cluded as to whether the man was insane or not, that they take him out and talk to him themselves. And I was told by one of the jury that on first ballot the majority were for sanity, but that acting on my suggestion they brought the man before them and in twenty minutes returned a verdict of insanity, because of their examination and that medical testimony cut no figure in the result! Boils have been called the opprobrium of medicine; medical expert testimony is the opprobrium of medicine of to-day. It is degrading the profession; it is perverting truth, and some means should be taken by which justice can be had and the medical profession exonerated from the odium which at present surrounds so-called expert testimony.

Dr. George H. Noble, Atlanta: Doubtless it would take a great deal of experience and much time to satisfactorily settle this question, and I wish to add a little to the discussion by making a suggestion; namely, that some authoritative medical body in this State might make a list of men who were considered to be competent to testify in the different departments of medicine and surgery and recommend the same to the courts, which should appoint from this list two men who are acceptable both to the plaintiff and defendant.

The two appointees should select a third man which is acceptable to the court, and they, as a commission, should take the printed testimony, weed out all foreign matter, and return it to the court under oath. This commission should be paid by the court so as to avoid the liability of becoming biased in favor of one side or the other. It is to be presumed that the efficacy of such a system as this would depend upon the character of the men that were recommended.

Dr. Willis F. Westmoreland, Atlanta: The medical expert reminds me of the man who was in a doubtful state during the last election. He had been a democrat up to a

certain length of time, when he changed over and helped the State to go Republican. One of his friends said to him, "The Republicans are in office." "Yes." "Do you expect an office?" "Well," he said, "I am human." I think this illustrates expert testimony all the way through. We expect office and we get it in proportion to the side that wins, and we are all human.

Every one knows that these recommendations amount to nothing. They will have no influence when any of us get on the stand, and will have absolutely no effect on the testimony that is given. The testimony given in cases of insanity is always very peculiar.

George Francis Train, of New York, who is quite a noted character, was tried some years ago for insanity with refer ence to the disposition of his estate. Dr. Hammond, an expert in nervous diseases and well known to the profession, testified in regard to Mr. Train's mental condition. He represented the heirs, and said there was no question in regard to his insanity, but that there was no need of confining him. He said: He said: "I do not think he is a man who would commit any crime." Mr. Train was a shrewd citizen, and the next morning, to get even with Dr. Hammond, he sat down and wrote him a note, saying that "according to your testimony and the findings of the court, if I were to meet you on the street to-morrow and shoot you through the heart no jury could do anything with me." Hammond read Mr. Train's letter, and it is said secured the services of two private detectives who followed him for about two years for fear that Mr. Train might carry out the recommendations of his letter. That is the position in regard to these cases. There was a little episode in Puck which said there were three kinds of liars-one was the doubtful liar, the other a damn liar and the third was the medical expert witness. This is practically true. So long as we try cases the way we do at present testimony will be given in the same way.

Every man is interested in any case he comes in contact with, not especially from a pecuniary standpoint, but the ego is so marked in every man that when he goes on the stand he will try to carry out his idea in regard to the particular case; I do not care whether he receives $5 or $500 for his testimony. The inconsistency of expert testimony which has been mentioned here to-day is true. Take the ordinary doctor on the stand and he makes a serious mistake in one regard. There are two classes of subjects upon which he is called upon to testify. He has to testify regarding the case which he has examined, then his testimony is direct; or he has to testify simply as an expert in regard to a hypothetical question entirely, not based upon this case. If he has not examined the case his testimony is hypothetical. If he has examined the case and takes the stand, his testimony in the direct examination is based on his conclusions in the case, and he says that the man has a fractured arm, for instance. He is honest, sincere and truthful in giving that testimony. The lawyer gets up and cross-examines him. The cross-examination is purely hypothetical. The lawyer will probably say to him, "So and so had such and such an injury-could you say that the arm was fractured?" The doctor says no. In the first place, the doctor testified in regard to the injury and said that the arm was fractured, but in the cross-examination he has not testified in regard to the particular case at all, but has answered a hypothetical question, which, unless the doctor is careful, is based upon that particular case. On cross-examination he says the arm was not fractured. The inconsistency of legal testimony arises largely from the manner in which questions are asked.

Some years ago, when I was on the witness stand, a lawyer on the opposite side said: "Dr. So-and-so has examined this case, has treated it, and comes here and testifies to so Now, won't you have to acknowledge that any

and so.

physician who has been connected with a case and has treated it all the way through, has seen it every few days, is better qualified to testify in regard to it than you are?" What are you going to say? You are to answer in regard to a fellow physician, who may be a personal friend or an enemy, it does not make any difference which side he is on. He has had charge of the case from beginning to end. You have examined it once and the attorney asks you whether he is not better qualified to testify in regard to the case than you are. It is simply such questions as these that catch the average medical practitioner when he gets on the stand. You have said that this man has so and so, your opinion being based on one examination, and at the same time you testify, no matter who examined the case and had charge of it all the time, that he is much better qualified to give evidence in regard to the case than you are. My rule is never to answer any questions that are propounded by lawyers except they are based on direct cases. I have taken the stand and a lawyer has said to me, "Do you know Dr. So-and-so? He is a practitioner in good standing is he not?" I replied, "I am very sorry, but I am here to answer questions in regard to this case." The lawyer then said, "Do you know Dr. So-and-so?" I again replied, "I am very sorry I cannot answer your question. I cannot give any testimony in regard to any fellow practitioner and you cannot compel me to do so. I have got no friends, no enemies in this case, and you cannot force me to reply to your questions except they pertain to or are directly based on the examinations I have made. If I have not made it, you can ask any hypothetical question."

The doctors themselves are largely to blame. They get into this trouble simply from the fact that they do not learn how to say no when on the stand. Nine doctors out of ten want to answer every question. If they would learn to say "I know," and "I don't know," expert testimony would not be in the position that it is to-day.

A CASE OF CYSTOCELE COMPLICATING

LABOR.

BY V. D. LOCKHART, M.D., MAYSVILLE, Ga.

Gentlemen: I report this case for the reason that few such cases are recorded in our literature, and because I experienced something in this case which may be of interest to the general practitioner from a clinical point of view.

By the term cystocele complicating labor is meant a prolapse of the bladder into the vaginal passage during labor. A cut illustrating this condition is printed in the American System of Obstetrics, and is here reproduced.

Mrs. J. N., robust, blonde, aged thirty-six, mother of eight children, two of them deaf mutes. Was called to attend her in labor October 12, 1893. Had treated her for a troublesome cystitis after her previous confinement two years before. She was a subject of partially lacerated perineum. The tear had not been very extensive. All her labors had been slow and troublesome. I was away when the messenger came for me, and there was some delay in reaching her. Arrived at the house at 11 p.m. She had then been in labor four hours; pains very strong and expulsive but, to use her own expression, they "seemed to do no good." She was lying on her back, straining with all her might, and I suspicioned at once that something must be wrong.

Made hasty examination and found a large, rounded tumor presenting at the vulva, which, in my haste, I took for a shoulder, and at once prepared myself to do a version. The patient was laid across a firm mattress, and after thor