20 research Confidentiality in obstetrics in the XIX th century Romania Sorin Hostiuc 1 , Ionut Negoi 2 , Octavian Buda 3 , Antoaneta Punga 4 , Tony Hangan 5 1. Department of Legal Medicine and Bioethics, University of Medicine and Pharmacy “Carol Davila”, National Institute of Legal Medicine Bucharest, Department of Forensic Pathology (Romania) 2. Department of Surgery, University of Medicine and Pharmacy “Carol Davila”, Floreasca Clinical Emergency Hospital, Bucharest (Romania) 3. Department of History of Medicine, University of Medicine and Pharmacy “Carol Davila”, National Institute of Legal Medicine Bucharest, Department of Forensic Psychiatry (Romania) 4. Department of Physiology, University of Medicine and Pharmacy “Carol Davila” (Romania) 5. Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Ovidius” University of Constanta (Romania) Correspondence: Dr. Sorin Hostiuc e-mail: soraer@gmail.com, sorin.hostiuc@umf.ro Acknowledgment: This work was supported by a grant of the Romanian National Authority for Scientific Research, CNDI– UEFISCDI, project number 215/201. Before the last part of XIX th century one cannot speak about obstetrics as a distinct medical discipline in Romania (nor in the most of Europe as a matter of fact). The act of birth was aided by untrained midwifes, whose empirical skills were responsible for numerous deaths. The purpose of this article is to present the way medical secret was implemented in obstetrics in Romania, its particularities and the influences guiding its development. Understanding the particularities and the evolution of the ethical ideas in medicine may aid our understanding of today’s particularities of medical ethics in Romania and the way it is implemented in clinical practice. By using original and derived sources obtained from the States Archive, the old fund of books from the Romanian Academy, and the National Library of France, and also online resources of old books (DacoRomanica for Romanian documentary materials, Gallica for French documentary materials, and Google Books and archive.org for materials in English) we were able to draw a sketch of the medical secret in obstetrics, whose main conclusions are: (1) medical confidentiality in Romanian Principalities, even if it has specific elements, like the almost complete absence of regulations or etiquette regarding the medical secret, is highly influenced by French and Ottoman culture; (2) the most preeminent regulations regarding medical secret belong to Midwifery institution, being implemented 30 years before the law regulating it for all medical disciplines; (3) knowing what are the origins of the medical confidentiality (and medical ethics in general), may lead to a better understanding of the way ethical principles are implemented in today’s clinical practice. Keywords: confidentiality, obstetrics, evolution, ethical ideas Abstract Received: July 28, 2013 Revised: October 22, 2013 Accepted: December 21, 2013 Introduction Before the last part of XIX th the situation was not however significantly different compared to other Euro- pean countries - for example, in Britain the first succes- sful attempts to organize the midwifery institution were done in 1872, with the Obstetrical Society of London issuing certificates for competence to midwifes (1) . The first attempts to organize and legislate the midwifery institution in Romanian Principalities were done in the first half of the XIXth century. In Walachia, in 1837 Mihai Ghica, manager of the ‘Pantelimon’ Hospital, buys the ground for an obstetrics hospital that will be opened in 1839. Two years after are printed a regula- tion for the hospital (2) , and a manual for midwifes (3) . In Moldavia is founded in 1852 the Grigorian Institu- te, aimed toward training midwifes. The Institute is founded by the Prince of Moldavia, Grigore Ghica, and includes an obstetrics clinic, a Midwifery School and an Asylum for the protection of the children (4) . Both however trained insufficient personnel, making that, until at the end of the XIXth century, numerous births to be assisted by unlicensed midwifes (5) , even in urban areas (6) . The purpose of this article is to present the way medical secret was implemented in obstetrics in Romania, its particularities and the influences guiding its development. Methods The study was conducted using original and derived sources obtained from the States Archive, the old fund of books from the Romanian Academy, and the National Library of France, and also online resources of old books (DacoRomanica for Romanian documentary materials, Gallica for French documentary materials, and Google Books and archive.org for materials in English). Results Medical secret before the XIX th century In Europe the Hippocratic oath, respected by most physicians, specifically forbid the breach of secrecy (see Latour-Dejean (6) for a detailed analysis). Keeping in mind however that the most influential culture for the Romanian Principalities before the XIX th century was Ottoman, we analyzed the way medical secret was implemented there. Data is scarce as the medical guild was mostly unregulated, and the medical profession was open (everyone could declare itself a physician and practice) (7-12) . However, the ethical standards for the medical profession in the Ottoman empire are known to be derived mainly from writing of Abu al Hasan al Tabari that writes, in 970 AD: ‘The physician ought to be modest, virtuous, merciful, not slanderous or addic- ted to liquor and speak no evil of men of repute in the community or be critical of their religious beliefs. He should honest towards women and should not divulge the secrets of his patients’ (13) . His principles, derived from both scriptural sources, revealed to the prophet Muhammad, and western texts (especially Galen and Hippocrates), stayed at the bases of medical ethics in the Ottoman empire in the middle ages (14) . In Romanian Principalities, medical confidentiality was not considered as an essential element for the pp. 20-23 (2014)