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CONTROL OF VENEREAL DISEASES.
114 that if the average yield per cow in the United Kingdom1 meeting, held under the auspices of the Insurance could be increased by one-tenth of a gallon per day the Faculty, Miss Norah March enunciated the views of the cost of milk at present prices would automatically fall1 society thus:"In the meantime we must face the problem of the about 2d. per gallon without affecting the profit made byT the farmer. By paying stricter attention to the methods; unchaste. Are they to be allowed to continue unaware or of feeding it is reckoned that an increased yield from insufficiently appreciative of the possible consequences unchastity? or are they to be impressed with the necessity 1 to 2 gallons per cow could be effected, which would of -if they are determined on anti-social behaviour-for safesolve the problem of scarcity and materially bring down Lguarding themselves, in so far as it is humanly possible, in prices. Then comes the suggestion of official milk- the interests of others, from the possible consequences of recording centres being established, a scheme which, in their action? Surely it is a matter of moral responsibility the opinion of the Committee, has been by far the most to take all possible precautions, and such education as the effective agent in the improvement of dairy stock Society for Prevention of Venereal Disease proposes to put throughout the world. Sensible proposals are also made at the disposal of the public is intended to thro2v onus upon the in regard to the selection of dairy bulls, the real test of individual, to make him responsible, if he does not conform to the social code, for limiting the evil results of his antiwhich should be the power to beget offspring which social behaviour to the narrowest degree possible." will yield large quantities of rich milk. The society does not advocate free distribution of Conclusion. prophylactic packets or the indiscriminate urging of Such are some of the salient features of the report, people to provide themselves with them. Its members, while recognising the value of chastity, realise also that a study of which shows how thoroughly the Committee has gone into the great and manifold questions involved many individuals will, in spite of all deterrents, indulge -questions, amongst many others, of improved transport in promiscuous intercourse, and they regard it as their facilities, preservation, and uncontaminated supplies. duty to the community to ensure that such individuals Agricultural developments apart, which deserve the are acquainted with methods of reducing their chance serious consideration of the dairy industry with a view of acquiring and conveying infection. The society to increased production, the hygienic or scientific would confer a greater gain on the community by demands have received anxious attention, the Com- laying more emphasis, in the instructions which they mittee evidently having settled upon the need of issue, upon the value it attaches to the practice of conadopting a policy which should lead to the ultimate tinence, and upon the undoubted fact that, while provision of both a clean and an abundant supply properly applied medicaments will in the majority of cases ensure safety, yet there can be no absolute of milk to the community. .
guarantee. The future of these two bodies.-It would be a national calamity if the effort associated with either of these
CONTROL OF VENEREAL DISEASES. The Anti- Venereal Campaign. THE campaign against venereal disease so ably inaugurated by the National Council for Combating Venereal Diseases is in danger of losing in effectiveness from an internecine struggle with the Society for Prevention of Venereal Disease, of which it was the predecessor and in large measure the progenitor. The position of the N. C. C. 1.D.-In their memorandum of Nov. 10th the National Council made these among other statements :— 2. It is no part of our policy to conceal the truth, and we have always acknowledged the value of cleansing and disinfecting materials, applied early and thoroughly, in diminishing the risk of disease. 3. Abstention from exposure to infection is the only certain safeguard against the ordinary risk of disease ; continence is to be encouraged by every means and on every ground, both social and hygienic. 4. No person who has indulged in promiscuous intercourse can be sure that he is not infected, and every such person is, therefore, bound in duty to him- (or her-) self and to society to seek means of cleansing at the earliest moment. 5. For this purpose a thorough local application of soapand-water is of great value, followed (if possible) by the use of such disinfectants as may be recommended by a medical
practitioner. It is evident from these clauses. that the National Council believe in the efficiency of immediate selfdisinfection and advocate its application. The work of the Council, freely spent in the inculcation of chastity, needs no emphasis from us. The position of the S.P. V.D.-The Venereal Prevention Committee, or, as it has now become, the Society for the Prevention of Venereal Disease, advocates the immediate application by the individual concerned of certain disinfectants, selected by a consensus of opinion In on the part of the medical members of the society. this respect the suggestion enunciated by the N.C.C.V.D. in Clause 5 of their memorandum is complied with. With regard to the attitude of the society to the question of morality, there is no colour for the suggestion which has been made that its members are indifferent to the importance of promulgating the value of chastity. Lord Willoughby de Broke, in his speech in the House of Lords on Dec. 10th, made it clear that the importance of chastity was realised by the society over which he presides. Because the immediate objective of the society is the direct prevention of disease, and because it takes the dictates of morality as read, this does not imply indifference or antagonism. At a recent
