THE LIMITS OF PROFESSIONAL SECRECY.

960 a

which many great thinkers have regarded as I am, Sirs, yours faithfully, HARRY CAMPBELL. Wimpole-street, W., Sept. 26th, 1898.

Dr. Michell Clarke may have been brought about in an entirely different way ; but the case reads as though it might illustrate a peculiarity which it may be sometimes

CONSCIENTIOUS OBJECTION AT KEIGHLEY. To the Editors of THE LANCET. SIRS,- W have this week the first example of the wholesale

useful to bear in mind at the bedside and to which reference has been made in a note on the Diagnostic Uses of Percussion of the Vertebral Spines, and in a Lecture to Advanced Students on Pleximetry and on Pleximetric Bones and Viscera,2 where the "boxy spleen" is further discussed. I am, Sirs, yours faithfully, WILLIAM WILIAM EWART. Curzon-street, Mayfair, Oct. 3rd, 1898.

position

untenable.

.

working of the new Vaccination Act in an anti-vaccinationist community. Keighley has for more than twenty-five years been one of the strongholds of anti-vaccination. On Tuesday, SPHINCTER STRETCHING IN Oct. 4th, 660 parents and guardians succeeded in gaining CONSTIPATION. for about children. At a 1670 similar court to be exemption held on Oct. 18th no doubt a large number of additional To the Editors of THE LANCET. exemptions will be granted. As the population of SIRS,-The subjects of fissure in ano have usually suffered Keighley is about 35,000 it will be seen how large from prolonged ccnstipation. This would seem to be pera proportion of the population has already exercised its right dilatation of the relieved and that to manently (granted by the wisdom of Parliament) to allow children to an extent which isbyincompatible with sphincter the supposition that become potential dangers to public health. and drug treatment have been the only agents in Conscientious objectors forsooth! How were the proceed- hygienicsuccess. The consideration of this fact has led me causing ings carried out ? The parents were brought into court in to employ sphincter stretching in several cases of intractable batches of from 10 to 20 at a time and asked whether in children with, so far, good results. I would they had conscientious objections. Some replied verbally, constipation that there are two factors making for this result : suggest and in many cases a nod of the head was deemed sufficient the destruction of what was mechanically a relative proof of their deep-rooted convictions. A fee of 2s. was (1) and (2) the presence of a nervous connexion stricture exacted in each case. With such rapidity were the proceed- between ;the anal bowel analogous to orifice and the ings carried out that in two courts the whole of the 1670 the so-called polarity of the uterus. large I have been unable to children were exempted in two hours and a half A pure this method a trial in adults and should be glad to learn farce from beginning to end. It savours more of a Gilbert give the experience of others in the matter. and Sullivan comic opera than the administration of laws I am, Sirs, yours faithfully, of the realm. All these people and their children have now SIDNEY VINES,

received the sanction of the Government to be a medium for the maintenance and diffusion of small-pox, whereas before the passing of the present Act they were tolerated by a negligent and apathetic board of guardians. One wonders how long the comedy will go on before it becomes a tragedy and wakens up the Government to a due sense of its responsibility. Should there be a serious outbreak of small-pox among these " conscientious objectors" the promoters and supporters of the exemption clause among the Government must consider that the responsibility lies at their door. If vaccination is of any use let it be absolutely compulsory, with on

imprisonment

as

punishment

for

non-compliance; if, voluntary. faithfully,

the other hand, it is useless, let it be I am,

Oct. 6th, 1893.

Sirs, yours CLEMENT

ROGERSON, M.D. Lond.

Officer, St. Mary’s Children’s Hospital, Plaistow, E.

Assistant Resident Medical

Plaistow,

E., Oct. 2nd, 1898.

SANITARY INSTITUTE CONGRESS. .

To the Editors of THE LANCET.

of the Congress at Birmingin error in attributing to me a motion regarding sanitary administration in Ireland. The motion was made by Mr. J. H. Fergusson, Killygordon, Donegal. Your insertion of this correction will oblige. I am, Sirs, yours faithfully, JOHN C. MC VAIL. Glasgow, Oct. 3rd, 1898.

