To any one, however, of true gentlemanly feeling the giving away of any confidence is repellent, and of no one ought this to be more true than in the case of the medical attendant.

To keep to oneself all that one's patients have confided in one might be termed the first commandment of medical ethics, and it ought never to be broken without grave cause.

The relationship between patient and medical attendant is a very close and intimate one; one can readily understand how confidences are given by the former to the latter, and often these are made during periods of trying illness or approaching death. It is therefore reprehensible in the highest degree for the doctor to give utterance, even by a hint or it may be in jocular fashion, to a single person of any trust (innocent or culpable) which may have been reposed in him in his capacity as medical adviser. This information may have been received in conversation, in writing or in the course of direct physical examination of the patient (e.g., present or former pregnancy, syphilis, etc.).

A request not infrequently made by a mistress to her doctor is that he should examine her servant, as she thinks she is pregnant. This is rather an unfortunate request, for a doctor has no right to force his services on any one unless they themselves desire it. Then, if the girl is innocent, she will naturally resent any of your questions, while if she is pregnant she will probably refuse to answer. If she consents to see you, you must tell her what her mistress thinks. She may allow you to examine her, but even if you find that she is pregnant you.

have no right to tell her mistress what her condition is unless the girl gives you full liberty to do so. If she refuses this liberty, and you do not tell her employer the state of affairs, the latter will probably find grave fault with you, seeing that she sent for you for this purpose. The probability is that you will no longer continue to be the medical adviser of that household.

In such a case it is much wiser to refuse to see the servant at all. Let the mistress be advised to send her maid to consult her panel doctor, and so you will escape Scylla as well as Charybdis.

Of course, there must be exceptions to the rule of medical secrecy, and in such one must act upon one's own judgment. For example, a man may confide in you that he has an almost uncontrollable impulse to suicide or homicide; as part of your treatment you would need to reveal this to one of his relatives, so that he might be put under restraint lest a crime should be committed. Then in the case of the approaching marriage of a man whom you know to be suffering from syphilis, it would be your duty to persuade him against entering into this contract, or at least to get him to inform his prospective father-in-law. If he refused, you might even take this latter step yourself, even though it broke the ethical rule of secrecy. You would be doing it in the interests of others, even though it might hurt the individual. It is incredible to think that any court of law would hold you culpable in such a case.

Again, one is compelled to give away confidence reposed in one by a patient in courts of law if the judge allows the question to be put to you. Before

answering it you would point out the confidential nature of the information you were asked to give, and suggest that you might convey the answer in private or in writing to the judge. If the latter insists on a public answer, then you must either do so, even though it may result in your making public a confidence reposed in you, or risk imprisonment for contempt of court. The statement of Lord Mansfield made in 1776 still holds good: "If a surgeon was voluntarily to reveal those secrets, to be sure he would be guilty of a breach of honour and of a great indiscretion; but to give that information in a court of justice, which, by the law of the land, he is bound to do, will never be imputed to him as any indiscretion whatever."

We may be enabled by our medical or surgical work to help in the elucidation of cases of manslaughter or even murder. Thus, a man may come for treatment on account of a severe wound and can give us no reasonable explanation of how it happened. A murder may have been committed, and your patient may have received this injury while committing it. Surely you would be fully justified in informing the police in such a case.

Again, if you were called to see a woman obviously dying as the result of criminal abortion, you should endeavour to obtain from her the name of the abortionist in order that he or she should be punished. In the trial, of course, the name of the woman would be made public, but in such a case the end would justify the means.

Should you be so indiscreet as to make public any medical secret which you may have acquired in any

way, and if this publicity does harm to an individual or his relatives, it is likely that a civil action for damages will be brought against you. Some years ago an eminent obstetrician had to pay £12,000 as damages for making public a statement reflecting on the moral character of a lady. He alleged that the statement was privileged, but the jury thought otherwise.

Privileged Communications.-A privilege is a right peculiar to a certain individual or class of individuals or an immunity not enjoyed by all.

Under certain circumstances a medical man may feel that he has a duty, and that he will be justified in imparting to another interested party certain facts which he has learned from a patient who has consulted him. Thus, for example, he may find that a children's nurse, cook or domestic servant is suffering from syphilis. He may feel it incumbent upon him to warn the master or mistress that their servant was suffering from an infectious trouble, without perhaps giving it an exact name. He must caution the master, however, to keep this information entirely secret. The doctor has only divulged this secret information to him in the interests of his family. He ought, however, to inform the servant that it is his duty to give information regarding her illness to her employer, and if she makes no protest so much the better. Such a communication would be privileged; the medical man did not make his knowledge public, but only privately to the party directly interested, her employer, and with due safeguarding of his patients' future interests.

In circumstances such as the above you must only

make the communication when it is absolutely necessary, and not merely as a matter of expediency, else you may render yourself liable to an action for damages.

Another form of privileged communication is the granting of medical certificates to public bodies in the case of their servants. In these you are expected and ought to put down the true cause of illness. It is no breach of medical secrecy, for both employee as well as employer know that you have to do this; it is part of the contract on joining the service of such a public body.

In the case of ordinary employers, however, the medical certificate does not need actually to specify the true nature of the disease from which an employee is suffering.

In courts of law, as I have stated, if the medical man, in spite of his protest, is compelled to answer a certain question, he then makes a privileged communication, and is held free from all blame in having made it.

Criminal Abortion.-When called to see a woman who has aborted, as you think from the result of criminal interference, it would appear from the statements of authorities that medical men are left to act as their conscience approves in giving or withholding information to the police. In any case, however, it is wise for you to call in the aid of a brother practitioner to share the responsibility. Should the woman be obviously seriously ill when you first see her, you ought to have her removed to an hospital or nursing home so that adequate (probably operative) treatment may be given to her. If you see