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the claimant. In so doing he prepares the claim agent for every contingent in the evolution of the case, and thus never misleads. The claim agent is pre-eminently an agent of compromise; adverse conditions constantly make compromise a virtue. Compromise stands in relation to personal injuries upon the railway and litigation as prevention and cure. A case compromised saves a thousand elements of attendant worry upon the part of the claimant and a large expense upon the part of the railway. It is the best and most economical element for all concerned in personal injury cases, just as prevention in disease saves time, pain and ulterior consequences; while litigation involves every element of expense and is productive of mental disease and at time death. Honorable, just compromise should be encouraged whenever possible, with a desire to do strict justice. The field of compromise is one where honorable professional men rarely disagree, where dignity is maintained and a truthful, manly standard. Compromise will oftentimes permit a much nearer approach to strict justice than a court which necessarily permits the conflict of truth and falsehood, frequently to the exclusion of justice. Compromise offers to all concerned, the purest and best forms of economy; for the plaintiff, it takes away the sting of delay and irritating circumstance; for the corporation, it saves money and reputation. It is a well established fact that medical expert testimony, as used in litigation before the courts, has reached such a state as to be almost inaffective; it is certain that it is constantly unjust, not only to the plaintiff, but to the defendant as well. Certain it is that the respect accorded to the profession of medicine is not commensurate with its intelligence. The loss of individuality and the subserviency on the part of the medical expert is due in many cases to his relations to the party employing him and the adaptation of medical opinion to a theory built in law; be it true or not, it often prevents the procurement of unbiased opinion. This is pre-eminently true in cases of personal injuries occurring upon railways where an almost inherited prejudice enables the most ignorant quacks to give expert testimony. Possessing scarcely the elements of true medical education, these impostors are accorded credence equal to that given the most skillful of experts. So prevalent has this practice become that we have heard reputable

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lawyers say, that the railway, to be opposed in a legal trial, the ignorant medical witness will exert more influence over the average court and jury than the well-posted and honestly-inclined medical expert. It is not ignorance that has brought this deplorable condition about, of medical expert testimony, but duplicity, dishonesty and the ready adaptation of the medical expert to the views of the counsel. The lawyer, himself, rarely competent in his knowledge of medicine to make plain the learning, competency and proficiency of the genuine expert, is as equally certain to fail to detect the ignorance and utter incompetency of the ignorant expert. The value of the medical expert testimony should mainly depend upon the expert proficiency and learning in his profession; but this is very far from being the case in practice. Winthrop says: "Reform in the methods of using medical men as experts is a plant of slow growth. Suggestions and recommendations are offered in sufficient number and there the matter ends. English and American courts continue to follow traditional usages and show no willingness to find a better way. Each of the parties in a suit in litigation secures the services of medical witnesses favorable to him and leaves the witnesses to justify their testimony as well as they can. This being in accordance with the theoretical right of every person to call on behalf of his defense such witnesses as he sees fit."

The medical expert is supposed to have special knowledge, skill and experience in medicine. First it is not necessary according to the existing tenets of the law that the medical expert should have practiced his profession, neither does the law take cognizance of what particular school of medicine the expert belongs to. Secondly, "The extent of the previous study and investigation and the amount of skill and information which must be shown will depend upon the facts of each particular case. But some special and peculiar knowledge or skill must be established, the amount of it to be determined by the trial judge in his discretion. The possession of such knowledge and skill is presumed in medicolegal cases if the witness is a licensed practitioner."-Tracy C. Becker, Medical Jurisprudence, Forensic Medicine and Toxicology.

It is not relevant to the subject-matter of this paper to discuss the justice of the expert receiving other than the ordinary fee, but it is

held in some states that the expert does not stand upon the same footing as an ordinary witness. That he is in the position of impart ing something of value, that his knowledge, skill and experience "is his property as much as any other thing movable or immovable of which he is possessed."-Becker. Under the practice of the courts of this country the expert is selected by the litigants. The amount of special and peculiar knowledge or skill of the expert is to be determined by the trial judge, and he is oftentimes a very good lawyer, but a very poorly informed person in a medico-legal way. The proof demanded does not generally bear the stamp of much profundity of thought, the statement of the qualification of the expert is usually made by the expert himself. He may qualify himself by proof of his legal right to practice the profession in which he is engaged, or by showing that he is conducting a business, a wide knowledge of which he should, but may not have. To testify as an expert there is usually no proof either offered or required as to fitness; generally the fact is accepted that the expert has been or is engaged in a business or profession which should give him the required knowledge and experience to qualify him. The question of his actual knowledge is left to be ascertained from his own answers on cross-examination. And as before stated, the possession of such knowledge and skill-in the medical expert-is presumed in medico-legal cases if the witness is a licensed practitioner. A legalized or licensed practitioner in our country, particularly in some western states, means merely a self-imposed or authorized prefix to a name to constitute a full-fledged physician.

