the Society knows no decay, but is full of youthful vigour and lusty life, is seen when we glance over the work done during its 57th and 58th sessions, which differ in no noteworthy detail from those immediately preceding them; rather they show a maintenance and even a development of those characteristics which have. in the past made our meetings interesting and our Transactions valuable. We have listened to contributions dealing with nearly all the burning questions of the day in both Obstetrics and Gynecology, and we have from time to time been called upon to consider also matters of Pediatric interest. To such of our Fellows as have been unable to be present at our gatherings, these contributions are nevertheless ready to hand in our annual volumes of Transactions; while those of us who have assembled. in this room have not only heard the papers read, but have also enjoyed the privilege of seeing the many rare and interesting specimens which have been brought before our notice. I may be unduly exaggerating the value of this part of our work, but I feel that those who miss the periodic 'Exhibition of Specimens' lose not a little.

WORK DONE IN THE PAST Two SESSIONS.

To begin at the beginning, we have listened to investigations dealing with the very springs of life, from the fertile pens of Dr D. Berry Hart and Dr J. W. Ballantyne, and in the 'Preliminary Note on the Development of the Clitoris, Vagina, and Hymen,' and in the 'Morphology of the Vaginal Segment of the Genital Tract,' we have had placed before us studies in Embryogenesis of farreaching importance. Hardly less valuable have been the contributions dealing with Morbid Embryogenesis, or 'Teratogenesis,' as our editor of Transactions prefers to call it, and we have followed with interest his 'Inquiry into the Causes of Monstrosities' and into 'The Causation of Twins,' and his paper on Congenital Teeth.' We have also to thank him for showing so many Teratological specimens, and for communicating papers dealing with Malformations, from the pens of Dr Rutherford Morison, Günsburg, and Michin. This does not exhaust the contributions which have dealt with embryological and fœtal questions, for Dr Haultain has described A Rare Form of Abortion,' Surgeon-Captain C. H. Bedford has written fully on 'Criminal Abortion in the Punjab,' Drs Berry Hart and Buist have related cases of Atresia Vaginæ,' and the latter has also detailed an operation for the relief of Hernia into the Umbilical Cord.' Neither must we forget Dr Kynoch's paper on 'Fatal Infantile Jaundice from Congenital Narrowing of the Common Bile-duct,' nor Dr Adamson's (communicated by Professor Simpson) on A Case of Triplets,' which elicited from other Fellows of the Society the records of not a few interesting instances of prolificacy in the human subject.

The subjects of Pregnancy and Labour have been represented by the able papers of Dr Freeland Barbour on 'Braune's Os Internum and the Retraction Ring,' and on 'Laparotomy for Extrauterine Gestation;' of Dr R. Milne Murray on 'Forceps with Adjustable Axis-traction,' on 'Deflection and Rotation of the Pregnant and Puerperal Uterus,' and on the 'Positive Pressure in the Growing Pregnant Uterus;' of Dr Mackness on 'Some Modifications of the Midwifery Forceps;' of Dr C. F. Ponder on the 'Action of the Midwifery Forceps;' of Dr Coromilas on the 'Technique of the Dilatation of the Perineum in Labour;' of Dr G. Elder on 'Peripheral Neuritis in Pregnancy;' and of Dr Kynoch on 'Interstitial Pregnancy.' It would have been unpardonable if your

President had allowed the Jubilee of Anesthesia in Obstetrics to pass unnoticed; and he, therefore, attempted to celebrate that event and to inaugurate his own holding of the Presidential Chair by an address on Chloroform in Midwifery Practice.'

Morbid phenomena occurring in the puerperium have called forth papers from Dr J. L. Lackie on 'Puerperal Pulmonary Thrombosis, and from Dr Haultain on the 'Culture Diagnosis and Serum Treatment of Puerperal Infection;' while the duties of the mother as the nurse of her infant were emphasised by Dr James Carmichael in his contribution on 'Indigestion of Breast Babies.'

