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a capsulated type d strain. TURK,’ however, using ahaemagglutination technique which he believes to

measure capsular but not somatic antibodies, has foundtype d antibodies in a variety of subjects more com-monly than those of any other type, although type dorganisms account for only 4% of the capsulated strainsfound in his laboratory. " Thus the distribution of

recognisable type d strains seems inadequate to accountfor the serological findings "; and the possibility mustbe borne in mind that apparently type-specific hxmo-philus antibodies are in reality antibodies produced inresponse to some other organism-for example, a

pneumococcus, whose capsular polysaccharide and

homologous antibody often cross-react with those ofH. influenza-.1 8

Until further information is obtained, all the anti-bodies found in chronic bronchitis should be regardedas probably species-specific, although it must beremembered that the results reported have been obtainedby a variety of techniques and may not be comparable.If the antibodies are indeed species-specific, that

simplifies the application of serological methods to thediagnosis of haemophilus infection, both in the estab-lished bronchitic and in investigations of the earlystages of the disease, since only one antigen extractneed be used. But two other problems arise. First,what is a significant antibody ? All the reports we havecited mention a number of positive findings in controlsubjects, although far less commonly than in bronchitics.KOHN,9 however, in a study of 80 patients and 40controls, found high titres of complement-fixing anti-body in almost all cases and was unable to detect anysignificant difference between the average titres of thesera of both groups. MAy,45 5 on the other hand, founda significant difference in the prevalence of agglutininsin patients and controls at a titre of 1/250 but not atlower levels; and it seems clear that the precise relationbetween the findings with different methods and therelevance of each to clinically recognisable infectionwill need careful evaluation before a practical diagnostictest can be devised. Secondly, for how long do theantibodies persist after the infection has subsided?Patients with chronic bronchitis are often infected

continuously with H. influenza for many months oryears, and in these circumstances it is hardly surprisingthat no rise in antibody titre is recorded during acuteexacerbations.2 But the lower frequency of antibodiesin patients with mucoid sputum (i.e., without infection)suggests that they do not persist indefinitely, since eventhese patients have almost certainly been infected atsome time in the past. Clearly, until the time relationsof the appearance and disappearance of antibodies inrelation to infection have been assessed, the significanceto be attributed to the findings in an individual patientmust remain uncertain.An entirely different problem is posed by the

application of immunological methods to studies of theepidemiology of hxmophilus infections of the res-

7. Turk, D. C. ibid. Aug. 7, 1965, p. 287.8. Alexander, H. E. in Bacterial and Mycotic Infections of Man (edited

by R. J. Dubos); p. 479. Philadelphia, 1948.9. Kohn, J. Lancet, 1965, i, 1337.

piratory tract. Here the need is for some means

whereby the non-capsulated strains can be typed so

that problems of relapse and cross-infection can beinvestigated. Type-specificity in capsulated strains is

dependent on the nature of the polysaccharide in thecapsule, but so far no indication has been given as towhether and how non-capsulated strains can be

typed. Early attempts at antigenic analysis ofH. influenza- by agglutination methods indicated thatthese strains showed remarkable heterogeneity, butMAY 4 suggested that this may be a consequence ofvariability in the distribution of antigens between thesurface and interior of the bacterial body; and the lackof evidence of heterogeneity in precipitation reactionsalso casts doubt on that reported by early workers.Whether or not a type-specific antigenic system can nowbe demonstrated remains to be seen.

Medical Privilege in English Law" THE privilege is confined to the cases of Counsel,

Solicitor and Attorney ... it is indeed hard in manycases to compel a friend to disclose a confidentialconversation; and I should be glad if by law suchevidence could be excluded.... There are cases towhich it is much to be lamented that the law of privilegeis not extended: those in which medical persons are

obliged to disclose the information which they acquireby attending in their professional characters." This

comment, by MR. JUSTICE BULLER 11 giving a judgmentin 1792, substantially represents English law as it is

today. The only professional relationship which attractsprivilege from disclosure of facts communicated is thatof the legal adviser and his client.At a very early stage in the development of the

Common Law it was recognised that there was a

conflict between, on the one hand, a man’s moral orcontractual duty not to disclose information acquired ina professional or confidential capacity and, on the otherhand, the need that the courts should discover the truthin the interests of justice. It was established that thereshould be very few cases where public policy demandedthat because of the circumstances in which a witnesshad learned of the facts it would be better that thecourt should not discover the truth. Communicationsbetween husband and wife were recognised to be one case;those between a client and his legal advisers another.The Law does not wholly ignore the confidential

relation between doctor and patient; and voluntarydisclosure of confidential information given by a patientmay render the doctor liable in an action for damagesfor breach of an implied term in their contract, at leastwhere the doctor is in private practice, although thelaw is uncertain on this point. Nevertheless, the ruledenying privilege to medical men has been regarded bythe courts as a strong one; in 1920 a doctor was obligedto disclose information although it had been obtainedunder a scheme (for the treatment of venereal disease)10. Wilson, G. S., Miles, A. A. Topley and Wilson’s Principles of Bac-

teriology; p. 970. London, 1964.11. Wilson v. Rastall (1792) 4 Term Rep. 753 at p. 760.

