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led to a number of resolutions which are, in presentconditions, of great interest to doctors everywhere.

It has been clear for some time that requests frompublic authorities for medical and statistical informationare tending increasingly to encroach on the private andconfidential relations between doctor and patient. Thosewho seek medical advice have a right to expect thatwhatever they as patients confide to their doctors willgo no further, and doctors are equally anxious to respectabsolutely the confidences they receive. Nevertheless,certain legislation, particularly that dealing with socialinsurance and health, tends to restrict, or even remove,this protection. Police regulations, notification and

registration orders, tax and criminal laws, and thedemands from public authorities, private concerns, andinsurance companies for certificates of incapacity or

health were all mentioned at the congress as causes forthe gradual confounding of the patient’s natural expecta-tion that what he tells the doctor will be passed on tono-one else. The congress came to the conclusion thatmedical secrecy must be regarded as a fundamentalhuman right which, for the sake of patient and doctoralike, needs far more definite protection by the law thanit has hitherto received in Germany. Accordingly, a

resolution was passed asking the Federal Parliament atBonn to introduce comprehensive legislation establishinga definite medical code. This legislation is to be basedon the principle that only the consent of the patient ineach individual case can release the doctor from his duty,which is at the same time his right, not to divulge anyknowledge gained in the consulting-room or elsewhere inthe exercise of his profession. This would give him thenecessary legal ground on which to resist firmly anyunjustified request from whatever source.

In these discussions it was, of course, acknowledgedthat in certain situations a breach of secrecy may benecessary : the prevention of an epidemic or a seriouscrime would justify such a step ; but there was unanimousagreement that the limits of such exceptions should beas narrowly drawn as possible, and that, in cases of doubt,the final decision should be left to the doctor’s discretion.No doubt as a result of certain abuses in Western Ger-many,7 practitioners in Germany are no longer requiredto report all miscarriages and abortions among theirpatients. The congress has gone much further in sug-gesting that by no means all the other notifications nowdemanded by law are justified, and that they are inconstant danger of abuse. It was suggested that, whensuch returns were strictly necessary, in many cases thenames of patients could be withheld without seriouslyinterfering with the purpose of the regulations, and that,where names must be given, these should be sent insealed envelopes to be opened only by the doctors directlyconcerned. One of the demands most strenuously madeat the congress was that confidential medical detailsshould not be known to non-professional civil servants oroutsiders. It was proposed that, whenever a publicauthority or semi-official body asked for a report on aperson’s health or capacity for work, the informationshould be available only to the authority’s health officer,and not to the authority at large. In these circumstancesthe health officer would himself be bound by professionalsecrecy, in the same way as the doctor acting on behalfof, for example, a private insurance company. He wouldpass on the result of the medical examination in theform of a definite recommendation or proposal, with-holding the actual details. It was also proposed thatmedical certificates for employers should identify thedisease by a code word, at the same time giving theseriousness and expected length of the illness.How far these recommendations are likely to be put

into practice in Germany is not yet clear. At all events,

7. Ibid, p. 676.

the German press and public have been strongly impressedby the practitioners’ call for effective legal safeguards.Meanwhile it is interesting to note that, under an

amending Bill to the German Criminal Code, which isbefore the ’"Federal Parliament just now, the privilegeof doctors in German courts of law is to be extendedto their auxiliaries-consulting-room assistants, nurses,and midwives-and that secrecy is to cover not onlywhat has been expressly entrusted to them by their

patients, but all information which they have gainedin the exercise of their profession. Past experience ofoverriding authority, and probably a knowledge’ofconditions in Eastern Germany, where all medical secrecyhas been abolished and doctors have in many respectsbecome the servants of a ministry of labour, havecertainly made German doctors especially sensitive toencroachment on what they rightly regard as a funda-mental principle.

