Part 5

=Do not send written certificates= to third persons as to the result of the examination, unless (1) In an open envelope, having read the certificate to the patient who takes it to its destination; (2) After having received the written consent of the patient so to do.

The payment of the fee by a third person does not absolve from the rule of professional secrecy.

The symptoms and =feelings of a patient= are sometimes admitted as (hearsay) testimony from a medical witness, especially where the former is dead. =Letters= from a patient to a medical man containing such statements are not allowed.

A =confession= (which must be quite voluntary) or a =dying declaration= (from the lips of a victim of homicide convinced of impending death) made in the hearing of a medical man should be noted down at once, word for word, and, in the absence of a magistrate, signed by all persons present. Should death be imminent after a criminal assault (which includes abortion), the medical man should urge the victim to make such a dying declaration.

If a patient is sent to gaol or an asylum, communicate at once, but privately, with the medical officer should you know of any =mental or physical abnormality=.

EXAMINATION OF THE DEAD.

=Do not order the removal= of a dead body; leave that duty to the police or to the Coroner’s officer.

=Forbid=, however, any disturbance of a body to which you are called until you have seen it and the circumstances.

1. Where the Coroner orders “evidence touching the external appearance of the body, and the cause of the death”:

The body should be identified in your presence; if it cannot be identified, special care must be taken with the inspection. A photograph should be taken at once.

The appearance of the corpse, both when clothed and when stripped, must be noted.

In all cases the probable time of the death must be estimated.

The presence and nature of parasites must be recorded.

Should the cause of death still =remain obscure= after a complete inspection, the Coroner should be informed of the fact and requested to order an anatomical post-mortem examination of the body.

2. Where the Coroner orders a =full post-mortem examination=, thus:

“You are required to make or assist in making a post-mortem examination of the body, which shall comprise an examination of the viscera of the head, chest, and abdomen, and, if necessary, an analysis of the contents of the stomach, and report thereon at the said inquest.” As to the analysis, see the Home Office Circular (Jan. 7, 1903).

The body must not be opened until the Coroner’s order has been received; apart from inquests the =consent of relatives= must be secured before a body is dissected.

Wherever manslaughter or murder is suspected, the Coroner will order a necropsy as a matter of course.

If the deceased’s friends =charge you with negligence= in treatment, you must not conduct the examination.

Do not commence =until the body is cold=; do not delay until marked putrefaction has set in.

Have all necessary appliances at hand; having once started =do not leave the room= until your final note has been made and signed.

Do not employ a hammer or a chisel.

=Remember= that it is dangerous to attend lying-in women after making an autopsy.

If the mortuary attendant does the manual work you must watch each step.

If portions of organs are retained for subsequent examination, have the fact witnessed.

DRAWING UP A MEDICO-LEGAL REPORT.

In most cases the witness must recite the report in open court.

For a complete investigation three sets of facts must be collated: