Nearly all who now refuse to report would do so willingly if names could be withheld. A few will continue to refuse until the Board of Health explains more fully to what use the information will be put. One physician in a large county seat told of a case where a young woman of prominence had been reported. A leak occurred in the local Board of Health, with prompt general publicity. Another knew of an "embarrassing situation" which had resulted from a report and thereupon ceased reporting. Here are a few sentences taken from different cards: Reporting will drive patients from good physicians to quacks. An innocent man might be forever branded as a syphilitic because of errors in laboratory technique. All men who fall by the wayside are not necessarily the "scum of the earth." Patients should not have their social status irreparably injured by leaks from the local Health Board. I am a family physician, not a policeman. It affects the patient's family as much as the patient and thereby necessitates a double breach of confidence. The venereal problem is not only a medical one but is complicated by moral and sociological features which will not permit of its treatment along simple epidermiological lines. I only report the "poor nobodies." In small communities it is easy for such information to leak out and become generally known, the attending physician getting the blame. That records can be kept secret is a delusion and a snare. No case reported by me ever returned for further treatment. One physician practiced in a mountain district where venereal disease was unknown. That other leaks than that mentioned have not been heard of is doubtless due to two facts; reporting is of recent origin, and, more especially, nearly all the cases reported in Maryland (as in the country at large) are dispensary and Venereal Disease Clinic cases- -"The poor nobodies." If physicians reported all their cases, which would include people of prominence, the temptation to gossip would be infinitely greater. No one cares if Jim Smith of Duncan Alley has syphilis. How different if the Honorable James Smythe of Mt. Vernon Place were reported! CONCLUSIONS 1. The medical profession should coöperate with Public Health officials in their attempts to stamp out the venereal plague, when such coöperation is compatible with honor and common sense. 2. The profession in the United States, Great Britain and France is at the present time keenly in favor of the principle of medical secrecy. 3. The issue as to whether this time-honored ethical principle is to be scrapped in the interest of public health has been put squarely before us by the Maryland State Board of Health. It is no light matter to be pried loose from one's principles. If we part with this, our sacred heritage, our birthright, let it be with open eyes. Let it not be filched from us unguardedly. The Board of Health, before requiring such a sacrifice should clearly demonstrate to the profession and the public that the results are worth the sacrifice and can be achieved in no other way. 4. The reporting of names and addresses of those "by whom infected" is the reporting of that of which the physician knows nothing, which may be scandalous, vicious and untrue. It cannot produce reliable statistics and lies are no part of scientific medicine. 5. The reporting of cases of venereal disease is more rational for here the physician has self-obtained knowledge. It should be done, but under conditions which will not violate professional secrecy and will not subject the reporter to litigation. 6. Our Board of Health should give Maryland physicians the privilege of guarding the confidences of patients at least to the same extent as is enjoyed by doctors of the great majority of States where reporting is by number and not by name and address. If the State law as it exists is a bar to immediate action, our State Board, endorsed by the medical profession, can readily have it changed. Forty-one State Boards have secured, either by statutory law or by their own regulations, laws safeguarding medical secrecy. 7. The Public Health Service (1922 Report), alarmed by the falling off in reporting, suggested to Health Boards that they make an organized effort to secure better cooperation on the part of physicians. Our State Board would be in a better position to make such an appeal if it first changed its obnoxious reporting feature. Doctor Fulton in his letter of May 24, 1918, says: "At every step the confidence and cooperation of the medical profession are prime requisites of success. Want of confidence and coöperation, as surely, harbingers of failure." 8. We suggest the passage of the following resolution: Resolved that the Medical and Chirurgical Faculty of Maryland reaffirms its adherence to the principle of professional secrecy. Resolved that it recommends to the State Board of Health that it secure the modification of the reporting feature of the Venereal Disease Law so as to conform with the forty-one States requiring no names. Resolved that the Committee on Legislation confer with the State Bar Association regarding the enactment of a statute of Privileged Communications for the medical profession and report back at semi-annual meeting. WM. T. WATSON, Chairman Mr. President, and Members of the House of Delegates: Your Committee has had the usual difficulties of holding its meetings: after many efforts by the Chairman, one full meeting was held and one meeting of three, one member being unable to attend. The entire membership agreed upon one point, namely, that these diseases should be reported; but how they should be reported was the stumbling block-two were in favor of the reporting of such cases as it is now done, and the other two favored reporting by number. You have heard the report of those who favor the reporting by number and their reasons. We respectfully submit our report in favor of the law remaining as it now is: The law as it now is, is the fundamental law and easy of administration and affects all communicable diseases alike. The source of the infection is not required in the report. With few exceptions these diseases are contracted as a result of immorality and those that have them are a danger to public health whether they be private or dispensary patients. The records are kept from the public and none but the officials know them, no clerk would dare divulge such records-immediate dismissal would result, with the probabilities that he or she could never obtain another position of trust. The responsibility rests upon the Department Heads, and from present indications there is little probability of their being removed for some time to come. The physician reporting such cases could not be prosecuted for complying with a State Law. The Hippocratic Oath was made long ago and our interpretation of it is as follows: "What might be the ailment of an individual was his business and not to be told by the attending physician to another." Control of diseases was not thought of in those days. Now it is an accepted governmental function. For proper statistics and control of social life and health, names are given in births, deaths, marriages and divorces, in small-pox, typhoid, typhus, cholera, tuberculosis, leprosy, malaria, and 40 other diseases; if giving the name of them having venereal disease is a "breach of confidence," so is the giving of the names in all other cases. The same objections raised now against the reporting of venereal diseases were raised and used against the recording of marriages, death, tuberculosis and other diseases, they have been successfully controlled and in the lapse of time, forgotten—a few more years and the objections now raised will be equally as lost. Any physician having a secretary immediately violates the Hippocratic Oath as soon as a diagnosis is made and recorded. The reporting of venereal diseases seems to have fallen off recently, the cause is not known, but Maryland and Massachusetts in proportion to population are running nip and tuck in their reports. Massachusetts reports by number and Maryland by name. If every physician had a competent secretary and each physician were equally interested in the cure of these cases, reporting by number might be of value; without these two provisions the records would soon become a bungled mass, of no use or value to the physician, patient, or public health. As the situation now is, of the many thousand cases reported not a single, definite case has come to the notice of the departments of health, so that said departments are known not to be responsible for the leakage. Many cases are generally known among their associates; this you all know. Believing that the law as it now is, is easy of administration, whatever the objections are, whether real or imaginary it would be extremely unwise at this time to recommend any change. We therefore recommend that no action be taken, so that the departments of health may be unhampered in the protection of public health. Respectfully submitted, Baltimore, Md. JOSIAH S. BOWEN REPORT OF THE COMMITTEE FOR FUTURE IMPROVEMENTS ON THE BUILDING Your Committee has met several times and discussed the need of changes in the building to take care of a new Osler Hall, some small halls, suitable extension of the present book-stacks and more work room for the Library staff. Through the kindness of Mr. William A. Emmart, the architect of the present building, we are enabled to show you some tentative plans and we urge that a vote of thanks be given Mr. Emmart, as the work which he has done is without compensation or the expectation of it at the present time. We call particular attention to the fact that the plans as exhibited are only tentative and must be the subject of further study, as there are a number of changes which will undoubtedly have to be made. We particularly request that all the members study the plans carefully and submit in writing any suggestions which they may have. We also suggest that the Committee be continued, and that a Building Fund Committee, of the younger men of the Faculty, be appointed. JOHN RUHRÄH G. M. LINTHICUM SEMI ANNUAL MEETING EASTON, MD, SEPT. 26-27, 1923 ADDRESS OF PRESIDING OFFICER The President, Dr. Harry Friedenwald, as presiding officer made the following remarks in his opening address: In opening this semi-annual meeting of the Medical and Chirurgical Faculty, I desire to express my appreciation of the honor you have shown me in electing me President; at the same time I must tell you that I deeply deplore the fact that the man whom we hoped and expected to see standing here, Herbert Harlan, is no longer among us, and that another must take his place. All of us esteemed Doctor Harlan for his knowledge, his operative skill, and his high ethical standards as physician and surgeon; we admired him for his sterling character, we loved him as colleague, as friend, as man. This Faculty and the State of Maryland are forever indebted to him and to his memory in a measure greater than I can express, for his many years of service as member of the Board of Examiners, a service to which he gave himself with complete and rare devotion, with fairness and justice to the applicants and to this commonwealth. We shall always cherish his memory. PROGRAMME OF THE SEMI-ANNUAL MEETING EASTON, MARYLAND Wednesday, September 26, 1923 All meetings were held at the New Theatre 10.30 A.M. Clinics, Emergency Hospital, Easton. By the Staff. Addresses of Welcome-Hon. F. G. Wrightson, Mayor of Easton; Mr. Mason Shehan, .Dr. Harry Friedenwald President Medical and Chirurgical Faculty of Maryland Luncheon-Ballroom of New Theater. 2 P.M. Meeting of Council and House of Delegates. 2.30-4 P.M. SCIENTIFIC SESSION The prevalence of ectopic pregnancy on the Eastern Shore....Dr. W. N. Palmer Salpingitis...... ...Dr. P. L. Travers Protozoal Intestinal Infection-Relationship to Dysentery (Lantern Slides) 4-6 P.M. Oyster Roast-Country Club. 8 P.M. Evening Session-New Theater. Dr. G. Milton Linthicum Addresses by Hon. Albert C. Ritchie (by invitation), Governor of Maryland; Hon. Hubert Work, M.D. (by invitation), Secretary of the Interior. Thursday, September 27, 1923 10 A.M. Clinics, Emergency Hospital-Dr. Hugh H. Young; Dr. Arthur M. Shipley The Early Recognition and Treatment of Mental Disorders...Dr. Arthur P. Herring 4 P.M. Reception and Tea at "Hope"-Mrs. William J. Starr. |