- Email: [email protected]
CONTROL OF VENEREAL DISEASES.
103 of the Mission are training local workers to it must be possible to classify the available data continue its administration when the Mission leaves accurately and without overlapping. The function the country on Jan. 1st, 1922. The work has been of the central office is, in short, that of a telephone very successful so far, and the interest which the centre, enabling one doctor to get into touch with Slovak peasants have shown in it has been rnost another through a practically automatic and impersonal encouraging. Dr. Roger P. Stewart, of London, is medium. In time it will be possible for a doctor to in charge of the work under the direction of a learn the subsequent fate of a patient whose disease committee on which Lady Muriel Paget’s Mission, he treated in its early stage, and neurologists, oculists, the League of Red Cross Societies, and the Czecho- surgeons, and physicians will have a guide enabling Slovak Red Cross and Ministry of Public Health are them to learn not only whether a patient under their care has or has not contracted syphilis earlier in his represented. A Medical Strike. career, but also the nature of the specific treatmenthe has received, and other instructive information The Czecho-Slovak physicians who serve as medical officers to insurance associations went on strike on contained in his registration dossier. As Dr. Jersild out, registration of syphilitics, if it is to fulfil May 1st because the associations refused to double points functions adequately, should not merely yieldthe fees paid by an insured person for attendance. its The Czech physicians claim that German physicians statistical information as to the increase or decrease of new cases in a community, but it should also enable are receiving such fees from the German associations, and consider themselves entitled to the same. On the physician to trace the patient’s career from the the other hand, the associations claim that a contract first appearance of a chancre to his death. It should has been made with the physicians up to the end of also ensure continuity of treatment, however much the year 1921. The strike has already lasted for more the patient may flit between hospitals and from one than a month, but a speedy settlement is not prob- physician to another. five following identification data areentered able, as the [medical profession is well organised onThe the registration form : (1) Sex ; (2) birthday and and follows very closely the direction of its central ; (3) the first letter of the patient’s organisation. On the other hand, the insurance year of birth a hyphened surname being indicated by surname, associations claim that increasing the fees to the first letter after the hyphen ; (4) the date on which physicians would mean financial ruin to the associa- the the was first diagnosed or treated ; (5) the tions, involving a breakdown of the whole insurance namedisease of the physician or institution beginning treatin are which 90 of cent. the system, per population ment. the inclusion of the of birth of the
personnel
included.
By
year
it will be possible in a few decades automatically to omit from the register a certain number of patients, and thus the register will not be unnecessarily overcrowded. In practice, one shortcoming CONTROL OF VENEREAL DISEASES. has already been detected in this system of registration. Syphilologists are apt not to make use of WasserRegistration of Syphilitics. mann’s test during the first years after infection, for A census of the syphilitic fraction of a communityat this stage a negative Wassermann may prove may seem an impossible feat, owing to the subterraneanmischievous, as it may lead to the patient neglecting character of the disease and the natural disinclination treatment. The syphilologist also is less dependent of the persons concerned to figure in such a census. than his colleagues on a serological diagnosis. But, But it is obvious that if such a census were feasible, unfortunately, his distaste for Wassermann’s test and kept up-to-date year by year, our knowledge of early in the patient’s career means that many syphithis disease and our ability to treat it successfully litics evade registration just at the period in their livesIn a recent when it would be most useful, to themselves in parwould ultimately be much increased. paper, Dr. 0. Jersild7 has shown that such a system ticular. To overcome this difficulty, syphilologistsof registration of the syphilitic is not simply a counsel