-legal witness ? He should make 
a special study in order to prepare himself for the work which is 
to be performed. Examine the patient minutely and diligently. 
Hours, and sometimes days, are required for the proper perform- 
ance of this work. Weigh carefully the writings of the best 
authors, but don't accept blindly their statements. Accept only 
the truths and reject the errors. Banish from your mind mere 
theoretical views. The pathological lesions and carefully-made 
clinical observations furnish the only reliable basis on which to 
found a correct diagnosis or to apply rational treatment. The 
objective symptoms are nature's positive and truthful declaration 
of an injury done to some part of the organized body. In the 
majority of cases these symptoms point unerringly to the organ 
or organs which have received the injury. 
The subjective symptoms are the patient's declaration made 
by either words or acts, and may be entirely true, or wholly 
false, or partly true and partly false, and should therefore be very 
carefully weighed before they are admitted as important testi- 
mony. Briefly stated, objective symptoms are those morbid 
signs which cannot be either feigned or exaggerated by a litigant, 
while subjective symptoms can be feigned or exaggerated by the 
same. In exceptional cases there are pathognomonic symptoms 
which settle clearly the question of diagnosis. Thus in cases of 
concussion of the lungs hemorrhages from these organs with a 
well-marked area of dullness and an absence of respiratory 
murmur corresponding in locality with the above, points uner- 
ringly to the morbid condition when the hemorrhage follows 
immediately after the concussive accident. It is however true, 
that the lesions in the lungs may be either the principal injury 
or a mere complication of another which is more serious. In 
the majority of cases however, the diagnosis must be based on a 
certain group of symptoms rather than on pathognomonic signs. 
I recently examined a case which illustrates this point and 
will therefore venture to mention the most important symptoms. 
The plaintiff was about fifty years old, born in Ireland, came to 
this country in 1859 and had been employed several years as a 
porter in a mercantile house prior to 1889. During the month 
of December of this year he alleges he was injured by being EXPER T EX AMINA TIONS IN RAIL WA Y CASES. 
3 
struck on the back by bags of flour-weighing about one hun- 
dred and forty pounds each-the fall of which did not exceed five 
feet. The plaintiff's feet rested at the time of the accident on 
the ground while his hands were probably about one foot from 
the earth. He was at this moment shifting a barrel of flour. 
He denies all knowledge of the number of bags which fell on 
him, says, "Iwasunconscious," but in another portion of his 
examination reveals a full consciousness at the time, says, " I was 
pulled from under the bags by another workman. I remember 
that I walked to an office which was a few rods distant with 
assistance, seated myself in an arm-chair, was given some 
whisky, after which I was nauseated, think I vomited a little, 
an ambulance having been obtained I was sent home." 
