nothing about it, and does the best he can for his patient. Notwithstanding this, she dies from her self-inflicted injuries. No one knows of them but the doctor and his patient, and she is dead. He may properly certify the death as one from Septicemia. Possibly she may have consulted him about her condition before she was driven to commit the crime which ended her life, and rumour is busy and suspicion is aroused, and the public prosecutor gets hold of the case. A P.M. reveals the injuries which presumably have caused death. Then the question arises, Who would be the more likely person to commit the crime, the patient or the doctor? The procurator and public may think the doctor the more likely, and he may possibly come to be tried for murder, and should such a case come before Judge Hawkins, would he say you have done a monstrous cruelty and are worthy of death, or you would have done a 'monstrous cruelty' if you had informed upon this poor woman. In such a case the doctor, according to the judge, deserves to be hanged if he does inform, and may certainly be hanged if he does not.

But to return to the protection of the patient. Not only in this vexed question of criminal abortion, about the reporting of which lawyers and doctors both here and in America take such different views, arising doubtless from the laudable desire to stop the crime and at the same time shield the patient, but many others in which the Obstetrician has difficulty in deciding how to act. In cases of concealment of pregnancy,' I presume the medical man would be expected to inform, but to what extent does it differ from that of self-inflicted abortion, and why should the law or we be less careful to protect the poor woman who, in the agonies of labour and great distress of mind, destroys or allows her child to die while coming or having just passed through the maternal passages, than she who has destroyed her child in utero? This is surely a legal and altogether arbitrary distinction.

Then there are the cases of pregnancy sometimes with abortion, in women out of wedlock or where the wife has been separated from her husband for a considerable time. In no class of cases perhaps is it more necessary for the medical adviser to remain. silent in the interest of the patient and for the protection of himself.

Perhaps the most common experience, and one in which it is most difficult to preserve the secret of the patient, is that in which the practitioner is sent for to see a servant in the employment of a client. Her mistress may or may not be suspicious regarding the nature of the illness, and has employed the practitioner not only to treat the servant but to tell her what is wrong. How should such cases be dealt with? It has been said in justification of breaking the confidence existing between doctor and patient in such cases, that the doctor is acting solely as the professional agent of the employer, and that he was sent for the special purpose of

knowing in what condition she is, and pays him his fee. In such cases there is no justification. Such a supposition is quite fallacious, wrong in principle, unjust, not in accordance with law, and would in many cases be actionable. In such circumstances it is always necessary not only to have full permission of the patient to see and prescribe for her, but also permission to tell her employer what she suffers from.

In the trial of Kitson v. Playfair we have a warning how warily the Obstetrician must act in those cases of pregnancy in women long separate from their husbands, even when convinced that a great wrong has been done.

Perhaps no part of the practice of Obstetrics and Gynecology requires more tact and prudence than the management of syphilis and gonorrhoea in married people. It must not be always taken for granted that because a married woman has one or other of these diseases that the husband is the source of infection; and if not so, it would plainly be wrong to allow him to be exposed to the risk, just as much as when the husband is suffering from such complaints we must safeguard the wife, and this we endeavour to do effectively without breaking faith with the patient. The delicate question whether a woman should be told what she suffers from must be determined by the particular circumstances of the case, and whether it be in her interest and for her good that she should know. It sometimes is not. The aim in all such cases being to prevent disease, while at the same time the secret of the patient is kept. Should the practitioner think it his duty to break faith with his patient, he should feel perfectly certain there is strong reason for doing so, sufficient to have weight with both judge and jury. Scarcely less difficult is it to know how to act when such diseases occur in servants and employees, and in these cases the medical practitioner runs greater risk of an action at law should professional confidence be broken. I trust the time is not far distant when the practitioner will be freed from this responsibility by the compulsory notification of all contagious diseases.

But not only is the question of professional secrecy in relation to the law upon an unsatisfactory footing; the law itself as it at present stands is directly opposed to the very frequent practice of the Obstetrician, notwithstanding the assurance of counsel given about two years ago to the Royal College of Physicians, London, 'that the law does not forbid the procurement of abortion during pregnancy or the destruction of the child during labour, where such destruction of life is necessary to save the mother.' But this is only the opinion of counsel-the law remains; and though the illegality of these operations may not be entertained in the law courts, still, 'in the event of the death of the mother, the medical man exposes himself to a prosecution for a criminal offence.' Why then should the law not be amended to run as it does in the

Penal Code of the State of New York. 'A person who, with intent thereby to procure the miscarriage of a woman, unless the same is necessary to preserve the life of the woman, or of the child with which she is pregnant, is guilty of abortion,' etc.

After what has been said, it must, I think, be admitted that with the law on one side and the patient on the other, the position of the Obstetrician is in a very uncertain state of equilibrium, and that this condition of affairs calls for early re-adjustment. Whether the adoption of a law such as exists in America and France (and it has much to recoinmend it) should be made is a matter for serious consideration. But whatever may be done, the law should emphasise in some very decided way a patient's legal right of privilege which she only can waive, except-and the law should make the exceptions-in certain well-defined cases. It does so now in the notification of infectious diseases; it may in the future do so in the case of contagious diseases, and it ought to specify in other cases what the doctor must reveal.

As things now are, the public generally think that professional reticence is merely the fastidious rule of a fastidious profession, contrary, as they often signify, to common sense.