i.e., heads of V.D. clinics-have been supplied with of perfection, but can be put into effect in a small special registration forms. Although registration has country such as Denmark, without disconcerting existed only half a year, about 10,000 persons have intrusion into the patient’s privacy. But it must already been entered on the Serum Institute’s register,. from the outset be made clear that a system which is and its effici0ncy has been tested in several instances. perfectly feasible in a country like Denmark may be As an instructive example of the workings of this. quite unworkable in a larger and less compact com- system, Dr. Jersild refers to a patient whose dossier munity. In Denmark, where a system of registration showed that, though he masqueraded as a new case of the syphilitic has existed for about half a year, at Dr. Jersild’s hospital, he had been treated there carried out only in at aa earlier date. Wassermann’s reaction is This cenone institute, and under State control. A Hostel for Infectious Cases. tralisation of the Wassermann reaction is probably The annual report of the Royal Free Hostel second unique, and it would be difficult to overrate the im- for Women and Girls has just been issued. The portance of this point. It means that in Denmark, hostel was opened in June, 1919, at 24, Gloucesterat any rate, the prestige of this reaction has not been undermined by uncontrolled, semi-professional work, road, Regent’s Park, London, N.W., for the care of and the fact that 41,093 Wassermann tests were made girls and women suffering from venereal diseases in in 1920 at the State Serum Institute, shows that an infectious stage. Ten beds are available in rooms of one or three beds. The patients are drawn chiefly hospital authorities and practitioners make extensive from those attending the Royal Free Hospital V.D. use of the Institute for this purpose. The machinery for the Wassermann reaction being Clinic, and are selected by the medical officer to the but cases from part of London or the centralised, it was comparatively easy to evolve a clinic ; can be receivedany under certain conditions. country system of registration centring about this reaction. Sir Thomas Barlow is the chairman of the committee The Wassermann forms have been worded so as to of the hostel and the medical members include Miss serve the double purpose of a serological report and Aldrich Blake, Lady Barrett, Sir Francis Champneys, and the have e two registration, following principles been conscientiously followed : (1) Notification should Dr. Dorothy C. Hare, Dr. T. S. Higgins, Dr. A. G. be so organised that it would work almost auto- Phear, Dr. Ethel Vaughan Sawyer, and Dr. Margaret aims of the committee include not matically without compulsion or discomfort to anyone Rorke.careThewith treatment and isolation during only whenever a syphilitic changes his doctor or address ; period, but the after-care of those (2) owing to the confidential character of the matter the infectious there should be absolutely no chance of personal discharged from the hostel. The great importance of identification at the central office, where, however, after-care is recognised. Even in the most promising cases physical and mental recovery often takes several months, and much help must be given if the 7 Ugeskrift for Laeger, June 2nd, 1921. Prague, June 15th.
patient,
104 individual is to become a, useful citizen. The hostel is closely associated with the Royal Free Hospital,
and arrangements made for them to continue under the care of their own medical officer. Applications for vacancies should be made to the Almoner, Royal Free Hospital, Gray’s Inn-road, London, W.C.I. The most suitable cases for admission to the hostel are young girls. Married women, professional prostitutes, or remand cases are not usually suitable. Cases of pregnancy are not admitted after the early months. Patients are kept in the hostel, if possible, until their condition becomes non-infectious, and suitable arrangements have been made for their return to work, or to their families. The circumstances of patients are inquired into and they are required to contribute towards the cost of their maintenance if in a position to do so, but no patient is refused on grounds of inability to pay. A maximum charge of 35s. per week is made ; the average charge is 15s. Further information regarding the hostel may be obtained on application to the Almoner, Royal Free Hospital, Gray’s Inn-road, London, W.C.1, or the Hon. Secretary, 6, Drayton-gardens, London, S.W.10.