He details minutely all the occurfences of the day on which 
he was injured. Prior to the day of the accident he asserts he 
had been perfectly healthy with the exception of occasional 
attacks of intermittent fever. At the time of the examination he 
was in a plethoric condition, face seemed somewhat livid and 
dull. The body was everywhere covered with a superabundance 
of adipose, the muscles were soft and flaccid, but in connection 
with this condition it should be remembered that the plaintiff has 
performed no manual labor during the past two years and nine 
months. The objective symptoms were as follows: the whole 
surface of the body was cyanosed, covered with a profuse per- 
spiration which continued to trickle down for an hour or more 
while the plaintiff was entirely disrobed and the temperature of 
the room was only seventy degrees F. The reflexes were com- 
pletely absent. The temperature was normal. There was no 
atrophy, or more accurately stated, careful measurements failed 
to show any want of symmetry in the limbs or other parts. The 
following are the important subjective symptoms : complained of 
lameness in the whole of the back immediately after the accident 
the right ankle was sprained, the right leg is mentioned as a seat 
of pain, but soon after he adds, "both legs became painful "-loss 
of sexual power-headache, etc. There is not the slightest, 
indication of paraplegia or any other form of paralysis shown by 
the plaintiff's statements during the first few months after the 
receipt of the injury. The bowels and bladder continued to act 
normally. There is no complaint of numbness or pricking sensa- 4 
B. A. WATSON. 
tions, etc. The pain in the lower extremities having continued 
several months he was then attacked with pain in the upper 
extremities. He now complains of loss of power in the upper 
and lower limbs. The pulse is frequent and small. The physician 
in attendance immediately after the accident and under whose care 
the injured man remained for about three months, says, there was 
no inflammatory reaction following this injury, and the plaintiff's 
statements confirm the doctor in this. The plaintiffs appetite 
has remained continuously good. There is no evidence to show 
that he has ever suffered from venereal disease, but he admits that 
he commenced drinking whisky when so young that he does not 
remember when he commenced -has taken some stimulants every 
day, and has occasionally been drunk, but does not think he has 
ever suffered from delirium tremens. He says, " I have never 
been able to walk more than three miles at any time since I was 
injured," and when asked why he could not walk further- 
replied, " 1 was too weak." An examination of the urine shows 
that it is acid in reaction and perfectly normal in every respect. 
The tongue was slightly furred on the day of the examination, 
the pupils were normal and the patient walked with an awkward 
limping gait. I am fully satisfied that he has not been coached 
for this examination by an expert surgeon; but at the same time 
he exaggerates the injurious effects of the accident and attributes 
all the ills from which he has suffered since its occurrence to this 
source. 
The opinion which I have expressed in the above is based 
in part on the statements made by the physician who attended 
him immediately after the receipt of the injury and for the next 
three months. This physician is an honorable and trustworthy 
member of our profession and informs me that he was dismissed 
from this case, because he refused to give to the plaintiff, at this 
early date, a certificate of total and permanent disability. The 
plaintiff then passed into the thralldom of quackery, where he 
remains at the present time. The claimant's presentation of his 
case is so defective that it is impossible for any surgeon to base 
a diagnosis on it, or even conjecture what his real condition is, 
or has been since the accident. It has been previously stated, 
that when the plaintiff was disrobed it was observed that every 
portion of his body was cyanosed while he was perspiring pro- EXPERT EXAMIN A TIONS IN RAIL WA Y CASES. 
5 
fusely. How are we to interpret these morbid signs ? The 
cyanosed condition was unquestionably produced by a vaso- 
motor paresis and the complete abolition of the reflexes indicates 
muscular paresis, while the loss of sexual power may depend 
partially or wholly on the same morbid condition. It will be 
here observed that I accept the loss of sexual power as an existing 
factor in the case, and I am prompted to this action from the fact 
that such acceptance is in strict harmony with my examination. 
The examination fully convinced me in regard to the exis- 
tence of a multiple motor paresis, while there was no evidence of 
any sensory disturbance. We are now confronted with the 
important question, what is the malady from which the plaintiff 
is suffering? Does the disease take its origin in part or wholly 
from the accident which has been mentioned ? This was 
apparently followed by no symptoms of paralysis or inflammation. 
My own experimental studies satisfy me that the force applied 
was entirely insufficient to produce traumatic lesions of the spinal 
membranes or cord. The plaintiff's own statements on this 
point do not warrant the conclusion that any such injury was 
received, or that even an injury was done to the peripheral nerves. 
All the statements made which bear on this case during the first 
three months immediately after the accident are essentially 
negative. I am therefore convinced that the case before us is 
one of chronic alcoholic multiple neuritis. The plaintiff says, " I 
have used stimulants daily from my boyhood to the day of the 
examination-having taken a drink of whisky this morning- 
and, furthermore have occasionally been intoxicated, but have 
never suffered from delirium tremens." 
