350

Annotations.

PROFESSIONAL SECRECY.

"Ne quidnimis."

WE understand that certain of our readers haveconcluded from a sentence in a leading article whichappeared in THE LANCET of July 23rd, that we urgedthe General Medical Council in the exercise of itspowers with regard to infamous conduct in a profes-sional respect to remove from the Register the nameof any practitioner who gave evidence against a

patient in a court of law, whether ordered to do soby the judge or not. We did not make any so directrecommendation, and the motive of a purely tentativesuggestion has been misunderstood. In a briefreference to the discussion at the meeting of the BritishMedical Association, we wrote :

" As it is, the lawyerand the priest are not protected by statute, but noone questions the lawyer as to what the prisoner hastold him and the priest would be punished for divzlgi7zg.Possibly the General Medical Council ’might assist byoffering to remove from the official register the nameof any practitioner who laid bare his patient’s secretson the invitation of a judge." This was intendedto convey, and in our opinion was only calculated toconvey, the suggestion that, at present, the oftenreferred to case of the Roman Catholic priest offers noparallel to that of the medical man. If the formerenjoys any special privilege or protection in thewitness-box, as to which we are sceptical, it is due tothe belief (1) that he has solemnly pledged himselfnot to reveal the secrets of the confessional ; (2) thathe would incur ecclesiastical penalties by so doing.We consequently suggested that as no such pledge or

"

penalties exist for the doctor, his refusal to giveevidence might " possibly " be strengthened by his possible " being able to point to the danger that he would incur ’ ’.in giving it. We frankly agree with one correspondent correspondent that the High Court of Justice might resent such iaction on the part of the General Medical Council. <The mention of what ’* possibly" might be done was, <however, a suggestion only. It was made in accord- aance with the view developed in a leading article in (

THE LANCET of July 30th, that at some future date E

a test case calculated to arouse a strong combined c

protest by the medical profession, should call attention r

to the whole subject. Moreover, the suggestion, tas another correspondent has pointed Qut to us, i

was made at the meeting of the British Medical a

Association. --

I

THE INTERNATIONAL ASPECTS OF CHILD

WELFARE WORK.

Ax informal conference on the InternationalAspects of Child Welfare Work was called by theFriends’ Relief Mission in Vienna on Julv 18th. The

honorary president was Frau Marianne Hainisch,mother of the President of the Austrian Republic,Miss K. D. Courtney acting as chairman in the morning

. and Dr. Hilda Clark in the evening. Other speakersincluded Prof. von Pirquet. Miss Jane Addams,president of the Women’s International League forPeace and Freedom, Dr. Poerner, and Dr. Horneck,as well as representatives of child welfare agencies inSwitzerland, France, Austria, and Germany. The valueof relief work in promoting international understand-ing was dwelt on by several speakers, Dr. Hilda Clarkpointing out that, while international legislation wasvitally important, the interest and goodwill of ordinarypeople, especially of those concerned with questionsof family life, might have far-reaching effects in theeconomic welfare of nations. Miss Jane Addamsadvocated an international standard of child welfarebelow which no country should go, which wouldprevent children from starving in one country whileabundant food was available in an adjacent one. Prof.von Pirquet, dealing with the incidence of tuberculosis

in Vienna, said that, while it had been very preva-lent before the war, the years of under-nourishmenthad given it a terrible impetus. It had been found that90 per cent. of the children examined reacted to thecutaneous test, and as soon as symptoms of tuberculosisdeclared themselves in an individual it was necessaryto take active steps to increase the powers of resistance.Prof. von Pirquet described the means taken to supple-ment the insufficient sanatorium accommodationin Austria. The roof of a hospital for tuberculouschildren had been adapted to take 100 patients, whothus spent their whole time in the fresh air, the bedsbeing placed under a roof shelter. By this simple andinexpensive device the accommodation of the hospitalhad been doubled, and remarkably good results hadbeen obtained. Dr. Poerner said that, whereasdiseases of the digestive tract formerly accounted forthe greatest number of infant deaths, general debilitynow ranked first as a cause of infant mortality, sug-gesting an embryonic weakness resulting from badhealth conditions in the parents. The decrease indigestive disorders was mainly due to the fact that,owing to the scarcity of fresh milk, a far greater pro-portion of mothers nursed their babies than in pre-wardays. in spite of their own under-nourishment.Pyaemia and skin diseases showed an increase as acause of death, while a falling-off in nervous diseasesmight be accounted for by a reduced consumption ofalcohol on the part of parents.

THE TEACHING OF OBSTETRICS AT LEEDS.

THE Leeds Maternity Hospital is one of the youngestand most useful of the Leeds charities. Founded in1905 by the Leeds Ladies’ Hospital and MaternityFund, it began its work with 33 beds ; in 1910 thehospital was transferred to the present buildings,which are well situated and not far from both themedical school of the University and the infirmary.There are now 70 beds, and material enlargement isneeded. During 1920 the number of patients treatedat the hospital was 1540 ; of these 1314 were cases ofconfinement. the balance being made up of cases

attended elsewhere, in which complications had arisenas a direct result of labour. In addition to the workdone within the walls of the hospital, there is anextern department in which. last year, the number ofconfinements was 1366. Five subsidiary homes aremaintained in connexion with this extern department;the managers of the hospital have from the firstrecognised the importance of the teaching of midwivesas a part of their work, and during the year 98 pupilmidwives received training, 83 obtaining the certificateof the Central Midwives Board. In connexion withthe training of nurses at the General Infirmary anarrangement has been made by the board of theinfirmary for 20 of the infirmary nurses to receivethree months’ training at the Maternity Hospital, sothat they may obtain the midwifery certificate. Tocarry this arrangement out the infirmary grants tospecially selected nurses scholarships which cover

fees and expenses during training. Nurses are alsoreceived for training from the Poor-law infirmary,from the West Riding Nursing Association, from thegeneral infirmaries at Halifax and Nottingham, andfrom other institutions. The work is under the con-trol of the members of the honorary staff, of whichthe Professor of Midwifery at the University is anex-officio member.The presence of this well-equipped hospital in Leeds

has enabled some great improvements to be broughtabout in the instruction of students ; prior to 1885the latter had to rely on the private practitioners fortheir experience in practical midwifery, while a fewwent to special institutions such as the Rotunda.At the request of the board of the medical school anextern maternity department was instituted at theinfirmary ; after some years the desire for moresystematic teaching in practical midwifery led tosome few cases of special difficulty being admitted tothe infirmary, and subsequently a very small intern