I was once informed by a medical student who had failed to pass the final examination at a medical college that he was now a legal practitioner, that he had passed a satisfactory examination before a local board of examiners in a neighboring state. Upon inquiry I elicited the fact that the local or county board in the county in which he was practicing consisted of a blacksmith, a barkeeper and a justice of the peace and as our informant expressed it, that there was "not much medicine in the crowd, but a good deal of muscle and whisky."

When you take into consideration the ineffectiveness of medical expert testimony, the injustice of litigation and the improbability of

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We will not endeavor to enter extensively into consideration of the elements supposed, which lead to a generation of diseased condition and the production of what is pre-eminently a condition of modern civilization. Nor will we at this juncture refer to the influence of the excessive use of narcotics and stimulants, such as alcoholic drinks, tobacco, opium, nor the absorption of tainted foods and organic poisons and to other conditions tending in this direction. But in order to make our meaning more plain, we will quote from Nordau, as regards the peculiar influences of modern life in the production of hysteria: "The enormous increase of hysteria in our day is partly due to the same causes as degeneracy, besides which there is one cause, much more general still than the growth of large towns, a cause which perhaps of itself would not be sufficient to bring about degeneracy, but which is unquestionably quite enough to produce hysteria and neurasthenia. This cause is the fatigue of the present generation. That hysteria is in reality a consequence of fatigue, Fere has conclusively demonstrated by convincing experiments. In a communication to the Biological Society of Paris, this distinguished investigator says: 'I have recently observed a certain number of facts, which have made apparent the analogy existing between fatigue and the chronic condition of the hysterical. One knows that among the hysterical involuntary symmetry of movements frequently shows itself in a very characteristic manner. I have proved that in normal subjects this same symmetry of movements is met with under the influence of fatigue. A phenomenon, which shows itself in a very marked way; in serious hysteria there is that peculiar excitability which demonstrates that the energy of the voluntary movements through peripheral stimulation or mental pre

sentations suffers rapid and transitory modifications co-existing with parallel modifications of sensibility and of the functions of nutrition. This excitability can be equally manifested during fatigue. Fatigue constitutes a true temporary experimental hysteria. It establishes a transition between the states which we call normal and the various states which we designate hysteria. One can change a normal into an hysterical individual by tiring him. All these causes, which produce hysteria can, as far as the pathogenic part they play is concerned, be traced to one simple physiological process, viz., fatigue and depression of vitality.' Now to this cause, fatigue, which, according to Fere, changes health into hysteria, the whole of civilized humanity has been exposed for half a century. All its conditions of life have in this period of time experienced a revolution unexampled in the history of the world. Among the hysterical, and it must not be thought that these are met with exclusively, or even proponderently among females, for they are quite as often, perhaps oftener, found among males." ***The leading characteristic of the hysterical, says Colin, "is the disproportion of impressionability of their psychic centers. They are above all things impressionable. From this primary peculiarity proceeds a second quite as remarkable and important, the exceeding ease with which they can be made to yield to suggestion. The early observers always mention the boundless mendacity of the hysterical, growing, indeed, quite indignant at it, and making it the most prominent mark of such patients. They were mistaken, the hysterical subject does not consciously lie, he believes in the truth of his craziest inventions. The morbid mobility of his mind, the excess of excitability of his imagination conveys to his consciousness all sorts of queer and senseless ideas. He suggests to himself that these ideas are founded on true perceptions and believes in the truth of his foolish invention, until a new suggestion. Added to this emotionalism and susceptibility to suggestion is a love of self, never met with in the same person, or anything like the same degree. The hysterical person owns that 'I' towers up before his inner vision and so completely fills his mental horizon that it conceals the whole of the remaining universe. He cannot endure that others should ignore him. He desires to be as important to his fellowmen as he is to him

self; an incessant need pursues and governs the hysterical to busy those about them with themselves. The means of satisfying this need is the fabrication of stories, by which they become interested. Hence, comes the adventuresome occurrences, which often occupy the police and the reports of the daily press. In the busiest thoroughfare the hysterical person is set upon, robbed, maltreated and wounded, dragged to a different place and left to die; he picks himself up painfully and informs the police. He can show the wounds on his body. He gives all the details. And there is not a single word of truth in the whole story; it is all dreamt and imagined. He has himself inflicted his wounds in order for a short time to become the center of public attention, and if in a railway accident his tales are never probable, but always miraculously colored."