The outlines here supplied cannot fail to impress on the 
reader's mind the necessity of a most careful and scientific 
examination of these cases. It requires on the part of the 
surgeon scientific knowledge, dexterity, tact and patience. In 
the examination of these cases nothing should be taken for granted 
which can be demonstrated by the most scientific manipulation. A 
hasty conclusion, unless based on a pathognomonic sign, is a 
disgrace to the examining surgeon, and is frequently not only 
worthless, but highly expensive to the parties who have ordered 
the service. Here, as in all other cases, honesty is the best 
policy. 6 
B. A. WATSON. 
The surgeon having made a full and correct report of the 
case examined, it is then placed in the hands of your client's 
lawyer who will decide whether it is a case to be compromised 
or settled in the courts. In this connection the value of an 
honest and correct opinion from the surgical expert must become 
apparent to all. An incorrect opinion furnished by a surgical 
expert may lead to disastrous litigation or the payment of a large 
sum of money to secure a compromise even in cases where no 
disability has been caused by the accident. The possession of 
scientific knowledge must be regarded as a sine qua non for the 
work required to be performed by an expert. However, the 
critic will object to the above statement, and assert that it is too 
general to possess any scientific value in this connection. There- 
fore I must express myself more definitely on this point. The 
medico-legal expert must be able to detect every objective sign-to 
trace the same to the pathological lesion on which it depends-to 
weigh correctly every subjective symptom-to discover at this point 
all efforts at malingering or exaggerating and then to group all 
signs or symptoms in such a manner as to form a perfect picture of 
the malady. To accomplish this object requires dexterity and 
perseverence. Dexterity of hand enables the surgeon to make 
the physical examinations in such a manner as to reach the facts, 
while intellectual dexterity draws from the mouth of the specula- 
tive litigant a full statement of the case-but it rarely resembles 
the purity of a nugget of gold, when first obtained; but may be 
fitly compared to a poor ore, which contains a small amount of 
the precious metal and a large quantity of extraneous matter. 
The same power-intellectual dexterity-when skillfully em- 
ployed will enable the surgeon to separate truth from falsehood. 
Dexterity can not be learned from books, but can only be 
acquired by patience and experience. The next in importance is 
time and perseverance. With time we bring the truth to light 
and detect the malady-verily it is the test of truth. 
The following expresses the important lesson perseverance : 
" Stick to your aim; the mongrel's hold will slip, 
But only crow-bars loose the bull-dog's lip; 
Small as he looks, the jaw that never yields, 
Drags down the bellowing monarch of the fields."-O. W. Holmes. EXPERT EX AM IN A TIONS IN RAILWA Y CASES. 
7 
The following are the powers which every skillful surgeon 
must employ to solve the mysteries of obscure maladies, viz.: 
Scientific knowledge, dexterity, time and perseverance. Hurried 
examinations and hasty conclusions are always dangerous and 
commonly worthless. Many of the cases in which medical 
expert testimony is sought are naturally very obscure; and are 
likewise frequently severely complicated by litigation symptoms. 
How can the surgeon eliminate the extraneous matter and 
thus obtain possession of the facts ? No perfect rule can be 
stated-since every case must be managed according to its 
peculiarities and surroundings. If any absolute rule ought to 
be followed, it should be the following: 
