Book Review

Bodies of Evidence: Medicine and the politics of the English inquisition, 1830–1926

N Engl J Med 2000; 343:588-590August 24, 2000

Article

Bodies of Evidence: Medicine and the politics of the English inquisition, 1830–1926
By Ian A. Burney. 245 pp., illustrated. Baltimore, Johns Hopkins University Press, 2000. $39.95. ISBN: 0-8018-6240-X

In the late 12th century, the office of the coroner came into being in England. The coroner served as the king's local agent to ensure the receipt of royal revenues from the administration of justice (Figure 1A Coroner's Inquest.). Sir Thomas Smith's 16th-century De Republica Anglorum provided a rationale for the coroner's inquest: Because “the death of everie subject by violence is accounted to touch the crowne of the Prince, and to be a detriment unto it, the Prince account[s] that his strength, power and crowne doth stande and consist in the force of his people, and the maintenaunce of them in securitie and peace.”

Ian Burney's examination of the medical, legal, and political components of the English coroner's inquest highlights the forceful interplay between government and science from 1830 to 1926. As a cultural historian, Burney questions assumptions favoring science as a standard of valid information. In addition, he discusses the genealogy of the popular inquest, the registration of deaths and vital statistics, the role of the medical expert and the postmortem examination, and deaths due to anesthesia.

By the late 1890s, there were 330 coroners in England and Wales. In 1905, only 15 percent of the coroners were physicians; most were solicitors. In adhering to the concept of a “poor man's court,” the coroner's office initiated inquests when citizens reported unexplained deaths. Twelve to 24 men were sworn as a jury. The coroner and the jury went to the location where the body lay and performed a “view of the body.” Evidence was taken from the “first finder” of the body and from other witnesses. Occasionally there was a medical witness selected by the coroner. Although the bulk of the questioning and note-taking was done by the coroner, the jury could address questions to the witnesses. At the end of the inquest, the coroner summed up the evidence for the jurors, who then deliberated in order to render a verdict. An inquisition form was signed by the coroner and the jurors. Riders could be added to the verdict to suggest reforms, render praise or blame, or comment on the procedure.

After 1836, physicians were paid £1.1 for simple evidence without a postmortem and £2.2 for postmortem testimony. A legislative act in 1919 allowed women to serve on inquest juries. By 1894, viewing of the body was considered “useless, revolting, and the cause of illness to Jurors.” Legislation in 1926 made viewing of the body by the jury discretionary. Interestingly, a few months before the 1926 legislation, a high court had voided a coroner's inquest verdict because there had been no viewing of the body.

In 1830, Thomas Wakley ran for election as Middlesex County coroner. Wakley was a surgeon, a journalist, and a public figure. One of Wakley's election slogans was “Reason and Science against Ignorance and Prejudice.” There were objections to having a medical coroner, and Wakley lost the battle. Nine years later, however, he was elected coroner of the Western District of Middlesex County. Coroner Wakley was a reformer who sought to bring about changes in work homes and institutions where unexplained deaths occurred frequently. On one occasion, a pauper fell into a vat of boiling water and died. At the coroner's inquest, the home's proprietor questioned the identity of the body. Wakley responded, “If this is not the body of the man who was killed in your vat, pray, Sir, how many paupers have you boiled?” In the investigation of another pauper's death, the inquest jury added to its verdict the admonition that it was “not humane to imprison him without fire, and on a low diet.”

The coroner's inquest was held in a public place, often a pub. In The Uncommercial Traveller, Charles Dickens describes the inquest location as being “amidst several implements of conviviality, the odour of gin and the smell of tobacco-smoke.” Dickens was a juror in an inquest conducted by Wakley, and there is an illustration of Dickens and Wakley in this book. Early in the 20th century, there was a move to hold inquests in coroners' courtrooms.

In 1878, Douglas Maclagan, a professor of medical jurisprudence at the University of Edinburgh, spoke about expertise in postmortem examinations at a meeting of the British Medical Association: “A dead body tells no tales, except those which it whispers to the quick ear of the scientific expert, by him to be reported in the proper quarter.” During the 1890s, Stanley B. Atkinson, a London barrister and justice of the peace, published the Golden Rules of Medical Evidence. He urged witnesses to cultivate the “power of expression and repression” and the use of plain speech so “the jury will think they understand.”

Burney explores the relation between medicine and an inquisitive public as he investigates violent deaths caused by anesthetics. Ether and chloroform were initially used in medical care during the mid-1840s. Thereafter, death due to an anesthetic was the only type of death related to medical care that required a coroner's inquest.

Burney's epilogue updates the situation and explains the 1926 Coroner's [Amendment] Act. A jury became optional, the body could be removed from the place where it had been found, and coroners could get information from a postmortem examination before deciding whether to conduct a full inquest. Public reaction included the following headline in an October 3, 1929, newspaper: “The Coroner a Law Unto Himself, Extraordinary Powers of Exclusion.” By 1938, 46 percent of deaths were handled without inquests, and more than 90 percent of those cases were concluded after a postmortem examination. Maintaining tradition, a 1971 governmental report lauded the public's continuous “instinct, curiosity and suspicion” regarding the causes and circumstances of death.

This well-researched book recounts an enthralling tale of the rise of the medical forensic expert. In addition to several illustrations, the book includes reference notes, which provide enlightening background material. The 172 pages of narrative text are informative and easy reading.

Allen D. Spiegel, Ph.D., M.P.H.
Downstate Medical Center, Brooklyn, NY 11203