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methods, in my judgment and that of professional friends— two different surgeons beside myself seeing her. She lingered for three months, suffering a great deal of pain. There were abscesses which were opened and discharged freely. She died at the expiration of the period mentioned.
The case was reported as one of caries of the cervical vertebræ, cervical abscess, septicæmia, and asthenia.
By inspection of the pathological specimen which I show you, it will be seen that the odontoid process is entirely necrosed, and has disappeared ; the anterior portion of the atlas had been fractured but reunited completely ; the spinous processes are almost entirely destroyed. The second ball, which could not be found until at the autopsy, which was very nicely made by Dr. E. C. Spitzka, the Curator and Pathologist of the Society, may be seen in situ, between the second and third vertebra.
Since the specimen has been macerated in alcohol, it has shrunk, so that it is not quite as good a specimen as it was when first prepared.
The free ball shown you is the one which was extracted. The marks of the forceps on the bullet are plainly visible.
The Medico-Legal bearing of this case, it seems to me, is of importance to the profession, and its consideration involves a reply to the question whether, under the circumstances, as related, of a person dying eventually from self-inflicted violence, I was justified in pursuing the course I did, of not bringing it to the notice of the coroner. I feel, myself, that my course was the only proper one. The family was one that I had
I known intimately for many years. They were people of wealth and culture. There was not the slightest suspicion of foul play or criminal carelessness, and I thought that, under such circumstances, and such people, it was better that a matter of this character should never be brought before the public and be heralded through the press.
I am aware that the law regulating coroners' inquests in the County of New York (Chap. 462, Laws of 1871) reads as follows :
“ SECTION 1. Hereafter, when in the City and County of
New York, any person shall die from criminal violence, or by a casualty, or suddenly, when in apparent health, or when unattended by a physician, or in prison, or in any suspicious or unusual manner, the coroner shall subpoena a properly qualified physician, who shall view the body of such deceased person externally, or make an autopsy thereon, as may be required (preparatory to an inquest]."
But, while recognizing the superiority of the law, my own conscience supports me in the conviction, that here was apparently a conflict between law and a physician's duty. We are obliged by the laws of the State to keep inviolate the secrets of patients necessary to the proper performance of professional duty, as will be seen from the following quotation from a report of the Permanent Commission of this Society, in reply to an inquiry by the Philadelphia Obstetrical Society (through Dr. John H. Packard, as its President), which very valuable report may be found in the Second Series of Medico-Legal Papers, pp. 46-48, inclusive. The law there quoted is as follows :
“No person duly authorized to practice physic or surgery shall be allowed to disclose any information which he may have acquired in attending any patient in a professional character, and which information was necessary to enable him to prescribe for such patient, as a physician, or to do any act for him as a surgeon." (Part 3, chap. 7, title 3, art. 8, sec. 73, R. S.)
Whether this law applies to this case, or not, I leave for determination to the legal side of the house.
I hold in my hand a translation of the ancient Hippocratic oath, which, with your permission, I will read :
“I swear by Apollo, the physician, and Æsculapius, and Health, and All-heal, and all the gods and goddesses, that according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents ; to share my substance
with him, and relieve his necessities if required ; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation, and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my own sons and those of my teachers, and to disciples bound by stipulation and oath, according to the law of medicine ; but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel ; and in like manner, I will not give to a woman a pessary to produce abortion. With purity and holiness I will pass my life and practice my art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
“While I continue to keep this oath, inviolate, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this oath, may the reverse be my lot!"
I also have before me the modern oath, which is administered to every graduate in medicine, by the authority of the State, before the degree is conferred. It is as follows :
MODERN HIPPOCRATIC OATH.
“You do solemnly promise and declare that you will honestly, virtuously, diligently, and faithfully conduct yourselves in the discharge of the several duties of your profession; that you will strive to preserve its purity and promote its advancement; that you will be kind and attentive to your patients, and treat their diseases, so far as your ability may avail, in such manner as shall most certainly secure their safety and promote their speedy recovery; and that
and that you will keep inviolate the innocent secrets of those persons and families to whom you may be called to render professional aid; you, moreover, do solemnly declare that you will never, by any considerations, be induced to administer medicines or prescribe remedies for improper or pernicious purposes. “ And
you do further agree, that in case of failure on your part to observe these obligations, the authorities of this college, from whom you received the right to exercise the healing art, may publicly revoke the same, and declare your diplomas null and void.
“These obligations you do now, each of you, assume and acknowledge."
was a woman of thoughtful mind, liberal intelligence, and exemplified the characteristics of a good mother and loving wife in the highest degree; and I think that none of you will hesitate to agree with me, that my duty was to protect her and her family under the circumstances; but whether I acted entirely according to law or not, I am unable to say. I leave that, Mr. President, for this Society to determine.
Hon. G. H. YEAMAN remarked that whether the ethics of the medical profession required Dr. Harwood to disclose these facts or not, he did not know. As to the confidence between physician and patient, the law protects both, and prohibits the doctor from divulging any information that is communicated by the patient, which was necessary to a proper treatment of the case.
They are sealed not only under professional confidence, but by the statute, and the seal cannot be broken without the consent of the patient.
The doctor asks the question: Was he justified in the course pursued? He could only say that in the profession of law, they would take the course which Dr. Harwood had taken. Still he would defer to the other members of the bar who were present, and who understood coroner's law better than he did. All could appreciate the fact
that in the case of this cultured, respectable lady, who had been smitten with this peculiar frenzy which terminated in that act, and of the family, it would be a great stroke and mortification to have the circumstances of the case known, but publicly discussed in the newspapers. It would require a very plain and positive statutory command to induce him (Mr. Yeaman), or to compel him, if he thought the best interests of all would be better served by withholding a similar case from the public, to report it, when he thought the happiness and peace of the family depended upon such a concealment.
D. S. RIDDLE, Esq., had not given coroner's law, in relation to the subject in hand, a very critical examination; but he wished to refer to a few points which had occurred to him. He did not wish to discuss the question raised by Dr. Harwood from the point of conscience or ethics, but from the point of law. There are three relations which the law regards confidential; those between physician and patient, lawyer and client, and clergyman and parishioner. Whatever disclosure is made by the patient to the physician in respect to the disease, or by the client to the lawyer in respect to the matter consulted about, or by the parishioner to the clergyman at the confessional, is confidential, and cannot be disclosed by physician, lawyer, or clergyman. The law will not allow it to be disclosed, and will not recognize it if disclosed. That is common law. He had in mind the case of a person who, at the confessional, disclosed to his confessor the fact that he had committed a murder. The secret was not and could not be disclosed, as the man knew, having been made to a priest at the confessional. Some time after this, however, this man met the same priest in the street and boastfully referred to his confession and the fact that it could not be divulged. But the priest replied: "What you told me at the confessional is sacred, but what you told me here is not. It is now my duty to inform on you”-and he did. This was strictly lawful. While it was the duty of this clergyman, as a good citizen, to disclose a crime which had come to his knowledge outside of his relations as a confessor, the law would not permit him to do so if he obtained the knowledge in his relation as such. The law will not penetrate the secret of this relation, and will allow no light to shine upon it.