But until there is a clearer understanding between the law and the medical profession, and something definite achieved in this direction, the Obstetrician and medical practitioner should bear in mind that it is the duty of the law to detect crime, that the public prosecutor is alone responsible for its proper investigation, and that the duty of the physician is simply to his patient. For his own protection, about which the law thinks nothing, the general practitioner, at least, should never induce premature labour without consultation with another medical man; that in all cases of suspected criminal abortion he should safeguard himself by calling in, as early as possible, another independent medical witness, and that never under any circumstances whatever should he be induced to examine a woman without her full consent, and preferably in the presence of witnesses.

VALETE.

And now the last few moments which end my Presidency are gone, and it only remains for me to reiterate my gratitude for your kindness and for the great honour you have done me.

In my successor you will find not only much more worthy President, but a familiar friend; one already accustomed to the duties of this chair, and one whom we all delight to honour not only for the work he has done for this Society, but for his high standing as a Gynecologist, Obstetrician, and Teacher.

Dr J. Halliday Croom, in accepting office as President, thanked the Society for the honour again conferred upon him, and at the

same time proposed a vote of thanks to Dr Alex. Ballantyne for his address. This was seconded by Prof. Simpson, and carried unanimously.

VI. A paper by Dr C. F. Ponder, Kalimpong, entitled NATURAL PARTURITION, WITH A DESCRIPTION OF A NEW INSTRUMENT—THE

VECTOR, was communicated by the Secretary (Dr. F. W. N. Haultain). The instrument was to be used only in those cases where the skeletal framework of the pelvis was normal, and where delay in the descent of the head was caused by rigidity of the vaginal walls and perineum. It consisted of three blades somewhat resembling those of ordinary midwifery forceps, two of them lateral, the third posterior. The cavity of the blades was funnel-shaped, so that it was impossible to grasp the head. The handles of each of the three blades locked together to form a firm composite handle. The main object of the instrument-the vector -was to dilate the soft parts of the pelvic outlet, the posterior blade forcing back the perineum. Dilatation being thus artificially produced, Dr Ponder supposed that the expulsive forces would act to greater advantage. He also claimed that the cavity of the blades would guide and protect the foetal head, without, however, exerting any traction upon it.

MEETING II. DECEMBER 8, 1897.

Dr J. HALLIDAY CROOM, President, and afterwards Dr MILNE MURRAY,
Vice-President, in the Chair.

I. The following gentlemen were duly elected Ordinary Fellows of the Society:-W. J. Garbutt, M.B., C.M., 41 Albany Street, Leith; Harry Simpson, M.B., C.M., Royal Infirmary, Edinburgh; W. H. Goldie, M.B., C.M., Royal Infirmary, Edinburgh; C. M. Cooper, M.B., Ch. B., Royal Maternity and Simpson Memorial Hospital; W. A. Potts, B.A., C.M., M.B., Royal Hospital for Sick Children, Edinburgh; Angus Macdonald, M.A., M.B., C.M., 9 Glengyle Terrace, Edinburgh.

II. INDUCTION OF PREMATURE LABOUR.

By JOHN MOIR, M.D.

DR DENMAN informs us that in 1786 there was a solemn conclave of the principal medical men in and around London, to report on the morality, safety, and utility of this operation.

Should there exist any doubt as to the answer to this question being favourable, it should, I think, be removed by the perusal of the following cases. At the time when I commenced my medical education in 1824, the advantages of the Maternity Hospital were

confined to the students attending the class of the University Professor, Dr James Hamilton, and this continued until his death in 1840. My father was attached to the Hospital as surgeon, and I entered the midwifery class in 1824 as a perpetual pupil. I had thus the advantage of witnessing, and, further on in the course of time, of taking part in most of the difficult or interesting cases that occurred during these years. After the election of the late Sir James Simpson to the Midwifery Chair, he, of course, took a large share in the supervision and assistance of the students in difficult cases, and at the same time the advantages of the Maternity Hospital, as in the case of the Royal Infirmary, were opened up to all medical students.

So much to show how it was that a goodly number of cases requiring interference and assistance came under my special notice. Before detailing the practice recommended by Prof. Hamilton in the induction of premature labour, it may be right to mention that Baudeloque and many of the French obstetricians in those days objected to its utility on the ground that the os and cervix, being incompletely developed and prepared for labour before the full period of utero-gestation, the force necessary to overcome the increased difficulty would necessarily destroy the child from the pressure on the navel string. Dr Merriman seems to confirm this view as the result of his experience as recorded in the third volume of the London Medico-Chirurgical Transactions, a large number of the children being still-born. This may reasonably be accounted for by the practice then in use of puncturing the membranes to secure the discharge of the liquor amnii, and of then waiting for the labour pains. Dr Hamilton discountenanced the rupture of the membranes, especially at this early stage, and advised that they should be kept entire for the sake of the child. He separated them from the uterus around the os, and if labour did not supervene in two or three days, he recommended that a small portion only of the liquor amnii should be drawn off. When adopting this proceeding I have always used a male silver catheter, the point of which was cut off. The instrument is gently insinuated between the uterus and membranes for from 2 to 4 inches. The point of the catheter is then turned towards the membranes and the stilette pushed forward so as to puncture them and allow of the flow of a few ounces (two or three) along the catheter, which is then withdrawn. The pressure of the uterine walls on the slight puncture prevents any further discharge. He also recommended, as a means of inducing labour pains, the slipping up of an elastic catheter between the uterus and membranes, leaving it there, and re-introducing it if it were expelled.

Such were the general principles of practice inculcated by Professor Hamilton, in accordance with which I was guided in conducting the cases that came under my charge, and which I have to a great extent followed ever since, modified, however, to