but financially it is an entirely independent undertaking. Between April 1st, 1920, and March 31st, 1921, 65 girls passed through the hostel, the average length ,of stay being 39-19 days. The occupations and disposal of these girls were as follows : the average age of patients was 22-5 years, and their previous occupations were domestic ser-
vants, 21 ; factory or business, 10 ; clerks, 7 ; women’s services, 7 ; shop-hands, 6 ; no occupation, 5 ; waitresses, 3 ; prostitutes, 3 ; married, living at home, 2 ; companion, 1. Of these 19 returned to former
- employment, 12 are out of work, 8 have gone to fresh work or training, 4 have been sent to various homes, ’3 have returned to
prostitution, 3 have been lost sight of, 3 have married, 3 are at home with no occupation. 1 mentally deficient, has been taken under M.D. Act, 1 mentally deficient is with her sister, and 8
Patients attend the Free Hospital medical treatment such as douching is carried out by the sisterin-charge, as instructed by the doctor. Much improvement in general health is noticed while the girls are in the hostel, and their increase in weight is often astonishing. The attendance records at hospital for hostel patients are satisfactory. A few cases admitted from hospitals other than the Royal Free continue to attend their own clinics. Every girl is in the hostel by her own choice, and is free to leave if she will. Most settle down quickly, but some are unhappy and depressed at first, or are physically too ill to take an active part in the life of the home. The fundamental idea in the ethical teaching given is to develop such principles as the girls already possess, and to lead their often distorted views of life and morals into right channels. Open discussion on questions of religion The lighter work and social conduct is encouraged. of the house is done by the girls, under the supervision of the house matron. In the afternoons they rest or go out, and in the evenings they make their own clothes, or learn handicrafts, such as basket-making or raffia work. The staff consists of the sister-in.charge, who is a fully trained nurse, and two - assistants, a house matron and a kitchen matron. Of the 95 patients who have left the hostel since it was opened, definite news has been received of 92. The cases may be grouped as follows : doing well at present, 57 ; doubtful at present, 18 ; no good at present 10 ; lost sight of, 3 ; in homes needing permanent supervision, 5 ; certified under Mental Deficiency Act, 2. Of those classed as doubtful " or " no good," several were only in the hostel a few days, and owing to their harmful influence -on the other inmates, were returned to the senders or removed to the infirmary. It is regarded as impossible to furnish a report which shall be permanently accurate. On the whole, however, those ’considered as satisfactory have remained so, and of the rest some have become satisfactory, and some of the most unpromising have changed their mode of life, at least temporarily. The expenses for the year have amounted to £1026. The receipts (which include the balance in hand at the beginning of the year of .6204) amount The estimated outlay -for the coming to .E1302. The London County Council have year is £1120. recommended that the Ministry of Health should make a grant of £400, an increase of 2100 on the Patients’ payments may previous year’s grant. This leaves a sum be expected to bring in 2100. of £620 to be obtained in subscriptions and donations. The committee express their conviction that if a wider public could realise the great importance of the work done, sufficient financial help would be forthcoming. Medical practitioners who are desirous of securing the admission of a patient to the hostel are invited to refer the case with a note to the medical officer of the Royal Free Hospital V.D. Clinic. Patients from other hospital clinics in the district are admitted are
still in the hostel.
out-patient department at the Royal twice weekly. In addition, individual
The Services. ROYAL NAVAL MEDICAL SERVICE. Lieuts. (ret.) to be Surg. Lieut.-Comdrs. (ret.) : A. L. Robinson, G. A. Jackson, and W. L. Cowardin. Actg. Lieuts. to be Lieuts. : H. G. Marsh, P. R. Enright, and F. W. Langford.
Surg.
-
ROYAL ARMY MEDICAL CORPS.
Capt. and Bt. Maj. W. F. Christie retires, receiving a gratuity, and is granted the rank of Maj. Capt. W. Walker and Capt. P. J. Ryan relinquish the actg. rank of Maj. Capt. H. A. Hill, from R.A.M.C. Spec. Res., to be Lt., with the temp. rank of Capt. Officers relinquishing their commns. :-Temp. Capts. retaining the rank of Capt. : W. M. Muirhead, F. Whitby, H. Abernethy, and B. N. Sinclair. SPECIAL RESERVE OF OFFICERS.
Capt.
R.
Magill
to be
Maj.
TERRITORIAL FORCE.
Maj.
W. Bowater to be Lt.-Col. and commd. Ist S. Mid. Fd.
Amb.
Capt. A. P. Thomson resigns his commn. and is granted the rank of Maj. Capt. W. J. Lacy-Hickey and Capt. J. G. Hayes resign their commns. and retain the rank of Capt. Lt. J. P. Kitson (late R.A.M.C.) to be Capt. The King has conferred the Territorial Decoration upon the undermentioned officers : Lt.-Col. D. L. Hamilton, 2nd H. Counties Field Amb. ; Lt.-Col. C. L. Isaac, 3rd Welsh Field Amb. ; Maj. G. R. Wilson. attd. 8th Bn. Manch. R.; Maj. D. H. Weir, attd, 4th Bn. North’d. Fus.; Maj. W. F. McAllister-Hewlings, attd. N. Mid. A.S.C. (ret.) ; and Maj. E. L. Rowse, lst Lond. Fd. Amb.
