- Email: [email protected]
PEMPHIGUS NEONATORUM
397
Bill with this limited objective was, as it happens, introduced by Sir E. Graham-Little in 1927. Had it then been welcomed with the enthusiasm which Members of Parliament now show for its proposals retrospectively, perhaps it might have been passed into law. Its fault, possibly, was that
venereal disease, the claims of public health far outweighed the claims of justice. If this be true, some Parliamentary re-statement of the law is long overdue. If disclosure is never insisted upon where the fiduciary relationship of solicitors and their clients is concerned, why must it always be
enough. But it is disappointing insisted upon in the case of doctors and their legislative genius of Westminster patients ? Would Parliament accept, as an initial cannot hammer a Bill, however clumsy the original step, a measure to recognise medical privilege in shape, into serviceable form. The Solicitor- General civil but not in criminal proceedings ? The result was singularly pessimistic last week ; Sir E. would not be what doctors and patients understand Graham-Little’s Bill was hopeless ; nothing could by professional secrecy, but it might meet some of the criticism which complains that medical privilege be done to improve it; it must die. Meanwhile the medical practitioner is left in may shelter murderers and abortionists. If no doubt and difficulty. Last summer a doctor was such compromise be acceptable, we hope that judicially scolded for disclosing the disease for Sir E. Graham-Little will bring in his original which a patient had consulted him. It was a Bill again. If the sympathy expressed last week civil case at Leeds assizes. The patient was dead. be genuine, the third time he may be lucky. His widow was suing the doctor to recover a sum of money said to have been lent by her late husband. PEMPHIGUS NEONATORUM it did not go far to find that the
Mr. Justice CHARLES was horrified at the breach of privilege. " What do you mean," he demanded, " by revealing what ought to be a matter of the most sacred confidence between you and your " patient ? Usually the judicial bombardment thunders from the other flank. How dare a doctor claim privilege for professional secrets when summoned to give evidence in a court of law ?1 The dilemma, as Sir E. Graham-Little reminded the House of Commons last week, has been particularly unfortunate in the treatment of venereal disease. The Royal Commission of 1916 was satisfied that this racial scourge could be reduced within narrow limits by early and efficient treatment; it recommended free clinical facilities for the whole community, and it insisted upon the importance of secrecy if patients were to show the necessary trust in consultation and treatment under the scheme. Official regulations, made under statutory authority and having the force of law, were subsequently issued. They enacted that all information obtained in regard to patients treated under the scheme must be treated as confidential, it being essential that patients should be fully assured of the secrecy of the arrangements. That was clear enough. The medical practitioner, who has his own immemorial code of professional reticence in these matters, understood that it was a legal as well as a moral duty. In two High Court the doctor was cases, however, subsequently told that the secrecy enjoined by the Venereal Disease Regulations did not mean what he innocently supposed ; in fact, if he persisted in obeying the regulations, he might find himself in peril. It was after the second of these cases that Sir E. Graham-Little introduced his original Bill in 1927. The Ministry of Health might have been conscious of some responsibility for the deadlock due to its regulations, but it made no sign. If the claims of justice had to be weighed against the claims of public health, the Ministry refrained from intervention. Early in 1928 the learned judge who is now Lord ATKiN, in some extrajudicial comment on the 1927 Bill, said he thought that in some cases, notably those connected with
IT has long been known that pemphigus neonatorum and pemphigus vulgaris have nothing in common but the vesicles or bullse and the fact that either may be fatal. The former-which ought to receive some different name such as bullous impetigo of the new-born 1-is a highly contagious disease of infants that from time to time causes outbreaks in maternity or nursing-homes, and is always (so far as we know) due to the Staphylococcus pyogenes
‘
given by Normark2 is suspiciously long, including the permanganate bath (probably still the best, both in treatment and prophylaxis); various mild dusting powders and weak solutions of silver salts ; dyes such as flavine, brilliant green, and methyl. violet; and sulphur precipitate or even mercury in ointment or calamine lotion. It is quite true, as Normark says, that despite any of these applications a denuded surface may extend centrifugally ; and when this happens the outlook becomes black. It is of paramount importance, therefore, when such a tendency is observed, to limit and confine the spread of the infection to its primary locality, and this, he claims, can usually be done by occlusion with Elastoplast, whose use has already been advocated by Newman3 in a very similar disease-impetigo contagiosa. Adopting a procedure like Newman’s, and occluding the newly infected area or areas for a week at a time, there were no undesirable sequelse, and the period of treatment is said to have been reduced from 16 days to 9. The number of cases (11, with 12 controls) was admittedly small, but further trial would certainly be justified. THE Hunterian oration of the Hunterian Society is to be given by Lord Horder at the Mansion House, London, on Feb. 22nd, at 9 P.M. His subject is the Hunterian tradition. 1 Poole, W. H., and Whittle, C.
H.
(1935) Lancet, 1, 1323,
1333.