Let the surgeon under no circumstances antagonize the 
person whom he is examining. The general observance of this 
rule is an absolute necessity. But should an exception ever 
arise be sure to postpone the asking of any question which 
might possibly give offence to the person being examined, or 
even his friends, until you have obtained all other information 
which may have a bearing on the case before you. Let the 
examination be systematized. Begin with a biographical sketch 
of the litigant, follow with a history of the accident, and finally, 
with a careful inspection and thorough examination of every 
part of the body. This biographical conversation-commencing 
with the name, nationality, occupation and age-commonly 
serves the purpose of introducing the surgeon to the party to be 
examined. This subject may be made very agreeable even to 
the ordinary litigant, and the surgeon may receive from him 
certain points which will aid in unravelling the case. Further- 
more the litigant in this free and easy conversation frequently 
forgets to act the part of a deceiver, and he thus enables the 
surgeon to behold him in his true character. In this conver- 
sation the surgeon must take his part-may ask leading 
questions, etc., but he must never fail to be a pleased and attentive 
listener. Whenever a communication is made bearing especially 
on the case under consideration the surgeon should not fail to 
enter it in a note-book. Let me here reiterate what I have 
previously said, " Never offend or antagonize the party whom 
you are examining." Your object is to draw forth from this 
party a full and honest statement. An angry person under 8 
B. A. WATSON. 
these circumstances is much inclined to lie and greatly exagger- 
ate, while he may either refuse to allow you to go on with the 
examination or so act as to prevent you from performing it 
satisfactorily. The introductory part having been well per- 
formed, let the surgeon then ask the litigant to give a full and 
careful statement of the accident. The description should be 
noted down in the words of the litigant. There ought not to be 
asked a single leading question, but should the party wander 
away from the subject, his attention may be cautiously directed 
by the surgeon to those points which have some bearing on the 
case. It is indispensable if the surgeon would obtain all the 
facts in the case to allow the litigant to go over the details of 
the case many times. While, at the same time, it will be found 
advantageous to require him to state the various incidents in the 
order of their occurrence. The advantages arising from this 
order of narration are too numerous to be fully enumerated 
here, but I will briefly say that the narrator finds it much easier 
to follow up a continuous chain of occurrences-the rehearsal of 
the last act narrated naturally suggests that immediately follow- 
ing, and so on to the end of the chapter. It is likewise much 
easier for the surgeon to follow up this unbroken chain of events 
and to record the same, than it would be if the history were 
given in a disconnected and haphazard manner. The surgeon 
ought to be especially careful to obtain a full description of the 
disability, including its degree, etc., as well as the symptoms 
which followed immediately after the occurrence of the alleged 
injury. For the accomplishment of this end the party being 
examined should state here, for instance, if he has asserted that 
he was thrown from his berth to the floor, the portion of the 
body which first came in contact with the floor or other portion 
of the car, how long did he remain in this position, did he arise 
without assistance, if assisted by whom, where did he go imme- 
diately after the accident ? Did he have assistance, etc.? What 
symptoms did he complain of at this time ? Let the surgeon 
now follow him with the same care during the next forty-eight 
hours, even for a longer period. The necessity for this pro- 
cedure is based on the allegation that inflammatory and other 
morbid changes have arisen from concussive injuries which were 
not accompanied by morbid symptoms; while it is self-evident EXPERT EXAMINA TIONS IN RAIL IP A Y CASES. 
9 
that this statement is a mere hypothesis, which has been dis- 
proven by experimental observations and analagous reasoning, 
but, nevertheless it is worthy of further clinical study, owing to 
the high authority who gave birth to this theory. 
Even if it be admitted that symptoms of degeneration of 
nerve tissue have manifested themselves six months after an 
accident, is it therefore logical to conclude that the accident is 
the cause of the degeneration ? Mr. Erichsen, in the last 
addition of his work, says:1 "But during the whole of the 
interval, whether it be of long or short duration, it will be 
observed that the sufferer's condition, mentally and bodily, has 
undergone a change. This is a point which I would particularly 
insist upon. He never completely gets over the effects of the 
accident. There may be improvement; there is not recovery. 
There is a continuous chain of broken or ill health, between the 
time of the occurrence of the accident and the development of 
the more serious symptoms. It is this that enables the surgeon 
to connect the two in the relation of cause and effect. This is 
not peculiar to railway injuries, but occurs in all cases of pro- 
gressive paralysis after spinal concussion, and may be noted in 
the histories of many that have been given in these lectures." 
That portion of this quotation to which I wish especially to 
direct attention reads as follows : " There is a continuous chain of 
broken or ill health, between the time of the occurrence of the acci- 
dent and the development of the more serious symptoms. It is . his 
that enables the surgeon to connect the two in the relation of cause 
and effect." This statement should never be forgotten in our 
attempts to make a diagnosis in cases of concussion of the spinal 
cord or other injuries of the back which have been included in 
Mr. Erichsen's so-called " spinal concussion." Tins statement 
is in perfect harmony with the results which J obtained in my 
experiments on animals, so far as it goes, but it is likewise 
equally true, that in a large number of these cases, although the 
animal seemed to be very seriously injured immediately after the 
infliction of the traumatism, they entirely recovered within three 
to five days. There is another point in connection with these 
examinations which is certainly entitled to our careful considera- 
1 " On Concussion of the Spine." Longmans, Green & Co., London, 1882, 
page 158. 10 
B. A. WATSON. 
tion. It has sometimes been asserted that it is beneath the 
dignity of our profession to make any effort to detect malingering 
or exaggerations by observing the movements and general 
appearance of the party examined after he passed through this 
ordeal at the hands of the examining surgeon in his office. 