bodies were to be eliminated. Should the National Council sink into abeyance, its valuable educational and propaganda work at home and abroad would be nullified. In view of the fundamental similarity of policy in the programmes of the N.C.C.V.D. and the S.P.V.D. there is nothing to preclude members of the one body from assuming or retaining membership of the other. By such a condition of dual membership a better understanding might be reached and unnecessary friction obviated. There is no logical reason against the dual allegiance, since, as we have seen, both bodies inculcate the need of immediate self-disinfection and both are alive to the importance of the practice of chastity. A conjoint crusade would be to the national gain. The National Council has the machinery, the experience, and the staff for organising and effectively carrying out educational measures. The Prevention Society appears the better adapted for stamping out disease by sanitary methods. By a sympathetic and broad-minded coöperation in principle and a wise division of specialised labour there is an opportunity of benefiting both the generation ’ that is and those which are to come. A
Plea .for
Treatment Centre for London. Whilst controversy rages with regard to the respective merits of immediate disinfection and early treatment, hundreds of individuals are daily becoming infected in London alone. Insistence is laid by the advocates of early treatment upon the necessity which exists for individuals to seek assistance within a few hours after exposure to infection. In order that this advice may be put into practice it is necessary for an early treatment centre to be available during the whole of the 24 hours of the day. As far as we are aware no We strongly urge the such accommodation exists. of at once instituting such a centre, and thus rectifying a position which is as illogical as it is callous. The advantages of an all day and night centre would be multiple. 1. It would undoubtedly prevent the development of much disease, especially amongst those (and they will long be with us) who for various reasons do not have recourse to immediate self- disinfection. 2. It would, after trial, give a substantial idea as to the necessity, quantitative and topographical, which exists for such centres. 3. Being admittedly of an experimental nature, improvements in technique and organisation which presented themselves could readily be adopted. After the attainment of a reasonable standard of perfection other clinics could then be founded and worked on similar lines.
necessity
an
Experimental Early
115 The organising, equipping, and staffing of an experi- the use of alcohol before exposure, and 85 admitted mental pioneer centre need occupy but a short time. intoxication. If instructions were given to-day such a centre could be A Post-graduate Course of Instruction. in full working order in two to three weeks. Knowledge A post-graduate course of instruction in the diagnosis of the existence and the situation of the centre could and treatment of venereal disease is being arranged by be promulgated by the same methods as are already Mr. K. M. Walker at St. Bartholomew’s Hospital Clinic, V.D. for known the clinics. utilised ordinary making Golden-lane, E.C., established by the Corporation of The number of cases attending these clinics are London. The first course will be confined to male increasing rapidly, and we are justified in regarding practitioners, of whom 15 can be accommodated. The the carrying out of the above suggestion as essentially suggested dates are Thursday afternoons at 5.30 P.M. an emergency measure. We commend it to the Ministry The beds attached to the clinic are available for the of Health and the medical department of the London reception and study of suitable cases in addition to County Council. work in the out-patient department. Any medical practitioner wishing to attend is invited to send his The Appointment of Medical Officers to Treatment name to the Medical Secretary, National Council for Centres. Combating Venereal Diseases, 81, Avenue Chambers, It was inevitable that, during the war, venereal Southampton-row, London, W.C. 1. If more than clinics should be placed in charge of medical men who 15 names are received a second course will be held had but little experience in the diagnosis and treatment as soon as possible after the termination of the first. of venereal diseases. Now that the number of specially qualified practitioners has increased, it is necessary in the interests of the community at large for clinics to be TUBERCULOSIS. placed in charge of those who have gained sufficient experience to justify their acceptance of such posts. Unless a high standard of efficiency is insisted upon Tuberculosis in Birmingham. treatment will be prolonged and its cost unnecessarily THE report on tuberculosis in Birmingham in 1918 by increased. No electoral body should