2 Normark, A. (1936) Uppsala Läk Fören. Förh. 42, 309. 3 Newman, J. L. (1933) Brit. med. J. 1, 823.
-
Bill with this limited objective was, as it happens, introduced by Sir E. Graham-Little in 1927. Had it then been welcomed with the enthusiasm which Members of Parliament now show for its proposals retrospectively, perhaps it might have been passed into law. Its fault, possibly, was that
venereal disease, the claims of public health far outweighed the claims of justice. If this be true, some Parliamentary re-statement of the law is long overdue. If disclosure is never insisted upon where the fiduciary relationship of solicitors and their clients is concerned, why must it always be
enough. But it is disappointing insisted upon in the case of doctors and their legislative genius of Westminster patients ? Would Parliament accept, as an initial cannot hammer a Bill, however clumsy the original step, a measure to recognise medical privilege in shape, into serviceable form. The Solicitor- General civil but not in criminal proceedings ? The result was singularly pessimistic last week ; Sir E. would not be what doctors and patients understand Graham-Little’s Bill was hopeless ; nothing could by professional secrecy, but it might meet some of the criticism which complains that medical privilege be done to improve it; it must die. Meanwhile the medical practitioner is left in may shelter murderers and abortionists. If no doubt and difficulty. Last summer a doctor was such compromise be acceptable, we hope that judicially scolded for disclosing the disease for Sir E. Graham-Little will bring in his original which a patient had consulted him. It was a Bill again. If the sympathy expressed last week civil case at Leeds assizes. The patient was dead. be genuine, the third time he may be lucky. His widow was suing the doctor to recover a sum of money said to have been lent by her late husband. PEMPHIGUS NEONATORUM it did not go far to find that the
Mr. Justice CHARLES was horrified at the breach of privilege. " What do you mean," he demanded, " by revealing what ought to be a matter of the most sacred confidence between you and your " patient ? Usually the judicial bombardment thunders from the other flank. How dare a doctor claim privilege for professional secrets when summoned to give evidence in a court of law ?1 The dilemma, as Sir E. Graham-Little reminded the House of Commons last week, has been particularly unfortunate in the treatment of venereal disease. The Royal Commission of 1916 was satisfied that this racial scourge could be reduced within narrow limits by early and efficient treatment; it recommended free clinical facilities for the whole community, and it insisted upon the importance of secrecy if patients were to show the necessary trust in consultation and treatment under the scheme. Official regulations, made under statutory authority and having the force of law, were subsequently issued. They enacted that all information obtained in regard to patients treated under the scheme must be treated as confidential, it being essential that patients should be fully assured of the secrecy of the arrangements. That was clear enough. The medical practitioner, who has his own immemorial code of professional reticence in these matters, understood that it was a legal as well as a moral duty. In two High Court the doctor was cases, however, subsequently told that the secrecy enjoined by the Venereal Disease Regulations did not mean what he innocently supposed ; in fact, if he persisted in obeying the regulations, he might find himself in peril. It was after the second of these cases that Sir E. Graham-Little introduced his original Bill in 1927. The Ministry of Health might have been conscious of some responsibility for the deadlock due to its regulations, but it made no sign. If the claims of justice had to be weighed against the claims of public health, the Ministry refrained from intervention. Early in 1928 the learned judge who is now Lord ATKiN, in some extrajudicial comment on the 1927 Bill, said he thought that in some cases, notably those connected with
IT has long been known that pemphigus neonatorum and pemphigus vulgaris have nothing in common but the vesicles or bullse and the fact that either may be fatal. The former-which ought to receive some different name such as bullous impetigo of the new-born 1-is a highly contagious disease of infants that from time to time causes outbreaks in maternity or nursing-homes, and is always (so far as we know) due to the Staphylococcus pyogenes
‘
given by Normark2 is suspiciously long, including the permanganate bath (probably still the best, both in treatment and prophylaxis); various mild dusting powders and weak solutions of silver salts ; dyes such as flavine, brilliant green, and methyl. violet; and sulphur precipitate or even mercury in ointment or calamine lotion. It is quite true, as Normark says, that despite any of these applications a denuded surface may extend centrifugally ; and when this happens the outlook becomes black. It is of paramount importance, therefore, when such a tendency is observed, to limit and confine the spread of the infection to its primary locality, and this, he claims, can usually be done by occlusion with Elastoplast, whose use has already been advocated by Newman3 in a very similar disease-impetigo contagiosa. Adopting a procedure like Newman’s, and occluding the newly infected area or areas for a week at a time, there were no undesirable sequelse, and the period of treatment is said to have been reduced from 16 days to 9. The number of cases (11, with 12 controls) was admittedly small, but further trial would certainly be justified. THE Hunterian oration of the Hunterian Society is to be given by Lord Horder at the Mansion House, London, on Feb. 22nd, at 9 P.M. His subject is the Hunterian tradition. 1 Poole, W. H., and Whittle, C.
H.
(1935) Lancet, 1, 1323,
1333.
2 Normark, A. (1936) Uppsala Läk Fören. Förh. 42, 309. 3 Newman, J. L. (1933) Brit. med. J. 1, 823.
-