THE YOUNG CHILD IN HOSPITAL

A FILM, A Two-year-old Goes to Hospital, has been madeas part of the research work in progress at the TavistockClinic, and it was shown to the section of psediatrics ofthe Royal Society of Medicine on Nov. 28. Opening themeeting, Dr. John Bowlby said that it might seem thatthe subject of a small child’s stay in hospital for eightdays for a minor operation, and the fact that she spentmost of the time fretting for her mother, were hardlyworth making a film about ; but evidence was accumu-

lating that prolonged periods of separation from themother in early life could have serious effects on a child’smental health. He welcomed the film as a new andobjective approach to the problem.

Mr. James Robertson, a psychiatric social worker atthe Tavistock Clinic, who made the film, said that whilehe was studying the emotional reactions of children inhospitals and sanatoria he became aware of the bias bothof the psychologist, who tended to identify himself withthe small patient he was observing, and of the doctorsand nurses, who were apt to develop a self-defensiveunawareness of the child’s mental suffering in order tospare their own feelings. He had therefore decided tomake this film to record objectively what actuallyhappened. Before the child went into hospital he hadvisited her at home, so that she was accustomed bothto him and to the camera. Later, through the cooperationof the authorities of the Central Middlesex Hospital,he or a colleague was able to watch the child continuouslyduring her waking hours. Each important event wasfilmed-the child’s admission to hospital, the first bath,the administration of an anaesthetic by enema, and theparents’ visits-and in addition films were taken eachdav from 11.0 to 11.40 A.M. at five-minute intervals.The only departure from routine was that a nurse wasspecially detailed to talk and play with the child duringthe morning filming. The little girl, Laura, aged 21I2,had been selected at random from the waiting-list ofchildren between 18 months and 3 years who were tocome into hospital for an operation for umbilical hernia.This operation was chosen because it was minor anduncomplicated and not very painful.The film opened with Laura playing happily with her

parents in the garden of her home. Her mother hadexplained that she would be going into hospital andwould stay there until she had had her operationand her tummy was better. On the day of her admission,she was bright and interested as she sat waiting withher mother at hospital; but she was looking a bithesitant some minutes later when the nurse" took herinto a strange bathroom, and she asked anxiously," where’s my Mummy " When the nurse began toundress her she cried and struggled ; but by the timeshe had been bathed, dried, and dressed in a nightgown

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she had regained her composure, showing remarkableself-control for her age. She was given a cot in a

children’s ward with 12 beds. She looked about her in a

puzzled way, and cried when a nurse took her temperaturein the axilla. But she cheered up again when her mothercame to say good-bye ; and she waved happily enoughand watched the bus drive away. Her mother had toldher she would come again tomorrow, and had left withher a teddy-bear and a piece of blanket she alwayscherished, her " blanket-baby." However, she spentmost of the day crying and calling for her mother,and she did not take kindly to a visit from the

surgeon.Next day she had her operation. She was given an

anaesthetic by enema, an experience which terrified herand made her scream with apprehension. She was nextshown when both her parents came to see her as she wasrecovering from the anaesthetic. She cried most of thetime, and was especially distressed because her mothercould not take her up in her arms. When her motherleft first, she clung to her father until he, too, had to go.On the third day she seemed very sad and subdued.She was unresponsive to the nurse, and tears came easily.She called for her mother, but when her mother came shereceived her without enthusiasm, and it was some timebefore she became lively and joined in a game. From thistime onwards, she became less and less responsive bothto the nurses and to her mother. She spent a good dealof time watching another child who was howling lustily,and she exclaimed, " He wants his mummy." She clungto her teddy and her blanket-baby and to some booksher mother had brought, but she still cried for hermother whenever some kindly grown-up came to speakto her. When her mother came to take her home, shewas extremely reserved, but she brightened up consider-ably when her shoes were put on. She insisted on gatheringup all her toys and books, and she waved good-bye as shegot to the door of the ward. Then she dropped a bookand for the first time showed real temper. She leftrather unsteadily, but not holding her mother’shand.