"
TERRITORIAL FORCE RESERVE.
Lt.-Col. (Bt.-Col.) C. J. Jacomb-Hood, having attained the age limit, is retired, and retains his rank with permission to wear the prescribed uniform. The King has conferred the Territorial Force Decoration upon Col. Sir R. H. Luce, K.C.M.G., V.D. DEFENCE FORCE.
Temp. Capts. relinquishing Campbell and W. T. Briscoe.
their
commns.:
G.
M.
ROYAL AIR FORCE. Lts. to be Squadron Leaders : D’Arcy Power, J. Rothwell, K. Biggs, and A. J. 0. Wigmore. Flight Lts. to be Hon. Squadron Leaders : A. E. F. F. Huntsman and G. D. Kerr.
Flight
INDIAN MEDICAL SERVICE.
i
Maj. J. J. Robb to be Lt.-Col. Temp.-Lt. H. R. Rishworth (since to be temp. Capt.
relinqd.
his commn.)
personnel
included.
By
year
it will be possible in a few decades automatically to omit from the register a certain number of patients, and thus the register will not be unnecessarily overcrowded. In practice, one shortcoming CONTROL OF VENEREAL DISEASES. has already been detected in this system of registration. Syphilologists are apt not to make use of WasserRegistration of Syphilitics. mann’s test during the first years after infection, for A census of the syphilitic fraction of a communityat this stage a negative Wassermann may prove may seem an impossible feat, owing to the subterraneanmischievous, as it may lead to the patient neglecting character of the disease and the natural disinclination treatment. The syphilologist also is less dependent of the persons concerned to figure in such a census. than his colleagues on a serological diagnosis. But, But it is obvious that if such a census were feasible, unfortunately, his distaste for Wassermann’s test and kept up-to-date year by year, our knowledge of early in the patient’s career means that many syphithis disease and our ability to treat it successfully litics evade registration just at the period in their livesIn a recent when it would be most useful, to themselves in parwould ultimately be much increased. paper, Dr. 0. Jersild7 has shown that such a system ticular. To overcome this difficulty, syphilologistsof registration of the syphilitic is not simply a counsel i.e., heads of V.D. clinics-have been supplied with of perfection, but can be put into effect in a small special registration forms. Although registration has country such as Denmark, without disconcerting existed only half a year, about 10,000 persons have intrusion into the patient’s privacy. But it must already been entered on the Serum Institute’s register,. from the outset be made clear that a system which is and its effici0ncy has been tested in several instances. perfectly feasible in a country like Denmark may be As an instructive example of the workings of this. quite unworkable in a larger and less compact com- system, Dr. Jersild refers to a patient whose dossier munity. In Denmark, where a system of registration showed that, though he masqueraded as a new case of the syphilitic has existed for about half a year, at Dr. Jersild’s hospital, he had been treated there carried out only in at aa earlier date. Wassermann’s reaction is This cenone institute, and under State control. A Hostel for Infectious Cases. tralisation of the Wassermann reaction is probably The annual report of the Royal Free Hostel second unique, and it would be difficult to overrate the im- for Women and Girls has just been issued. The portance of this point. It means that in Denmark, hostel was opened in June, 1919, at 24, Gloucesterat any rate, the prestige of this reaction has not been undermined by uncontrolled, semi-professional work, road, Regent’s Park, London, N.W., for the care of and the fact that 41,093 Wassermann tests were made girls and women suffering from venereal diseases in in 1920 at the State Serum Institute, shows that an infectious stage. Ten beds are available in rooms of one or three beds. The patients are drawn chiefly hospital authorities and practitioners make extensive from those attending the Royal Free Hospital V.D. use of the Institute for this purpose. The machinery for the Wassermann reaction being Clinic, and are selected by the medical officer to the but cases from part of London or the centralised, it was comparatively easy to evolve a clinic ; can be receivedany under certain conditions. country system of registration centring about this reaction. Sir Thomas Barlow is the chairman of the committee The Wassermann forms have been worded so as to of the hostel and the medical members include Miss serve the double purpose of a serological report and Aldrich Blake, Lady Barrett, Sir Francis Champneys, and the have e two registration, following principles been conscientiously followed : (1) Notification should Dr. Dorothy C. Hare, Dr. T. S. Higgins, Dr. A. G. be so organised that it would work almost auto- Phear, Dr. Ethel Vaughan Sawyer, and Dr. Margaret aims of the committee include not matically without compulsion or discomfort to anyone Rorke.careThewith treatment and isolation during only whenever a syphilitic changes his doctor or address ; period, but the after-care of those (2) owing to the confidential character of the matter the infectious there should be absolutely no chance of personal discharged from the hostel. The great importance of identification at the central office, where, however, after-care is recognised. Even in the most promising cases physical and mental recovery often takes several months, and much help must be given if the 7 Ugeskrift for Laeger, June 2nd, 1921. Prague, June 15th.