Now, then, hysteria is characterized by hyper-susceptibility to suggestion. He believes in everything suggested to him with sufficient impressiveness. The excited and the hysterical are never to be trusted; still their stories, when taken into account in personal injuries, are not only believed by the laity, but by the physician as well. It is, indeed, a marvel to what extent suggestion may go, particularly under excitable conditions. Nordau says: "Mede Goncourt relates that in 1870, during the Franco-Prussian war, a multitude of men, numbering tens of thousands in and before the Bourse in Paris, were convinced that they themselves had seen, and really part of them had read, a telegram announcing French victories fastened to a pillar inside the Exchange, and at which people were pointing their finger, but, as a matter of fact, it never existed. This is essentially the condition of a hysteric. They see, fell, hear and taste in suggestion."

These remarks are interpolated in this paper essentially for the reason that while it is absolutely necessary for the physician to understand this modern enigma of civilization, still we believe that it is pre-eminently necessary that you, as claim agents, should be at least informed of the fact of its peculiar action upon the mental condition of modern man engendered by the peculiarities of his growth, progress and civilization.

Before passing on, it may not be out of place to indicate the full force and effect of litigation upon the plaintiff in a law suit, as it will serve to give a strong and forcible reason why the

claim agent, in performing his function, can be enabled to lessen disease-producing circumstances. It is a well-established fact, particularly in a certain class of cases which are the most troublesome and the most expensive for the railway, and known by the name of railway shock to the spine; but happily now, owing to honest work, they have been relagated to other causes as well. Permit me here to cite from Herbert W. Page regarding the baneful influences of litigation and causes of chronic invalidism. It is a well established fact that among the sociological problems attendant upon modern civilization, the general bestowal of damages in this class of cases is a portentous and ominous threat as regards existing social conditions. It is recognized by all competent authority that the chance of money redress is now greater than ever before; hence we have an invariable tendency inherent in human nature when anyone is injured upon a railway to exaggerate every symptom and by a more or less voluntary auto-suggestion construct a case which never would have existed had not the railway inflicted it. In fact, it is a pure litigation trouble engendered by social conditions, particularly the prospective gain, created by the competency to pay, of the inflicting agent. Let us now quote Page: "And out of this very exaggeration arises another cause of prolongation of the illness. The exaggerated estimate of the symptoms themselves leads to an erroneous estimate of the present incapacity and to an increasing belief in the impossibility of future recovery and usefulness; hence it is only natural that differences of opinions arise between those who are entitled to receive compensation for the injuries and for the perspective consequences, and those who have provided and who take a wholly unsentimental view of the value of the patient's health and life. Months, perhaps, are thus wasted in disputing about the claim, or, worse than this, the man is drawn unwittingly into litigation and is subjected to the anxieties and worries which a lawsuit involves. What surer means than this for aggravating the symptoms. Is recovery possible under such an influence? Is there not, indeed, every likelihood that the symptoms will get worse and worse, or at best, undergo no change, and is it not more appropriate now to call them 'litigation symptoms' than those of general nervous shock? ***. Make all the allowance that may honestly be made for the


special circumstances of terror attendant upon a railway collision (and I would not for a moment seek to lessen their real influence) and compare the state of one waiting for compensation, whom for the nonce, we will call a railway patient, with the state as nearly similar as may be of a hospital patient, who has no compensation to look forward to, and who has been compelled to resume his work as soon as he was able, and then see how different is their lot, and how infinitely less wretched is the one man than the other. The hospital patient has long ago been well, while the railway patient has been waiting for months, it may be, until compensation has been paid him, believing that he could not return to work and to a natural and more healthful mode of life. Settle your claim and get to work, is the best advice which can be given a man in these circumstances. Get to work and you will soon find you have the strength for it and will forget the gloomy prognostications of those who say that you can never tell what may happen after a railway accident, and that you ought to wait and see how things turn out."