In the discussion which followed, the first reaction ofthe audience seemed to be a frank refusal to admit thatthe child was distressed. However, Dr. Mildred Creakpointed out that it had taken a second showing of thefilm to overcome her initial resistance to the fact thatmost young children in hospital were unhappy. Of thosewho agreed that the film showed the child’s distress

clearly enough, many were reluctant to admit that such anexperience might cause long-continued or even permanentemotional disturbances. They felt that the emotionalafter-effects were negligible, and depended largely on theindividual child’s upbringing and home life. There wasa need, they thought, for control films of normal children’semotional upsets at home, and of the effects both of alonger stay in hospital and of a stay undisturbed by analarming operation. In reply, Mr. Robertson said it washoped that other films would eventually be made. Hefelt that, in spite of Laura’s exceptional self-control, thefilm gave a fair idea of the typical reactions of a child inhospital, and he disagreed with the view that the mentalsuffering was negligible. Dr. Bowlby agreed that weneeded detailed evidence on the effects of a period ofseparation from the mother, but he thought that thisevidence would be of little scientific value unless it wascollected and weighed by people with the necessarypsychological training.Despite daily visits by her mother, this child was shown

in silent grief during most of her stay in hospital. Herself-control broke down under frankly terrifying situ-ations. For most of the day she sat quietly clutchingher treasured possessions, preoccupied with her grief.Despite this unhappy picture, the film left an excellentimpression of the treatment and kindly handling of a

small child in this particular hospital. However, thereseemed no need for this particular operation at such apsychologically vulnerable age ; and even if the operationwas thought vital the child might possibly have beentreated as an outpatient. If hospital is unavoidable, thereare certain ways in which, on the evidence of this film,matters could be improved. Laura was kept in virtualisolation and given little physical comforting, even by hermother, who thought that it was not permitted in theward. A strange nurse gave her a bath while her motherwaited outside ; and some nursing procedures were

carried out without any attempt to explain them to thechild. Doctors and nurses can do much to help in

reducing the number of mother-child separations and tomake those that are unavoidable as happy as possible.The words of one paediatrician to his student nurses arememorable : "When you are admitting a child to

hospital always try to beliave as though you werewelcoming a strange and nervous child who has come tospend a weekend in your home."

.

SISTER KENNY

Miss Elizabeth Kenny, the Australian nursing sister,died on Nov. 30. Doctors have disagreed about the valueof her contribution to the treatment of poliomyelitis, butnone has failed to admire the energy and perseverancewith which she upheld her beliefs in the face of incredulityand discouragement. The ideas which were to cut so

sharply across orthodox medical opinion were plantedin her mind by her early nursing experiences in Queens-land ; and they grew into a system of treatment and aconcept of the disease which aroused discussion and C

controversy all over the world. For one thing, she

challenged the doctors’ insistence on rest and immobilisa-tion in the early stages of poliomyelitis, and she claimedthat, given the chance of treating a patient soon enough,she could improve on the results of any other form oftreatment.Her views were at first entirely rejected, and then

hesitantly acknowledged as worth investigating. The

report on the year’s trial at Queen Mary’s Hospital,Carshalton, in 1937-38 was almost wholly discouraging,and, added to the lukewarm findings of the RoyalCommission appointed by the Queensland State govern-ment in 1936, would have brought despair to the cham-pions of most causes. But if Sister Kenny ever despairedit was certainly-not for her treatment, but for the

perception of the doctors who refused to see what to herwas abundantly clear. She did not realise that her ownenthusiasm could go against her ; for the doctors thoughtthat their treatment, energetically pursued, could achieveas much as her own, and they suggested that the benefitsshe brought to paralysed patients owed more to herconfidence and optimism than to any originality ofmethod.

She went to the United States in 1940, and though atfirst her methods gained no wider acceptance than

elsewhere, things went more happily for her in the end.The Elizabeth Kenny Institute was set up in Minne-

apolis, and here, and in other clinics devoted to hertreatment, much of her work was more favourablyreceived than ever before. She never won for hermethods or theories the unconditional approval that sheand her many supporters believed them to deserve.Nevertheless, she whipped up so world-wide an interestin the treatment of poliomyelitis that, whatever the finaljudgment of her teaching may be, the sum of herwork, in terms of suffering directly or indirectlyrelieved, places her among the foremost members of herprofession.

Prof. R. S. AITKEN, F.R.C.P., vice-chancellor of theUniversity of Otago, has been nominated vice-chancellorof Birmingham University.