appoint a medical the chief tuberculosis officer, Dr. G. B. Dixon, brings officer to take charge of a clinic unless he produces out many points of exceptional interest. In this year, evidence of adequate instruction in a recognised institu- 3254 cases of tuberculosis were notified, as compared tion or has otherwise gained equivalent experience. with 3543 in 1917. The mortality for 1918 was 1385, and The Low VenerealRecord in the American Expeditionary as somewhat similar figures have been returned for earlier years, the calculation is made that the actual Forces. Colonel Ashburn1 of the United States Army states mortality among the cases notified is about 42 per cent. that the incidence of venereal disease in the American In other words, about 58 per cent. of the persons notified recover. In Birmingham there are more than Expeditionary Forces varied for the greater part of the 16,000 cases of the disease at any one time, the cost of which numbers of American time, during large troops which to the is at least one million a year. There city were present in France, between 62 and 31 per 1000, the average being about 45 cases per 1000 men annually. is, therefore, everyjustification for the expenses incurred in stamping out the disease, all the more as there are The raterise rose rapidly as troops were being sent home, many indications that its incidence is being reduced. was and rate but this the true at fictitious, this time could not be determined. It was a remarkable As judged by notifications, the report shows a definite fact that the corresponding incidence in the United decline of the incidence of pulmonary tuberculosis. States was always reported as higher than in France, The war has, however, increased the mortality among the persons already suffering from tuberculosis. A averaging about 60 even after the armistice. In order comparison with the notifications in five other large to set an explanation of the low incidence rate of with 248 notifications per 100 deaths, venereal disease in France a questionnaire was sent out towns shows that, comes first, the ratio of notifications to Birmingham to obtain information on the following subjects : (1) 100 deaths being as low as 167 in Manchester, and What is the percentage of chaste men among soldiers?’? 176 in Leeds. A table showing the incidence of, (2) What is the average number of unprotected venereal and mortality from, tuberculosis at various ages brings contacts to each case of venereal disease’?(3) What the incidence and out the curious fact that whereas proportion of men have been exposed to venereal mortality are about equal in the two sexes up to the age of More or less disease without using prophylaxis? at every age-period over 15 the incidence and mortality complete answers were obtained from 13,648 men 15, much higher in the male-often more than twice located in four base sections, principally at Bordeaux, are Those who maintain that bad housing is the as high. St. Nazaire, Brest, and Tours. It was found that in producing tuberculosis will 34 per cent., or about a third, had abstained most important factor to find that in 1918, as in previous years, be surprised from sexual intercourse while in France. Another third of all the men had indulged in intercourse so the incidence of the disease among males aged 35 to 45 was 7’69 1000 living at these ages, as compared infrequently as to make their chance of acquiring with 3’33 per per 1000 females of the same age. Again, disease quite small, so that relative continence was the rates at these ages for males was 4’46, probably next in importance to real chastity in keeping as mortality with compared only 1’55 per 1000 for females. Yet down venereal disease. From a study of the replies women at these ages spend far more of their time in and from collateral evidence Ashburn came to the conThe report clusion that in France there were about 30 unprotected the dwelling-house than do the men. an account by Mr. J. Malcolm, M.R.C.V.S., of includes contacts with women of promiscuous sexual habits for each case of resulting venereal disease, while tuberculosis with reference to the milk-supply. prophylaxis reduced the incidence to about one-third of Borough of Poplar Dispensary. what it was without prophylaxis. ’The much greater The report of this dispensary, which was founded as relative frequency of soft chancre in France, approxi- a memorial to King Edward VII., is for the years mately two-fifths of all venereal disease, and the lesser 1917-18. Many pages are devoted to tables showing relative frequency of gonorrhoea suggested that prophy- the amount and -nature of the work done. The scope laxis was less effective against chancroid than against of this work is ever widening and bringing the disgonorrhoea or syphilis. The contact rate among men pensary into some new official relationship or other. on leave was very high. 50 to 70 per cent. of the venereal But the lack of suitable institutional accommodation for disease in the army came from leave areas, and from advanced cases of pulmonary tuberculosis is deplored, towns en route thereto. According to statements made and the fact that such cases are still dependent on the. by 614 men with venereal disease alcohol seems to have Poor-law infirmary is recognised as a grave flaw in the played a smaller part as a factor predisposing to venereal antituberculosis campaign. disease in the American Expeditionary Force than Sanatorium Benefit in Ayr. might-have been supposed. Of the 614 only 215 admitted In the report for 1918, the Insurance Committee for 1 Journal of the American Medican Association, Dec. 13th, 1919. Ayr reviews the results of institutional and domiciliary