On the borderland between Obstetrics and Gynecology lay the exhaustive and most admirable work on 'Osteomalacia' by Dr James Ritchie, the able Experimental Research into the Action of Viburnum Prunifolium' by Dr T. Shennan, and the successful and original suggestion made by Dr Berry Hart concerning the Treatment of Extra-Uterine Gestation at Mid-term by Extra-Peritoneal Incision.'

Gynecology has been enriched by several noteworthy contributions. I need scarcely recall to your minds the splendid record of success obtained by Dr C. Martin in his experience with 'Panhysterectomy,' nor the more recent operative work carried out by Dr Freeland Barbour by means of Vaginal Hysterectomy by Doyen's Method.' Dr Halliday Croom showed all his accustomed skill in dealing with a difficult subject when he described that anomalous phenomenon, the Mittelschmerz,' and even more so when he opened the discussion on the Use of Checks to Conception.' It was peculiarly appropriate that Professor Simpson should be the Fellow to communicate a case of 'Ovariotomy under Local Anaesthesia,' and we should probably have been surprised had not the names of Drs Milne Murray and Haultain been attached to the two eminently practical and able papers dealing with the 'Electrical Treatment of Fibroid Tumours of the Uterus.' In order to complete our survey of the work of these sessions, reference must be made to the important communication on 'Some Peculiar Relations of Abdominal and Pelvic Tumours,' in which Dr Halliday Croom drew upon the vast resources of his extensive operative

experience, to our great benefit. Dr Barbour reported a dermatological curiosity in his paper on 'Ulcus Serpiginosum of the Vulva,' and Dr J. Lamond Lackie dealt with a pathological rarity in his report on Retention of Menstrual Fluid in one half of a Double Uterus.' Finally, those who wish to know all about that useful operation, Curettage of the Uterus,' will surely find it in Dr J. W. Ballantyne's communication on that subject.

PROFESSIONAL SECRECY.

During my term of office, the last meeting of each session has differed from those of the previous years in so far that it has been held in camera.

In reverting to the subject under debate at the first of these meetings, it is not my intention to give a résumé of the various opinions expressed, nor even to state what direction the discussion took (for this you can recall as easily as I can), but to endeavour to ascertain what relation Obstetricians and Gynecologists stand to the law, chiefly on the question of professional secrecy. It is granted on all hands that there is much that is uncertain, and much that is unsatisfactory regarding this matter, and that not only medical men but lawyers differ as to when and under what circumstances it becomes the duty of the medical adviser to break faith with his patient.

Theoretically, of course, the doctor is constantly under the Hippocratic oath, that facts, medical or otherwise, which a practitioner learns from his patient during professional attendance should not be divulged. And the law of this country seems clearly to hold that a secret acquired by a medical man during his attendance upon a patient is the secret of the patient, and therefore that he or she has a prima facie right in law to require that his or her secret should be kept, unless it can be shown that there is some paramount reason setting aside that right. The law then so far upholds our old professional rule.

Individual judges have from time to time gone even further, and have indicated that medical men should legally be under this ancient rule, with certain exceptions. Thus Justice Buller expressed his regret that the information got from medical men was not privileged. Lord Brougham expressed himself in much the same way, and Chief Justice Best said that the law was hard in itself, of questionable policy, and contrary to that of America and France. While Justice Hawkins, in the comparatively recent case of Kitson v. Playfair and Wife, said that there were criminal cases, and he instanced one-that of self-inflicted criminal abortion —where it would be 'monstrous cruelty' for the doctor to inform the police, and with regard to those when it was said the doctor should inform, the judge might himself in some cases refuse to commit a medical man for contempt in refusing to reveal confidences. From this it is evident that there are many cases

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occurring in medical practice in which a practitioner may be in serious doubt whether he should inform the public prosecutor, and about which any judge in the event of the information being given may express his own individual opinion, adverse or otherwise, as circumstances presented themselves to his mind during a trial.