Here I differ emphatically with those who hold the above views, 
and earnestly declare that since a correct diagnosis is the only 
basis on which justice can be secured, it is therefore the plain 
duty of the surgeon to use every means which he possesses for 
the attainment of this end. He who neglects this on the plea 
that it is beneath his professional dignity disgraces science and 
either defeats or contributes to the defeat of justice. The 
malingerer comes into our office and, having been well coached 
for this work plays well his part in the drama, while in the 
surgeon's presence he is apparently the decrepit man ; but a few 
hours later when seen on the street in the company of boon 
companions he has regained the sprightliness of youth, while his 
movements resemble those of the young spring-buck. 
We have now sketched some of the important outlines to be 
followed in making a medico-legal examination, while it is 
thought that a competent examining surgeon will readily fill in 
the necessary means best suited to secure the object sought in 
any individual case. 
The medico-legal examination is most frequently sought for 
the purpose of enabling an equitable compromise to be effected ; 
but in other cases it is not demanded until the parties have 
joined issue in courts of justice. It matters not whether the 
examination is sought for the former or latter purpose ; since it 
frequently happens that the efforts made to effect a compromise 
fail and the case is finally adjusted in the court. Consequently 
a complete written report should be made immediately after this 
examination and all the notes taken at this time should be care- 
fully preserved. Furthermore, the chief object sought in all 
these cases is a correct diagnosis which must be sustained by a 
most thorough and scientific examination. It may be further 
added that the best coat-of-mail with which an expert witness 
can be provided, when he takes the witness-chair in a court- 
room, is a thorough knoivledge of the subject on which he is to 
give testimony and a full determination to adhere strictly to the EXPERT EX AMI NA TIONS IN RAIL IVA Y CASES. 
11 
truth. Thus armed he cannot fail to acquit himself creditably. 
Another point to be kept constantly in view is the fact, that he 
has no right to be swayed from the path of duty by sympathy 
or to bestow the benefits of his doubt on either of the contend- 
ing parties. The expert witness ought at all times in the court- 
room to avoid, as far as possible, the use of technicalities, the 
only effect of which is to make the witness appear pedantic, 
while the court and jury will justly regard this course on the part 
of the witness as an attempt to hide his own ignorance. How- 
ever, should it ever happen that a technicality has been employed 
by a witness, he should immediately explain the same, in lan- 
guage so simple that the most ignorant member of the jury can 
understand it. Let the witness in no case attempt to explain 
that which he does not understand, and do not be afraid to admit 
that many questions in science can be asked which the human 
mind cannot comprehend or fathom. The answers which are 
based entirely upon theoretical grounds are entitled to very little 
consideration ; and consequently ought to be commonly avoided 
in the court-room. This sort of testimony is usually brought 
forward by lawyers who are managing weak cases, and who thus 
seek to divert the attention of the jury from the facts of the case 
before them. The only theories which are entitled to considera- 
tion in a court-room, are those which are firmly based on demon- 
strated facts. The expert witness should never attempt to an- 
swer a question until he is sure he understands it. This is com- 
monly a very simple matter and only requires the witness to give 
strict attention to the queries and at the same time carefully con- 
sider the answer he makes to the same. Hypothetical questions 
are frequently very carefully, even adroitly framed-and often 
with the especial object of puzzling the witness. The lawyer 
reads the question rapidly ; and then demands that the witness 
answer it with yes or no. The last procedure I am inclined at 
all times to regard with suspicion, and therefore ask for a written 
copy of the query. This copy is then apparently willingly 
placed in my hands, but frequently I find it is so composed, that 
while one clause might bear an affirmative answer, the other would 
require the negative. The witness may then return the question 
to the lawyer who propounded it, and inform the court that the 
query cannot be properly answered either negatively or affirma- 12 
B. A. WATSON. 
tively. The court thus appealed to commonly permits the wit- 
ness to answer the question in his own language. There should 
be allowed to the witness sufficient time to consider carefully the 
question and to formulate properly the answer to the same. 