We have often thought that if Erichsen, in his graphic and classical work on "Railway and Other Injuries of the Nervous System," had confined himself to clinical description, his work would have stood in the light which its merits deserve. But when he gave the details of the monetary consideration received in each case, he aroused the cupidity of the world, and he detracted from the pure, scientific character of his exposition. The damages awarded were enormous and before undreamed of. We read "the question of damages resolved itself, to a great extent, into one of loss of income and expense incurred." "The jury awarded £5,775, or the plaintiff recovered £6,000." In this country, owing to the example quoted, damages have been awarded in this class of cases. as high as $49,000. From that time railway spine and railway brain became speculative troubles. Not a physician who was not impressed, dishonest ones not only supplied the legal side of the question with its medical data, but invariably pointed to the financial side. No medical book ever written has been more ex tensively read by the laity, and none, certainly, has ever been more closely studied. It has been the means, by its plain, graphic description, of educating more malingerers than any single book eminating from a professional mind.

It has been the foundation of compensation. If the baneful effects of compensation lead to the production of marked psychic anomalies, the story of rewards of damages, first detailed by Erichsen, plainly emphasized this factor and made it a disease-producing agent. In describing a new trouble Erichsen made operative a new influence, which, in its turn, is oftentimes more serious in its effects upon the psychic condition of the injured person, than traumatism itself.

We will not bore you by any more reference regarding either litigation or the creation of medical troubles through this means, but we desire to say that the great lacking element in the compromising of claims is the fact of a lack of closer harmony between the surgeon and the claim agent. This is particularly so in railways which have no organized medical service, or depend upon different medical examiners. We do not know of any more perfect arrangement in the compromising of claims than that at present existing in the hospital department, as at present established upon some railways of this country. They are the means of giving a continued experience, a close contact, a perfect understanding of claim agent and surgeon, and if there be any virtue in experience and familiarity with the multi-faced conditions surrounding the railway surgeon and claim agent, these are certainly engendered by hospital departments. With this assertion, we will then proceed to detail the benefits of a railway hospital department in the shape of compromise and the perfect settlement of claims.

The hospital departments possess the following advantages: First, they are the means of concentrating all the injured employes in the hospital of the department, and surrounding them with elements which are conducive not only to their physical, but to their mental welfare as well. Humanity and truth should constitute the basis of treatment in any hospital department, and it can be proven that they have been the means of mollifying and changing prejudices into calm, considerate and sensible action more than any other means which can be suggested. We do not believe that the concentration of all the injured employes into one place, as in a hospital, debars them from receiving injudicious and bad advice, or that it is a potent cause of preventing litigation, for sufficient liberty is always allowed for them to consult whom they desire. When frankness, hon

esty and truthfulness mark the treatment of the hospital physician to their patients, there is created a mutual confidence, which almost always leads to well-considered action. There is never any endeavor to deceive, but a plain discussion of conditions as they exist. The possibilities and probabilities of future capacity to work are all plainly considered and indicated. The employe truly knows that the claim agent of the railway company will endeavor to settle with him at the most favorable terms he possibly can, for he has been taught this by the experience of others; hence he expects nothing from this source, but a regular combat, all hinging upon the liability of the company in the infliction of his injury.

It is admitted that many consider that any person, in order to serve a railway company, must necessarily indulge in trickery and loss of individuality; yet from many years' experience we know that the reverse of this is true. None appreciates the integrity of any man more than the intelligent and competent railway manager. It has been our duty and pleasure to take injured railway employes to the claim agent and insist upon the employes listening to every statement made to the claim agent; nothing being left hidden or unstated, but a plain and truthful statement being made of facts indicating the extent of injury, the likelihood of permanent disability and any condition likely to arise in the future; even giving advice to the patient in the presence of the claim agent, that he had better not settle if at all uncertain as regards the future. When this has been done for years, there will be naturally engendered confidence upon the part of the employe from the fact that the previous experience of others indicated the honesty and truth of both claim and hospital department. Again, the union of the hospital department with the claim department of the railway enables the accumulation of a truthful history of any personal injury to employes, passengers and others. With the employe, this history extends from the inception of the injury along with a daily history until recovery, debarring dishonest persons from falsification or the substitution of origin in doubtful injuries.

Secondly, it relieves the railway company from paying doctors', board, drug, funeral and. other bills in the treatment of the injured employes, as the hospital fund is always competent to pay these. That is, these hospital de

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