partly
guarantee. The future of these two bodies.-It would be a national calamity if the effort associated with either of these
CONTROL OF VENEREAL DISEASES. The Anti- Venereal Campaign. THE campaign against venereal disease so ably inaugurated by the National Council for Combating Venereal Diseases is in danger of losing in effectiveness from an internecine struggle with the Society for Prevention of Venereal Disease, of which it was the predecessor and in large measure the progenitor. The position of the N. C. C. 1.D.-In their memorandum of Nov. 10th the National Council made these among other statements :— 2. It is no part of our policy to conceal the truth, and we have always acknowledged the value of cleansing and disinfecting materials, applied early and thoroughly, in diminishing the risk of disease. 3. Abstention from exposure to infection is the only certain safeguard against the ordinary risk of disease ; continence is to be encouraged by every means and on every ground, both social and hygienic. 4. No person who has indulged in promiscuous intercourse can be sure that he is not infected, and every such person is, therefore, bound in duty to him- (or her-) self and to society to seek means of cleansing at the earliest moment. 5. For this purpose a thorough local application of soapand-water is of great value, followed (if possible) by the use of such disinfectants as may be recommended by a medical
practitioner. It is evident from these clauses. that the National Council believe in the efficiency of immediate selfdisinfection and advocate its application. The work of the Council, freely spent in the inculcation of chastity, needs no emphasis from us. The position of the S.P. V.D.-The Venereal Prevention Committee, or, as it has now become, the Society for the Prevention of Venereal Disease, advocates the immediate application by the individual concerned of certain disinfectants, selected by a consensus of opinion In on the part of the medical members of the society. this respect the suggestion enunciated by the N.C.C.V.D. in Clause 5 of their memorandum is complied with. With regard to the attitude of the society to the question of morality, there is no colour for the suggestion which has been made that its members are indifferent to the importance of promulgating the value of chastity. Lord Willoughby de Broke, in his speech in the House of Lords on Dec. 10th, made it clear that the importance of chastity was realised by the society over which he presides. Because the immediate objective of the society is the direct prevention of disease, and because it takes the dictates of morality as read, this does not imply indifference or antagonism. At a recent
bodies were to be eliminated. Should the National Council sink into abeyance, its valuable educational and propaganda work at home and abroad would be nullified. In view of the fundamental similarity of policy in the programmes of the N.C.C.V.D. and the S.P.V.D. there is nothing to preclude members of the one body from assuming or retaining membership of the other. By such a condition of dual membership a better understanding might be reached and unnecessary friction obviated. There is no logical reason against the dual allegiance, since, as we have seen, both bodies inculcate the need of immediate self-disinfection and both are alive to the importance of the practice of chastity. A conjoint crusade would be to the national gain. The National Council has the machinery, the experience, and the staff for organising and effectively carrying out educational measures. The Prevention Society appears the better adapted for stamping out disease by sanitary methods. By a sympathetic and broad-minded coöperation in principle and a wise division of specialised labour there is an opportunity of benefiting both the generation ’ that is and those which are to come. A
Plea .for
Treatment Centre for London. Whilst controversy rages with regard to the respective merits of immediate disinfection and early treatment, hundreds of individuals are daily becoming infected in London alone. Insistence is laid by the advocates of early treatment upon the necessity which exists for individuals to seek assistance within a few hours after exposure to infection. In order that this advice may be put into practice it is necessary for an early treatment centre to be available during the whole of the 24 hours of the day. As far as we are aware no We strongly urge the such accommodation exists. of at once instituting such a centre, and thus rectifying a position which is as illogical as it is callous. The advantages of an all day and night centre would be multiple. 1. It would undoubtedly prevent the development of much disease, especially amongst those (and they will long be with us) who for various reasons do not have recourse to immediate self- disinfection. 2. It would, after trial, give a substantial idea as to the necessity, quantitative and topographical, which exists for such centres. 3. Being admittedly of an experimental nature, improvements in technique and organisation which presented themselves could readily be adopted. After the attainment of a reasonable standard of perfection other clinics could then be founded and worked on similar lines.