Let the expert witness absolutely banish from his mind 
while in the witness-chair-all thoughts of hasty or brilliant 
replies and confine himself strictly to the part which he is play- 
ing in the administration of justice. The contemptible attempts 
sometimes made by lawyers to buldoze, intimidate, or otherwise 
annoy the witness are very rarely profitable and seldom, if ever 
justifiable. The natural effects of such procedures are to estab- 
lish an antagonism between the lawyer and the witness. The 
witness under these circumstances usually emphasizes more 
strongly his opinions, while if expert in the matter, receiving the 
attention of the court, he may be found troublesome in the hands 
of his persecutor. In order to illustrate this point more clearly, 
let us suppose that a medical expert is being cross-examined on 
a medico-legal subject by a lawyer who possesses no knowledge 
of medicine or surgery, the contest will be quickly settled if 
waged on a scientific basis, and the victory will belong to the 
witness and not to his tormentor. The witness, when thus 
attacked, should redouble his efforts to maintain his serenity lest 
in an unguarded moment his antagonist should discover some 
defect in his coat-of-mail. Every question put to the witness 
should be fully understood before the answer is formulated, and 
when the reply is put forth, it should be brief and pointed. The 
witness should avoid, so long as possible, any bandying of per- 
sonalities with the lawyer, since it is undignified and frequently 
embarrasses the administration of justice. The expert witness 
ought never to forget that his sole duty consists in throwing 
scientific light on the subject under consideration by the court, 
and thus aiding in procuring justice. In order that he may be 
able to perform this duty in the most advantageous manner, he 
ought, in every case where it is possible, to make a special study 
of the subject matter on which he is likely to be examined before 
he takes the witness-chair. He ought never to neglect this pre- 
caution-even though he may be fully posted,-perfectly confident 
that he can maintain his opinions against any rival who can be 
brought against him. He who fails to study constantly, will in EXPERT EXAMIN A TIONS IN RAIL WA Y CASES. 
13 
time discover that he is gradually losing some portion of that 
which he had previously learned. 
If he halts in the scientific race he will soon find himself 
distanced by those who have previously seemed perfectly con- 
tented to remain in the rear. Let me here assert that an expert 
witness should always interpret science honestly-if for no other 
reason-because it will pay him best in the end. He is frequently 
called to make expert examinations in order that the case may 
be compromised, or should all efforts in this direction fail, that 
he may gain a knowledge of the case which will enable him to 
serve subsequently his client in court. In all these cases the 
report should be so full that the claim can be expressed in dol- 
lars and cents. 
It will therefore be readily seen that those parties who desire 
expert services wish the report of expert examinations to 
be entirely reliable. The same is true in regard to expert testi- 
mony, the witness having made a careful examination of the pa- 
tient, entered the court-room, listened attentively to all the testi- 
mony, and informed the counsel that his own opinions would be 
dangerous to the interest of his client's case, will be readily 
excused and respected for his frankness. Mr. Erichsen says in 
referring to railway cases in this connection : 1 " It can never be 
to the interest of a company to fight a notoriously hopeless case 
as they must incur heavy costs in addition to being mulcted in 
damages, and if properly advised they will not do so, unless the 
claim be too exorbitant. They are often led into courts of law 
by incorrect information as to the real gravity of the case, or are 
forced into them by the sufferer, irritated by having been dogged 
by detectives, or the taunts of the company's officer, seeking to 
obtain exaggerated and vindictive damages." 
Another important factor in the causation of litigation are the 
cormorant lawyers, who, like turkey buzzards, possess a wonder- 
ful facility for finding out their prey, and who for a contingent 
fee are perfectly willing to shame the devil by their own villainy. 
They seek principally to rob the company, and afterwards they 
rob their clients. The daily paper has recorded an accident and 
before its sheets are dry the cormorant lawyers have found their 
1 " Surgical Evidence in Courts of Law." Longmans, Green & Co., London, 1878, 
page 39, et. seq. 14 
B. A. WATSON. 
prey in our large cities, especially New York and those in its 
vicinity. 
