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So in regard to communications made by a patient to his physician while the relation exists.

There is no provision of law which Dr. Harwood violated when he refused to disclose what was said to him by his lady patient.

R. J. O'SULLIVAN, M.D., has always been under the impression that physicians were bound, according to the common acceptation of the law, to report cases to the coroner if the case is criminal and life has been taken. He may be totally wrong; but that is his impression. We should be careful how our sympathies are excited.

CHARLES A. LEALE, M.D., thought that the law of the State of New York amply protected the physician, lawyer, and clergyman in cases of confidential communications, and even if professional men were not thus legally protected, no gentleman would for a moment doubt the propriety of burying forever secret communications (not beneficial to the living) made to regain health, by those no longer able to deny, or justify by explanation, the actions of life. Nor should any torture or threat have any avail in forcing such confidence to be betrayed, for just so surely as death is to be averted, so have absolute confessions to be made to the physician by those in all professions and conditions of existence. In justification of the laws of our State, Dr. Leale stated that shortly after receiving his diploma he was called to appear before the Grand Jury, and was importuned by two of the jurymen for a direct answer to a leading question involving a dying statement made to him. He refused to impart the information, although threatened to be sent to prison for contempt. He appealed to the foreman, saying nothing could make him reveal it, when one of the jurymen present jumped up and said: "Young man, do you refuse to answer a question of the Grand Jury?" He replied, "Yes, when it involves a professional communication." A legal gentleman, then present, instructed the jury that by the laws of the State a physician was protected. Thereupon he was discharged, and the case never again was referred to.

The doctor thought that Dr. Harwood had acted correctly in not permitting the publicity of an act for which no living person was responsible any more than if his patient had died of con

sumption, and which might cause pain and lasting sorrow to a large circle of intelligent and worthy members of society. Dr. Leale then expressed his opinion on a subject he had seriously considered for a number of years, viz: the eagerness with which not only the public but even the coroners render verdicts of suicide in cases where, perhaps, eccentricities or peculiar habits were seized upon as the easiest way of arriving at the supposed cause of an unexplainable or mysterious death. did not believe that more than fifty per centum of the recorded deaths by suicide were in reality cases of self-destruction. The onus probandi being so difficult, we ought to be exceedingly cautious before permitting to be rendered the verdict of suicide, considered by so many an unpardonable sin, and which, according to the ecclesiastical laws, prevents a Christian burial.


There are several Medico-Legal points illustrated by the case narrated by the author of the paper, but perhaps inadvertently omitted to be mentioned. First, the power of concealment which a patient might have after producing such an injury. He was called by the doctor in consultation to see this lady, and although the pistol was held within a few inches of the mouth, he could see no traces of the blackening by the charcoal of the powder, and as the wound of entrance was in such a vascular part and could only be seen by carefully examining the posterior fauces, by pressing the tongue forward, it can readily be understood how such a patient, if not minutely examined, could pass off her trouble as one of idiopathic tonsilitis, especially during a severe epidemic of diphtheria, such as we in New York were then having. The doctor gave the case a thorough examination, and by his treatment undoubtedly prolonged very much her life. He gave free exit to the discharge of pus, and frequently cleaned the then open wound thoroughly from the accumulations of the rapid destruction of tissue, which he had so often seen follow these injuries of the throat. Secondly, he was of the opinion that the woman was insane at the time she committed the act. She was at a critical period of her life, when we know women are frequently suffering from cerebral congestion. Just as menstruation ceases, women are subject to these severe attacks of transitory mania, and are often in the actual state of irresponsibility: and woe to the one who at this

period wantonly irritates the unfortunate sufferer, as the experience of many of us can verify. This lady had many of the surroundings to cause sleeplessness and disturbed mental equilibrium, and was in that state of frenzy placing her actions entirely beyond her own control. He thought that the doctor was perfectly justifiable and did right in keeping the secret; that he did all possible to save or prolong her life, and then protected the innocent family from the stigma of publicity, as Mr. Yeaman had so well expressed it.

Dr. E. C. SPITZKA stated that the case presented by Dr. Harwood was important from a Medico-Legal point of view. He did not think that the law required a case to be sent to the coroner unless it was the direct result of criminal violence. The death in this case was not the direct result of criminal violence, but was due to a series of causes which were remotely traceable to the injury.

The remarkable feature in this case was that, while the anterior half of the ring of the atlas had been entirely destroyed, and the articular process of one side of the epistropheus was carious, and that pus and detritus were in immediate proximity to the the spinal dura, the brain and cord, and their membranes, were entirely healthy.

It may be interesting negatively to report that while this patient had evidently committed the tentamen suicidii in a state of insanity--the form known as melancholia-a minute examination failed to reveal the slightest evidences of disease in the brain-tissue, an experience in conformity with others he had made.

Dr. HARWOOD said he was very much gratified at the interest which his report had awakened. He fully appreciated the remarks of his friend Dr. Leale, in regard to the possible concealment of the self-inflicted injury of his patient; but the fact that he could not see any blackening from the powder should be no surprise to him or to any one else, when he recalled the fact that Dr. Leale did not see the patient until twenty-four hours from the time the shooting occurred, and that he (Dr. Harwood) had practiced irrigation with warm water to the pharynx and buccal cavity for an almost uninterrupted period of six hours. Instead of the pistol being held within a few inches of the

mouth, as Dr. Leale remarked, the real facts were that the muzzle had been inserted in the mouth, in order to avoid the liability of producing an unsightly corpse.

He felt under lasting obligations to his friends Drs. Leale and Spitzka, for the support they both gave him in carrying out his convictions in regard to the propriety of keeping the record of this unfortunate woman hidden from the world.

There was no act of his professional life that he could recall which afforded him more satisfaction than the one that this estimable family had been saved through his instrumentality from the stigma of having it publicly known that this fond wife and mother, during an attack of frenzy had attempted her own life.

The beautifully articulated vertebral column loaned him by his friend Prof. Lewis A. Sayre, showed more thoroughly than any description could, the difference between the abnormal and normal condition of the specimen presented.

He felt that the law relating to the subject of confidential communications, and the professional oath as administered to those about to graduate in medicine, by authority of the State, thoroughly protected him in the course adopted in this case.


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