SIRS,-The newspaper reports

ham

are

" HOSPITAL REFORM ASSOCIATION." THE LIMITS OF PROFESSIONAL SECRECY. To the .Editors of THE LANCET. To the Editors of THE LANCET. SIRs,-In THE LANCET of Sept. 10th Mr. T. Garrett I was called upon as a Poor-law months SIRS,—Some Horder, the hon. secretary of the Hospital Reform Associa- medical officer to attendago an unmarried woman sufEering from tion, solicits the opinion of your readers as to "whether it metritis. I found the uterus to contain a decomposed would be desirable and useful to hold a congress in London septic foetus. She absolutely refused to communicate her condition some time during the ensuing year to discuss the subject." I, to anyone except a woman (a relation) in attendance. Her for one, answer decidedly, Yes, and it is sincerely to be hoped state was too serious to admit of delay and I could not refuse that both the medical profession and the subscribers who to attend her without divulging her condition to the board. should be so deeply interested in this important question I therefore procured the help of two colleagues, curetted the

will combine in making the meeting a success. I have been moving in this matter for the last few years and I feel convinced that we cannot too often draw the attention of the public to the increasing evil of hospital abuse. I am, Sirs, your obedient servant, FRANCIS J. A. WARING. Hove, Oct. 3rd, 1898.

RESONANT

SPLEENS.

of THE LANCET. SIRS,—In his interesting case reported in THE LANCET of Oct. 1st, p. 866, Dr. J. Michell Clarke remarks that a "small area of tympanites beyond the stomach to the left over the tenth and the eleventh ribs was difficult to account for." The situation described and that depicted in Fig. 2 corresponds so exactly with the normal splenic surface area that in the absence of a reference to the presence of any splenic dulness the view might perhaps be entertained that the tympanitic note was due to the spleen. This suggestion is made on the strength of a series of observations in which the dulness of the spleen was converted into a boxy tympanitic resonance. The resonance referred to by To the Editors

case as "septic metritis." In consequence of neighbourly gossip the guardians have now applied to me for information as to whether the late illness was produced by her own misconduct. I refuse all information as a violation of professional secrecy. Can you advise me if any conditions of relationship or employment warrant a medical attendant giving such information to any third person and if any statutory or common law protection against action is afforded to a Poor-law medical officer in such a case ? Could I have acted otherwise in dealing with the matter ? I am, Sirs, yours faithfully, " JOHN DOE." "JOHN Oct. 2nd, 1898. ** We consider that ’’ John Doe " was quite right in not divulging the cause of the metritis. He is not a censor of morals as well as a Poor-law medical officer. If he makes the return asked for we doubt if he would be protected by " privilege." Probably a defence in a civil action of giving information "without malice" would be successful, but we

uterus, and returned the

1 2

THE LANCET, July 2nd, 1898, p. 23. Clinical Journal, July 13th, 1898.

961 advise him not to

run

the risk.

If he is

pressed

for further

information he should refer the matter to the Local Government Board and await events.-ED. L.

NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.) The

the

Progress of

Plague Epidemie.-Statistics of

Inoculation. THE heavy rainfall of the past week in Bombay city, amounting to over 20 in., has been accompanied by a slight decrease in the total mortality. The official returns, however, show 175 deaths from plague against 168 last week, and as the total mortality is above the average by considerably more than this number of plague deaths there is strong reason to suppose that many cases are recorded as due to other diseases. This especially applies to the Mohammedans, whose record of plague deaths is obviously incorrect. Registration is admittedly very faulty and the total number of weekly deaths is the only thing which can be relied on. It is unfortunately too plain that plague is again developing, although the successive increases each week have not been

large.

In the Madras Presidency a few cases keep cropping up, but it has not yet been officially declared in the city. The excessively high rate of mortality is, however, very suggestive. Some disturbances have occurred at Bangalore, panic with regard to plague measures having seized the people, and troops have had to be called out. In the Bombay Presidency 3637 cases and 2749 deaths The were recorded against plague during the past week. total mortality from plague since the commencement of the epidemic in September, 1896, is 105,512. With regard to inoculation remarkable success is reported from Hubli. It is stated that no less than 32,000 people have gone through the process and that during the existing outbreak in that city only 69 of these have been attacked, while among the 8500 uninoculated there have been 417 attacks. If these figures be reliable they speak for themselves. In the district around, however, there has been a large number of deaths-the Dharwar district, in which Hubli is situated, being credited with 1047 cases and 892 deaths. To show how differently inoculation has been received at different places there remains only to compare Calcutta and Bombay, each with about 750,000 inhabitants and with about 2000 and 20,000 persons inoculated respectively, against Hubli, with a population of about 40,000 and no less than 32,000 inoculations. In Bombay there have been 27,305 deaths from plague and in Calcutta about 200. Amongst the inoculated in Bombav there were :-

(FROM

BIRMINGHAM. OWN CORRESPONDENT.)