Mr. Erichsen has correctly stated that, 1 " there are three 
classes of medical men who appear as witnesses in a court of 
law. These are, first, the bona fide medical attendants of the 
plaintiff; secondly, the ordinary medical officers of the company ; 
and thirdly, the consulting practitioners-so-called experts. These 
surgeons are called either by the plaintiff or the company to give 
opinions on the nature, the extent, and probable duration of the 
symptoms resulting from the accident that the plaintiff has sus- 
tained. The duties of the first two classes of witnesses are 
usually simple enough. They consist in a great measure in 
relating the history of the case, the treatment adopted, followed 
by some general opinions as to its future. The real conflict of 
evidence, if it occurs, lies between the so-called experts, whose 
opinions may differ widely as to the essential nature of the actual 
condition and probable future of the patient." In regard to the 
differences of opinion the same distinguished author has justly 
remarked : " Were such differences of opinion only exhibited by 
medical men when they appear in courts of law, the spectacle 
would indeed be a melancholy one, and would augur ill for the 
character and, possibly, even the honesty of our profession. But 
such conflicts of opinion are unavoidable accompaniments of all 
that is still vague and uncertain in the science of medicine . . . 
In every department of life, in politics or religion, in science 
or the law itself, conflict of opinions occur to an extent equal at 
least to that which is met with in medicine. There is much in 
medicine, and probably more in surgery, which is absolutely de- 
termined ; but in some departments there still exists, and none 
unfortunately, none more conspicuously than in that which 
becomes the subject of investigation in courts of law, namely, the 
remote consequences of injuries of the nervous system, one 
of the most intricate, obscure, and difficult problems in surgery, 
a certain amount of uncertainty both as to the true pathology 
and the possible duration of such lesions." The true explana- 
tion of conflicting opinions must in some cases be looked for in 
1 " Surgical Evidence in Courts of Law." Longmans, Green & Co., London, 1878, 
page 17. EXPERl EXAMINATIONS IN RAILWAY CASES. 
15 
the relative deficiency of one or the other of the experts. He, 
who, to-day, is willing to go into a court of law, and in matters 
of etiology, pathology, ;and treatment of surgical lesions, base 
his opinions on the science and practice of surgery, as it was 
thirty years ago, should be relegated as an antiquated surgeon 
to a surgical museum. A conflict of opinions between experts 
cannot be avoided ; and consequently, he who enters the field 
should never neglect to study carefully the various points in- 
volved in the investigation. In your study of the case, as well 
as in giving your testimony endeavor to be systematic. Avoid 
a rambling desultory course in your examination of a patient and 
likewise in the study of these cases. Seek out carefully the 
objective signs, and then group about them the subjective symp- 
toms which are in harmony with, or at least not antagonistic to 
the former. The citadel thus erected is to be defended by the 
expert witness ; and, consequently it should be built on a strictly 
scientific foundation. The subjective symptoms, when entirely 
unsupported by a single objective sign do not afford an adequate 
foundation for an attack, with any reasonable prospects of re- 
covering damages in the case of a railway injury ; but on the 
contrary in the majority of instances must be construed nega- 
tively; and negative evidence cannot justify the jury in finding 
for the plaintiff. With these brief allusions to the duties, privi- 
leges, and the required preparation of medico-legal experts, 
let us consider briefly whether the present system of procuring 
expert testimony can be materially improved. Two methods 
have been suggested heretofore in the place of the practice which 
is now in vogue, viz., the appointment of the expert witnesses by 
the State legislatures-while the other suggestion proposes their 
appointment by an order of the Court in which their services are 
required. Both of these suggestions are open to the most serious 
objections. In the first place neither of these methods of pro- 
cedure would procure even mediocrity of talent; since the 
appointments would always be made for political reasons instead 
of scientific qualifications. 
It is entirely unnecessary to go into further statement on 
this subject before those who are familiar with political jug- 
gleries. Furthermore the corrupt influences brought to bear on 
political appointees are commonly much more potent than those 16 
B. A. WATSON. 
which can be employed in the case of private individuals. The 
political appointee lives on the crumbs doled out to him by his 
party, while the professional man commonly depends on 
industry-scientific attainments-and an honorable character 
for his business success. The more intelligent his cliental the 
more urgent will be their demands on the expert witness. How- 
ever, in all this there is much satisfaction, since we are always 
fully assured that the demands are based on reason and sound 
judgment and not merely whimsical in their nature.