patient,
104 individual is to become a, useful citizen. The hostel is closely associated with the Royal Free Hospital,
and arrangements made for them to continue under the care of their own medical officer. Applications for vacancies should be made to the Almoner, Royal Free Hospital, Gray’s Inn-road, London, W.C.I. The most suitable cases for admission to the hostel are young girls. Married women, professional prostitutes, or remand cases are not usually suitable. Cases of pregnancy are not admitted after the early months. Patients are kept in the hostel, if possible, until their condition becomes non-infectious, and suitable arrangements have been made for their return to work, or to their families. The circumstances of patients are inquired into and they are required to contribute towards the cost of their maintenance if in a position to do so, but no patient is refused on grounds of inability to pay. A maximum charge of 35s. per week is made ; the average charge is 15s. Further information regarding the hostel may be obtained on application to the Almoner, Royal Free Hospital, Gray’s Inn-road, London, W.C.1, or the Hon. Secretary, 6, Drayton-gardens, London, S.W.10.
but financially it is an entirely independent undertaking. Between April 1st, 1920, and March 31st, 1921, 65 girls passed through the hostel, the average length ,of stay being 39-19 days. The occupations and disposal of these girls were as follows : the average age of patients was 22-5 years, and their previous occupations were domestic ser-
vants, 21 ; factory or business, 10 ; clerks, 7 ; women’s services, 7 ; shop-hands, 6 ; no occupation, 5 ; waitresses, 3 ; prostitutes, 3 ; married, living at home, 2 ; companion, 1. Of these 19 returned to former
- employment, 12 are out of work, 8 have gone to fresh work or training, 4 have been sent to various homes, ’3 have returned to
prostitution, 3 have been lost sight of, 3 have married, 3 are at home with no occupation. 1 mentally deficient, has been taken under M.D. Act, 1 mentally deficient is with her sister, and 8
Patients attend the Free Hospital medical treatment such as douching is carried out by the sisterin-charge, as instructed by the doctor. Much improvement in general health is noticed while the girls are in the hostel, and their increase in weight is often astonishing. The attendance records at hospital for hostel patients are satisfactory. A few cases admitted from hospitals other than the Royal Free continue to attend their own clinics. Every girl is in the hostel by her own choice, and is free to leave if she will. Most settle down quickly, but some are unhappy and depressed at first, or are physically too ill to take an active part in the life of the home. The fundamental idea in the ethical teaching given is to develop such principles as the girls already possess, and to lead their often distorted views of life and morals into right channels. Open discussion on questions of religion The lighter work and social conduct is encouraged. of the house is done by the girls, under the supervision of the house matron. In the afternoons they rest or go out, and in the evenings they make their own clothes, or learn handicrafts, such as basket-making or raffia work. The staff consists of the sister-in.charge, who is a fully trained nurse, and two - assistants, a house matron and a kitchen matron. Of the 95 patients who have left the hostel since it was opened, definite news has been received of 92. The cases may be grouped as follows : doing well at present, 57 ; doubtful at present, 18 ; no good at present 10 ; lost sight of, 3 ; in homes needing permanent supervision, 5 ; certified under Mental Deficiency Act, 2. Of those classed as doubtful " or " no good," several were only in the hostel a few days, and owing to their harmful influence -on the other inmates, were returned to the senders or removed to the infirmary. It is regarded as impossible to furnish a report which shall be permanently accurate. On the whole, however, those ’considered as satisfactory have remained so, and of the rest some have become satisfactory, and some of the most unpromising have changed their mode of life, at least temporarily. The expenses for the year have amounted to £1026. The receipts (which include the balance in hand at the beginning of the year of .6204) amount The estimated outlay -for the coming to .E1302. The London County Council have year is £1120. recommended that the Ministry of Health should make a grant of £400, an increase of 2100 on the Patients’ payments may previous year’s grant. This leaves a sum be expected to bring in 2100. of £620 to be obtained in subscriptions and donations. The committee express their conviction that if a wider public could realise the great importance of the work done, sufficient financial help would be forthcoming. Medical practitioners who are desirous of securing the admission of a patient to the hostel are invited to refer the case with a note to the medical officer of the Royal Free Hospital V.D. Clinic. Patients from other hospital clinics in the district are admitted are
still in the hostel.
