ceives kindness and confidence. It may, however, be otherwise as a consequence of the influence of disease upon the mind. Disease not infrequently renders persons impatient, querulous, irritable, distrustful, suspicious, and these morbid mental conditions may manifest themselves in language and manner, perhaps, much at variance from the traits of character belonging to the same persons when well. Both propriety and policy dictate the utmost forbearance under these circumstances, on the ground that one is not to be held responsible in sickness for utterances and conduct which in health might properly involve accountability. The physician does not compromise his self-respect by submitting patiently to rudeness, or even insults, from a sick patient, to which he would be by no means bound to submit quietly if the patient were well. This ethical rule is not, at least to the same extent, applicable to the friends of patients. But here allowance is often to be made for the disturbance of mind arising from anxiety and apprehensions. Less allowance is due to officious visitors and acquaintances. Forbearance toward these is not always to be embraced within the scope of medical ethics. Prudence and tact are to be exercised according to the circumstances in particular in

stances.

On the part of the physician, it is a gross impropriety to require the forbearance of his sick patients and their friends. For him there is not the excuse which the latter may fairly claim. Roughness and the lack of courtesy on his part are the more inexcusable for the reason that patients and their friends are, in a measure, at his mercy. They have a right to expect from him kindness and patience, and, if he be lacking therein, he is not entitled to the indulgence. which is due to them, if they be deficient in these regards. Brutality toward patients or their friends is a grievous of fense against the medical profession. It is especially repre

hensible toward hospital patients, or those from whom no pecuniary recompense is expected. Private patients in good. circumstances can elect and change physicians. This is a privilege denied to those who seek relief in public institutions, or to whom medical services are gratuitously rendered; hence, it is taking a mean advantage not to treat such patients with attention and humanity.

The binding force of secrecy as regards all information obtained in connection with professional relations, whenever it is desired, or is desirable, on the part of patients or their friends, that the information should not be communicated to others, is not sufficiently appreciated by many members of the medical profession, and still less is it appreciated by the public. Weaknesses, foibles, and vices, perhaps unsuspected by others, become known to the physician. He can not help knowing them if he would. No one but himself is to be the wiser for this knowledge. Physical ailments and defects which the physician must discover, he has no right to speak of. Confidential communications by patients relating to themselves, their families, or their progenitors, are to be held as a sacred trust.

Physicians should be reserved, and exercise judgment in speaking of the ailments of those under their care. Many ailments are of a nature that most persons desire to conceal, and they should not be deprived of the right of concealment. It can not, for example, be agreeable to a young woman for her acquaintances to know that she is troubled with a tapeworm. Other affections of a much more delicate nature might be cited as examples. The right of concealment by no means belongs exclusively to the female sex. Moreover, a patient may have a serious disease, of which, in order to spare family and friends anxiety, or for other reasons, concealment is desired. The physician is bound to respect this desire. A physician who appreci

ates fully the duty of secrecy can not but feel that it is a reflection upon his professional character when, as often happens, he is requested by a patient to observe this duty. It is true that some patients are not sensitive on this subject, and they may even desire that others may know of the nature of their maladies. Under these circumstances the physician is, of course, absolved from the duty of secrecy. He is not, however, to act upon his own presumption in the matter, when the feelings of his patients can be readily ascertained.

or Mrs.

or Miss

A more judicious reserve than is now practiced by not a few physicians would soon lead to a better understanding of the ethical duty of secrecy on the part of the public. How common is it for a practitioner to be asked, “What is the matter with Mr. ?" The answer is expected to embrace the nature and seat of the disease, the symptoms which are present, and, perhaps, all the details of the sick-room. If a patient happen to be a person of note, the attending physician is liable to be called upon by an interviewer, who expects to get the diagnosis, the symptomatic history, the prognosis, and the treatment, for publication in a newspaper. Now, the ground is by no means to be taken that nothing is to be communicated to friends, acquaintances, or the public respecting cases of disease. It would be simply absurd to take this ground. The condition of a patient in respect of danger, and, in some instances, the probable duration of disease, may properly be made known to those who are interested in the patient's welfare. It is sometimes proper and sometimes not to state the nature of the disease. It may not be proper to go further. Of this, the physician must be the judge. It should be left to his judgment and sense of propriety or duty how much should be told of details belonging to the privacy of the sick-room. Intelligent, well-bred per

sons, who have reflected upon the duty of a physician in respect of secrecy, will never place him in the unpleasant position of declining to answer questions relating to his patients.

Physicians have to deal with malingering. When called upon to decide whether or not persons are malingerers in prisons, in the army and navy, in hospitals, and other public institutions, and when impostors undertake to deceive the public by feigning diseases, either for gain, sympathy, or notoriety, there can be no question as to the duty of exposure. In private practice the duty will vary according to the circumstances in individual instances. The duty then points to the course which will be most productive of good, and with regard to this the physician is to exercise his judgment. In an instance like the following it seems plain that secrecy would have been improper: A young man, the son of a wealthy father, feigned paroxysms of intense pain and convulsions, and at times unconsciousness. He had imposed upon a medical adviser so far as to obtain from the latter a written statement that he would probably never recover, and was liable to die in one of the paroxysms. When he had reason to know that his deception was discovered by another physician, he became abusive in the extreme, instead of asking for concealment, with a promise that the malingering should cease. Under these circumstances, the diagnosis was stated to the parents, and the case relinquished. Secrecy outside of the family in such an instance would be proper, provided the diagnosis was not kept by them a secret, and the physician was not called upon to defend its correctness. There are instances, however, the object being to awaken interest or affection, in which exposure is not the physician's duty, inasmuch as it will not do good and may do much harm. It may be a question whether the physician should ever dissimulate so as to ap

pear to be himself deceived. Policy may seem to dictate this course. As a rule, it is more consistent with professional character to undeceive the malingerer at a proper time and in a proper way; otherwise, the physician becomes an accomplice in the fraud. With regard to secrecy beyond this, there can be no better rule than to pursue the course which will do the least harm or the most good to all concerned.

In respect of the knowledge of criminal acts, the physician is not to play the part of a detective or an informer. Some may consider it a strong assertion that a physician is under an ethical bond of secrecy when, through his professional intercourse, he may have ascertained that his patient is an escaped convict, a thief, a robber, a forger, or even a murderer. No matter how heinous the crime, the wretched criminal has a right to medical services in sickness. Who can tell how important it may be that his health should be restored and his life prolonged by these services, albeit in the light of human judgment it might seem better that he remain prostrated by disease or die. The duty of the physician in such instances relates exclusively to the patient. He would be debarred from medical services were it understood that physicians are to play the part of detectives and informers. It may be said that a distinction should be made as to the nature and degree of crimes which patients have committed. But where is the line to be drawn? is not for the physician to exercise a judicial discretion on that point. The ethical rule is without exceptions. Medical men do not always appreciate the binding force of this rule, and disastrous effects sometimes follow its non-observThe following recital is in illustration: An unfortunate young woman had sought to escape disgrace of maternity, and is a victim of malpractice. A physician is called to attend her in her extremity. He

ance.

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