OUR

The

Birmingham Medical School. was opened on the 3rd inst. at Mason University College, the inaugural address being delivered by Professor Michael Foster of Cambridge. The dean of the medical faculty, Dr. Windle, presided and a large attendance included the Lord Mayor of Birmingham THE

present session

(Mr. C. Beale), several members of the council, a number of the professors, and others’ interested in the cause of 1

See page 915 of this issue.

The address dealt with the rise of medical progress. universities and guilds, their development, aims, and functions. A sketch was given of the proposed university for Birmingham, in which it was insisted that it should not be an educational institution directed by the principle of payment by results ; nor should it be a system of classes "which proposes at the least expenditure of time, money, and, it may be added, of brains to drive a head through the same narrow gateway of this or that formal examination." The encouragement of learning and research was indicated as the object to be kept in view-the spirit of inquiry, the guiding spirit. Some valuable hints and counsel as to the future were given and attentively listened to. The address was marked by a thoughtful accuracy of expression and intimate experience of the subject, the outcome of the wise and deliberate reflection of a master mind. We hope to see it in a permanent form, so that we may be enabled to dwell upon the eloquent truths it proclaimed. The prizes of the clinical board will be distributed by Sir William Mac Cormac on. the 6th inst. at the General Hospital. The same evening Sir William Mac Cormac is to be entertained at dinner by the members of the Midland Medical Society, who celebrate, their jubilee on this occasion. They look forward to the honour of having the learned President of the Royal College of Surgeons of England as their guest. The inaugural address of the same society will be given by Mr. Treves on the 20th inst. Oct. 4th. ______________

MANCHESTER. (FROM OUR OWN CORRESPONDENT.) Insanitary Board Schools. DR. WOODCOCK, who is a member of the Manchester School Board, did good service at the meeting of the board held on Sept. 20th by calling attention to serious sanitary deficiencies in several of their schools. The playground into which 198 boys are turned out for air and exercise atone school contains 180 square yards. At the same school 212 girls have to find space for fresh air and activegames in 147 square yards. A sub-committee has recommended the increase of these "playgrounds"to 2642 and 239½ square yards respectively and it can be imagined how the children will revel in the sense of boundless space when these additions are made. In one class-room, 15 ft. 9 in. by 11 ft. 9 in., affording proper accommodation for 18 children, there were present when Dr. Woodcock visited it 50 children and their teacher, and in the boys’ department he found 27 boys and their teacher in a room with proper accommodation for 18. At another school, in which the only ventilation is by open windows, the odours from a deposit of manure are wafted in from the confined space at the back of the buildings and this manure is stirred up for removal, it is said, three times a week. At St. Michael’s Board School in Hulme, " the cellar communicating with the offices was occupied by 57 boys and 2 teachers. There were 5 gaslights burning." The boys had to wear their caps as a protection against the draught from the open windows, through which the filth from the street " was freely blown." In an adjacent room he ’’ found 30 boys and their teachers in a’poisonous den’-a dark room below the level of the street, 16 ft. by 11 ft., and only 8ft. high. There is not This state of things, an inch of playground to this school." of which examples could easily be multiplied, has not been suspected by the ratepayers of Manchester, and now that it has been at last revealed by a medical member of the board no doubt some energy will be displayed in removing evidences of-to say the least-gross disregard for the bodies, whatever may be the case as to the minds, of the poor children under the fostering care of the School Board. One of the older members of the board said, truly enough, that "the statement of Dr. Woodcock constituted a terrible indictment." Some people complain of lavish and unnecessary expenditure on the part of the School Board, but clearly there has been none too much done for the health of the children. More attention should be given to securing space and light, even if it should entail less expenditure on the costly decorative features so attractive to public-spirited members of "boards." It may be well, perhaps, if some candid friend will look to the sanitary conditions of the voluntary schools.