In America and France the law differs from that of this country, in so far that it binds the doctor to keep his patient's secret. In America, the law binds the professions of the Church, Law, and Medicine equally. According to this legal code, 'the clergyman is prevented from disclosing confessions made to him in his professional character in the course of discipline enjoined by the rules of practice of the religious body to which he belongs. The attorney or counsellor-at-law is not allowed to disclose a communication made by his client to him, or his advice given thereon in the course of his professional employment; and a person qualified to practise physic or surgery is not allowed to disclose any information which he acquired in attending a patient in a professional capacity, and which was necessary to enable him to act in that capacity.' From this it is plain that in America the three professions stand in precisely the same relationship to those seeking their counsel and advice. The law recognises that a certain portion of the community has from circumstances been placed at disadvantage, and is suffering in some way in relation to Religion, Law, or Medicine; that it needs help from some one of these professions, and that it would be wrong to place any obstacle in the way of obtaining it, whether guilty or innocent. The penitent is safe with the priest; the suspected criminal is safe with his attorney and counsel; and the patient is or should be safe with his medical adviser. The members of each profession get necessary information for a special and humane purpose, information they would certainly not have acquired had the simple benefit to the person not been the sole end in view, and which probably would have been withheld but for the seal of professional confidence. And the revisers of the American Code even go further, by stating that the necessity of the law relating to medical men is even stronger than in the case of a legal adviser, when life itself may be in danger. And yet the law which binds a physician to secrecy is very frequently broken by the ruling of its administrators. Thus Judge Bartlett, speaking on the subject of criminal abortion at a meeting of a Medical Society, presided over by Dr Joseph H. Raymond, said the rule may be regarded as pretty well settled in this state,-that the physician is compellable by law to disclose (in the witness box, not voluntarily) what he knows indicating the commission of criminal abortion, where the victim of that abortion is dead; where the patient, however, survives, and does not waive her privilege, the medical practitioner must keep silent.'

District Attorney Backus, speaking at the same meeting on the same subject, gave it as his opinion that a self-attempted abortion should not be disclosed whether the person lived or died; but where it is done by another, the doctor should endeavour to procure the consent of the patient to inform even though she survives. It is quite evident from these opinions and from cases constantly occurring in American Law Courts, that while the three professions are almost exactly word for word bound under the same law, the medical profession alone is compelled by law to break the law that binds them. Whether this be right is open to question. It is difficult to see in what way the doctor differs from the lawyer and clergyman. Under this law the silence of the medical man cannot be looked upon as concealing a crime; and surely his reticence defeats the ends of justice less than that of the lawyer who, often knowing the guilt of his client and all the circumstances of the crime, uses this knowledge entirely for the benefit of the prisoner, and, by reason of the information, probably gets an effectual means of defence. Yet his conduct is not looked upon as reprehensible, but would certainly be regarded as such if he announced in court that the man had confessed to him that he was guilty of the imputed crime.

In this country the doctor is not privileged, as we have previously said, and this opinion has again been recently confirmed by the answer of counsel to the question of the Royal College of Physicians, London, which ran as follows:-' Has a medical practitioner any privilege with regard to secrets confided to him in the course of his practice analogous to the privilege as between a solicitor and client, or otherwise?' Answer: We are of opinion that there is no privilege attaching to statements made to medical practitioner by his patient.' Our profession, then, is not in any degree protected or supported by law, as from time immemorial the legal profession has been; nor has it that tacit protection which is extended to the priest. Yet it is no less true, as we know, that should a doctor disclose any fact to a third party which may affect the character or cause injury to the patient, he would be liable to an action for defamation of character. There are pitfalls innumerable the moment we swerve from the golden rule of absolute reticence. And alas! it is also true that the most rigid adherence to this rule does not always bring safety to the practitioner, and indeed may sometimes land him in an awkward predicament. For example, let us take the hypothetical case instanced by Judge Hawkins at the trial already referred to, in which he remarked it would be monstrous cruelty' if the doctor did not keep silence in the criminal case which might come under his observation. Presuming such a case to occur, which it may do at any moment, and the doctor is faithful to his patient and does exactly as Judge Hawkins would have him do,--says