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which was required, by statutory instrument, to beconducted in confidence.12The medical practitioner is thus placed in an awkward

position. If he is compelled to attend court as a witnesshe may be obliged to disclose confidential informationon pain of imprisonment for contempt. This punish-ment is discretionary, and most judges would bereluctant to insist on its application. Indeed, one judgein his direction to the jury said:

" I can quite understanda case, especially in a civil case, where a doctor is quitejustified in refusing to divulge questions of professionalsecrecy ... The judge might in some cases refuse tocommit a medical man for contempt in refusing toreveal confidences. Every case must be governed byparticular circumstances, and the ruling of the judgewill be the test." 13 This somewhat Delphic approachto the problem doubtless explains the attitude of thejudge in the trial referred to by a psychoanalyst on p. 785of this issue.

In English Law there is no specific protection ofprivacy, although the law of nuisance and of trespassto land can be used to give some measure of physicalprivacy. The unsuccessful attempts to establish a rightto privacy made by Lord MANCROFT in his 1961 Billwere primarily directed against the undue harrying ofthe individual by the Press. Provided that evidence is

fairly and accurately reported, there is little danger ofan action for defamation against a newspaper that

publishes even the most intimate details of a person’sbehaviour as recounted in the witness box. Judgescannot order evidence to be given in camera unless theyare satisfied that a hearing in open court would defeatthe ends of justice or in infancy proceedings. In anyevent the fact that the hearing may be in camera wouldprobably do little to solve the problems that arise fromthe disclosure of the details of psychiatric treatment.The object of Lord MANCROFT’s Rights of Privacy

Bill in 1961 was to give to English Law something ofthe protective structure enjoyed in the United States(described by Dr. CASS and Professor CURRAN on

p. 783)-that is, in the words of a memorandum to theBill: " to give every individual such further protectionagainst invasion of his privacy as may be desirable forthe maintenance of human dignity while protecting theright of the public to be kept informed in all mattersin which the public may be reasonably concerned ".The basis of the Bill was to give the individual a rightof action for damages against anyone who, without thatperson’s consent, published in a newspaper or film orby sound or television broadcast any " words relatingto his personal affairs or conduct if such publication iscalculated to cause him distress or embarrassment".The main defences provided by the Bill against such anaction for damages were that the reference to the

plaintiff was unintentional; that publication was madewhen the contents were privileged; that the publicationrelated to a public figure; and that the publicationrelated to people temporarily in the public eye, such ascriminals, or to those who had deliberately sought to

12. Garner v. Garner (1920) 36.T.L.R.196.13. Mr. JUSTICE HAWKINS in Kilson v. Playfair (1896) March 28.

attract publicity, which made them the subject of" reasonable public interest". Hence the Bill containednothing which would prevent the transmission throughthe Press or any other public news organ of professionalconfidences disclosed in open court under threat of thecommittal of a doctor for contempt, provided that thePress reports of the court proceedings were fair andaccurate.

Since this Bill had been strongly opposed by thenational newspapers, it is perhaps ironical that thenational Press was confronted the following year witha problem of confidentiality in many ways similar tothat of the doctor compelled to disclose his patients’confidences. In defence of their refusal to disclosesources of information to the Vassall Tribunal, journalistspleaded that the confidential relationship between thePress and an informant was privileged; the informationhad been given on the understanding that the informant’sname would not be disclosed. The courts, however,gave the inevitable answer that the law of privilege didnot extend to this type of confidential relationship. In

giving judgment in the case of Desmond Clough theLord Chief Justice, Lord PARKER, did, however, saythat, although certain classes of communication hadbeen recognised as privileged, in other cases it wouldbe for the court to decide what public policy demanded.14" If in the circumstances of any particular case itbecame clear that public policy demanded a recognitionof some claim to privilege, then, as I conceive, it wouldbe the duty of this court to give due effect to publicpolicy and recognise the claim."

This pronouncement may leave it open at any rateto the House of Lords-if that court is ever confronted

by the question of privilege in relation to certain typesof medical treatment, particularly psychiatric treatment-to accord privilege to confidential communications incertain cases and thereby to alleviate a situation wheremedical advisers are obliged to rely on the favourableexercise of the judge’s discretion.

Annotations

YOUNG DOCTORS FOR OVERSEAS

MANY medical students in Britain are at some stageattracted by the idea of spending a few years at the startof their postgraduate career in one of the world’s develop-ing countries; but few of them actually come to do any-thing about it. And the chief reason is that they areanxious lest such an excursion abroad might hinder theirprogress when they return home. As a statement pub-lished this week by the Ministry of Overseas Developmentputs it,

" altruism consequently fails to compete with thehard requirements of a career ".The Ministry, unable to keep pace with the demands for

medical staff by developing countries, is now seeking togive altruism a better chance by offering young graduatesapproaching full registration a course of further trainingof up to one year’s duration " against an undertakingto serve overseas for a maximum of three years after

14. Attorney-General v. Clough (1963) 1 Q.B. 773 at page 788.