Decline and Fall

I t is a depressing paradox that in spite of the recent resurgence of interest OII

the wider scene of the forensic sciences, the long-established interest of the universities in forensic medicine seems to be rapidly on the wane.

In less than a decade, two energetic professional associations have been founded, two excellent journals launched and many enthusiastic meetings held. The Establishment themselves have been stirred to action-perhaps inevitably is the face of increasing crime and more clamorous public opinion. They have set up a Research Laboratory, advisory committees and an Interdepartmental committee as well as generally encouraging the increased use of scientific aids in law enforcement. Mass communication-television, newspapers and other means of popular exposition of forensic matters-has brought an awareness of the discipline to every man-in-the-street.

Yet, in the face of all this, academic forensic medicine has gone steadily downhill until there is now a danger of its complete extinction. With one or two notable exceptions in London, the universities appear to look upon the specialty with complete apathy, or even open antagonism. The Chair of Forensic Medicine in Birmingham was one of the first to go, the department being frag- mented. The Chair at Edinburgh has remained empty for some years. The Readership at Sheffield has been demoted to a lectureship and the department converted into a sub-department under the Professor of Pathology. All but one medical school in England and Wales has abandoned the degree examination, so that the great majority of new doctors now have little incentive to learn any legal medicine.

Now, and perhaps the most serious threat of recent years, is the fate of the only professorial department outside London (excluding Scotland). Professor Polson is soon to retire and the future of the well-known Leeds department hangs precariously in the balance-a balance, one might guess, that might be tipped one way or the other by the long-awaited report of the Home Office Brodrick Committee.

If Leeds is demoted, as have other departments, then the already make- shift career structure of the full-time forensic pathologist will crumble so badly that not only will there be no new recruits, as is the situation at present, but the existing younger men will be tempted to desert the sinking ship for more progressive disciplines.

What are the causes of this academic blight-and might it not be justified? Primarily, forensic medicine has fallen between not two, but three stools.

At the inception of the National Health Service in 1948, it was excluded as a speciality, which was unfortunate, both from the point of view of its develop- ment, its contribution to the community and, not least, the remuneration of its practitioners.

There remained the Home Office and the universities and a somewhat un- happy compromise has grown up between them. On the one hand, the Home Office wants the services of a forensic expert, but does not want to pay for them, whilst on the other hand, the universities-with few exceptions-seem neither to want the man nor want to pay him, suffering him to remain mainly because his appointment already existed. One only has to look around the country and try to find a department that has actually expanded-with one notable exception, the trend is in the reverse direction.

In most universities forensic medicine is virtually self-supporting, this forming the only basis for its toleration. Either all fees are paid in and a fixed salary given, or a small part-time salary is offered, the pathologist making up the rest by his individual efforts. One can hardly visualise a department of mathe-

121

matics, anatomy or languages functioning on this basis. The university argues that police and coroner's work is a service to the community, on a par with sanitary inspectors and refuse-collecting, and should be similarly provided by the public authorities.

The work load of a forensic pathologist is so great that he has little opportunity for research, this not endearing him to the academicians. Further, by their own edicts, teaching has been pruned to a travesty of what is necessary and this again reduces the attractiveness of forensic medicine to the university fathers.

The alternatives would be either to abandon academic forensic medicine altogether or to take it under the wing of the Home Office. Of the two, the first seems the most likely to occur unless a halt is called to the present process of attrition. The hospital pathologists already perform about eighty per cent. of all coroner's autopsies, mainly the non-criminal sudden deaths. Without them, British legal medicine would grind to a rapid halt. I t has been advocated that all forensic pathology should be handed over to the clinical pathologist, in spite of the fact that it already encroaches appreciably into the clinical duties of many of them. Apart from a few very experienced and enthusiastic men, the majority would not want this added burden and responsibility. The prospect of standing with policemen in muddy fields a t three in the morning, of subsequent days wasted in court and the prospect of a verbal lashing by Counsel, does not attract most hospital pathologists. More important, in spite of what many may say to the contrary, the expertise of forensic medicine-both technical considerations and mental orientation-can only be learned by much experience; to spread the available experience of criminal cases so thinly over the country so that each clinical pathologist saw but a few cases a year would be a most undesirable and retrograde step.

The other alternative--direct employment by the Home Office-seems out of the question for practical reasons. If every Forensic Science laboratory had a full-time pathologist, all the histological facilities available in universities would have to be re-duplicated and valuable liaisons such as those with anatomy and dental departments would be lost. If his only function was to deal with criminal cases, he would be underemployed, as the Home Office would have little interest in him doing routine sudden-death work. I t would require a major admin- istrative upheaval and a great increase in man-power to set up what would virtually be a National Forensic Service on the continental pattern, though inevitably this must come a t some time in the distant future.

The only immediate solution is the continuance and improvement of the traditional association with the universities. This could be attained by the added stimulus of a direct Treasury grant to sweeten the present academic attitude. Outside London and Scotland, there is a t present a forensic foothold in Bristol, Cardiff, Sheffield, Leeds, Manchester, Liverpool and Newcastle. If a direct subsidy was given to each of these universities, on the condition that the money was spent on establishing or maintaining a separate department of forensic medicine, then the university would have someone to teach and research without having to grudgingly count their own pennies--and the Home Office would have a first-class service available, even if it cost them a little more than the ridiculous pittance that they hand out as an honorarium a t present.

And, just as important, there might then be a few recruits attracted into forensic medicine-if not, the police are one night soon, going to find themselves standing alone in that muddy field.

B.K.