out-patient department at the Royal twice weekly. In addition, individual
The Services. ROYAL NAVAL MEDICAL SERVICE. Lieuts. (ret.) to be Surg. Lieut.-Comdrs. (ret.) : A. L. Robinson, G. A. Jackson, and W. L. Cowardin. Actg. Lieuts. to be Lieuts. : H. G. Marsh, P. R. Enright, and F. W. Langford.
Surg.
-
ROYAL ARMY MEDICAL CORPS.
Capt. and Bt. Maj. W. F. Christie retires, receiving a gratuity, and is granted the rank of Maj. Capt. W. Walker and Capt. P. J. Ryan relinquish the actg. rank of Maj. Capt. H. A. Hill, from R.A.M.C. Spec. Res., to be Lt., with the temp. rank of Capt. Officers relinquishing their commns. :-Temp. Capts. retaining the rank of Capt. : W. M. Muirhead, F. Whitby, H. Abernethy, and B. N. Sinclair. SPECIAL RESERVE OF OFFICERS.
Capt.
R.
Magill
to be
Maj.
TERRITORIAL FORCE.
Maj.
W. Bowater to be Lt.-Col. and commd. Ist S. Mid. Fd.
Amb.
Capt. A. P. Thomson resigns his commn. and is granted the rank of Maj. Capt. W. J. Lacy-Hickey and Capt. J. G. Hayes resign their commns. and retain the rank of Capt. Lt. J. P. Kitson (late R.A.M.C.) to be Capt. The King has conferred the Territorial Decoration upon the undermentioned officers : Lt.-Col. D. L. Hamilton, 2nd H. Counties Field Amb. ; Lt.-Col. C. L. Isaac, 3rd Welsh Field Amb. ; Maj. G. R. Wilson. attd. 8th Bn. Manch. R.; Maj. D. H. Weir, attd, 4th Bn. North’d. Fus.; Maj. W. F. McAllister-Hewlings, attd. N. Mid. A.S.C. (ret.) ; and Maj. E. L. Rowse, lst Lond. Fd. Amb.
"
TERRITORIAL FORCE RESERVE.
Lt.-Col. (Bt.-Col.) C. J. Jacomb-Hood, having attained the age limit, is retired, and retains his rank with permission to wear the prescribed uniform. The King has conferred the Territorial Force Decoration upon Col. Sir R. H. Luce, K.C.M.G., V.D. DEFENCE FORCE.
Temp. Capts. relinquishing Campbell and W. T. Briscoe.
their
commns.:
G.
M.
ROYAL AIR FORCE. Lts. to be Squadron Leaders : D’Arcy Power, J. Rothwell, K. Biggs, and A. J. 0. Wigmore. Flight Lts. to be Hon. Squadron Leaders : A. E. F. F. Huntsman and G. D. Kerr.
Flight
INDIAN MEDICAL SERVICE.
i
Maj. J. J. Robb to be Lt.-Col. Temp.-Lt. H. R. Rishworth (since to be temp. Capt.
relinqd.
his commn.)