526

States. These wards are conducted on hospital lines,and their beneficial effect may be seen from the factthat no fewer than 1240 patients passed through themat Stobhill and Duke-street during one year, and ofthese 788 returned to their homes without the I

necessity for certification. In the foreign clinics theadvantages are even greater, inasmuch as patientsrequiring advice do not become " paupers " in theprocess, while mild cases of nervous and mentalbreakdown seek skilled advice more freely and receivethe special treatment, which, owing to its cost, can beadequately provided only by public authorities. Forsuch patients there is no public provision here beyondthe observation wards, the majority being unable toafford the expense of private nursing homes. Early

’

stages of functional nervous and mental disorder areleft uncared for or treated in such a desultory mannerthat in the long run the majority seek admission asvoluntary boarders or are certified to asylums. InScotland the extension of the General Board’s powersso as to include all matters relating to mental healthshould present no great difficulty. This was thecourse recommended by the Royal Commission lastyear. If the jB115,000 granted annually to improvethe care of the lunatic could be allotted at the dis-cretion of the Board to assist all mentally defectivepersons other than those provided for as mentaldefectives, no matter what their circumstances or

station in life, the objects of the Board would bebetter furthered.

__ ______

BERLIN.(FROM OUR OWN CORRESPONDENT.)

Professional Secrecy.THE annual meeting of the Aerzte-vereinsbund was

held this year at Danzig, where the most interestingorder of the day was professional secrecy, the speakersincluding medical men and criminologists. Dr.Vollmann, the editor of the Bund’s journal, pointedout that professional secrecy is no longer absolutesince the laws on workmen’s insurance and recentlyon venereal diseases compel medical men in certaincases to reveal facts concerning their patients. Butapart from those exceptions the patient has a rightto be protected against indiscretion on the part ofhis medical attendant as well as of assistants, nurses,and students. Dr. Ebermayer, ex-Public Prosecutorat the High Court of Leipzig, said that the provisionsof the criminal law which make a medical man liableto punishment if he violates professional secrecyconcern qualified men only. A patient consulting anon-qualified person should be aware that neithercan he rely on his professional secrecy nor can heprosecute him should he reveal facts concerning his ’,illness. In the new Criminal Bill shortly to come before ’,Parliament these provisions will be extended toinclude assistants, nurses, and students. It will alsobe made illegal for a medical man to confirm a rumourconcerning one of his patients. A patient may dis-charge his medical attendant from the obligation ofprofessional secrecy, but may at any moment revokethis discharge. If a patient has died the good renownof the deceased demands that the medical attendantshould observe professional secrecy in the same wayas if he were still alive. There are, however, circum-stances, legal and social, where these professional rulesmay be infringed. According to recent legislationtaxing authorities are authorised to examine thebooks kept by medical men. The production ofhistories of patients written by medical men or inhospitals may be enforced by an order of court and inurgent cases by the police. The principle stands thatprofessional secrecy must be kept as strictly as

possible and infringed only when the law obliges.Dr. Hagemann, head of the detective department ofthe Berlin police, said it often happened that a criminalwas injured at the commission of a crime and inquirywas made by the police at hospitals and from medicalmen for the names of any persons who might havebeen dressed for injuries about that time. Their

inquiries were often, however, fruitless becausemedical men declined to answer such questions on theplea of professional secrecy. But there are, he said,overruling moral obligations. In the instance of aterrible murder a Berlin medical man, after havingscrupulously considered all the circumstances, veryreluctantly revealed the name of the criminal dressedby him, so that he could be arrested by the police.He was sure no one would blame the medical man forhis action. The meeting ended with the passing of amotion to the effect that the rules of professionalsecrecy should not be remitted except for reasons ofpublic welfare, that judicial orders to produce bookskept by medical men should be prohibited, and thatthe forthcoming reform of the criminal law shouldcontain provisions to that effect.

The Socialist Party and the Medical Profession.

I The number of medical members in the recently

elected Reichstag is only four, of whom one is ademocrat, one a member of the Bavarian popularparty, and two Socialists. Owing to the increasedinfluence of the Socialist Party it is of interest to knowtheir medical programme. It is explained by Prof.A. Grotjahn, who, although not belonging to theReichstag, is an influential member of the party andoccupies the chair of social hygiene at Berlin Univer-sity. Prof. Grotjahn demands that medical practiceshould be nationalised by an extension of theexisting social insurance system, now limited tocertain classes of workers, to every member of thepopulation. Hospitals, dispensaries for infants, fortuberculous and venereal patients would form thenucleus of socialisation. All private institutions, suchas sanatoria and convalescent homes, would be takenover. The medical profession would work in these insti-tutions under better conditions than hitherto. Theywould have the rights of civil servants, their workwould be done in common, and thus more economic-ally ; they would also enjoy the leisure hithertodenied to them. Pharmacies and factories producingchemical agents and sanitary appliances would beowned by the State. Prof. Grotjahn, who belongs tothe moderate wing of the Socialist Party, believesthese measures would have to be introduced gradually ;for a period the socialised and the capitalistic institu-tions would exist side by side. It may be pointed outthat these principles to some extent have been putinto practice by the sick clubs of Berlin, especiallythose the greater part of which are under Socialistmanagement. They have set up dispensaries fornearly every kind of disease at which appointedmedical men are working. They have fitted out thosedispensaries with modern apparatus and withlaboratories. They have stocked drugs the provisionof which is not reserved by law to licensed chemists.When such a drug is prescribed by a medical man thepatient is obliged to fetch it not from a pharmacy ora drug store, but from the drug store of the sick club.Prof. Grotjahn’s plan aims at extending this systemto the whole population.

Statistics of Suicide.Dr. Prinzing, of Ulm, the well-known medical

statistician, has published a report on suicides inGermany and abroad. Of the German States Saxonyhas the greatest number-namely, 31-9 for each100,000 of the population during the period 1900 to1910. This figure increased from year to year,reaching 36-6 in 1925 and 38-1 in 1926. In Prussiathe corresponding figures were 21 and 25-4. Thelowest numbers were those of Bavaria and of Wurtem-berg. The figures of Switzerland were nearly thesame as those of Germany. In Austria and in Hungarythey were much higher. France had about 20 suicidesfor every 100,000, Belgium 13-14. The lowest numberin Northern Europe were those of the Netherlands with6 and of Norway with 5 suicides for every 100,000.In Southern Europe the number of suicides was alwaysvery small, but in recent years a certain increase hasbeen observed in Italy and in Spain. Immediatelyafter the war suicides were more frequent amongwomen than among men.