necessity
an
Experimental Early
115 The organising, equipping, and staffing of an experi- the use of alcohol before exposure, and 85 admitted mental pioneer centre need occupy but a short time. intoxication. If instructions were given to-day such a centre could be A Post-graduate Course of Instruction. in full working order in two to three weeks. Knowledge A post-graduate course of instruction in the diagnosis of the existence and the situation of the centre could and treatment of venereal disease is being arranged by be promulgated by the same methods as are already Mr. K. M. Walker at St. Bartholomew’s Hospital Clinic, V.D. for known the clinics. utilised ordinary making Golden-lane, E.C., established by the Corporation of The number of cases attending these clinics are London. The first course will be confined to male increasing rapidly, and we are justified in regarding practitioners, of whom 15 can be accommodated. The the carrying out of the above suggestion as essentially suggested dates are Thursday afternoons at 5.30 P.M. an emergency measure. We commend it to the Ministry The beds attached to the clinic are available for the of Health and the medical department of the London reception and study of suitable cases in addition to County Council. work in the out-patient department. Any medical practitioner wishing to attend is invited to send his The Appointment of Medical Officers to Treatment name to the Medical Secretary, National Council for Centres. Combating Venereal Diseases, 81, Avenue Chambers, It was inevitable that, during the war, venereal Southampton-row, London, W.C. 1. If more than clinics should be placed in charge of medical men who 15 names are received a second course will be held had but little experience in the diagnosis and treatment as soon as possible after the termination of the first. of venereal diseases. Now that the number of specially qualified practitioners has increased, it is necessary in the interests of the community at large for clinics to be TUBERCULOSIS. placed in charge of those who have gained sufficient experience to justify their acceptance of such posts. Unless a high standard of efficiency is insisted upon Tuberculosis in Birmingham. treatment will be prolonged and its cost unnecessarily THE report on tuberculosis in Birmingham in 1918 by increased. No electoral body should appoint a medical the chief tuberculosis officer, Dr. G. B. Dixon, brings officer to take charge of a clinic unless he produces out many points of exceptional interest. In this year, evidence of adequate instruction in a recognised institu- 3254 cases of tuberculosis were notified, as compared tion or has otherwise gained equivalent experience. with 3543 in 1917. The mortality for 1918 was 1385, and The Low VenerealRecord in the American Expeditionary as somewhat similar figures have been returned for earlier years, the calculation is made that the actual Forces. Colonel Ashburn1 of the United States Army states mortality among the cases notified is about 42 per cent. that the incidence of venereal disease in the American In other words, about 58 per cent. of the persons notified recover. In Birmingham there are more than Expeditionary Forces varied for the greater part of the 16,000 cases of the disease at any one time, the cost of which numbers of American time, during large troops which to the is at least one million a year. There city were present in France, between 62 and 31 per 1000, the average being about 45 cases per 1000 men annually. is, therefore, everyjustification for the expenses incurred in stamping out the disease, all the more as there are The raterise rose rapidly as troops were being sent home, many indications that its incidence is being reduced. was and rate but this the true at fictitious, this time could not be determined. It was a remarkable As judged by notifications, the report shows a definite fact that the corresponding incidence in the United decline of the incidence of pulmonary tuberculosis. States was always reported as higher than in France, The war has, however, increased the mortality among the persons already suffering from tuberculosis. A averaging about 60 even after the armistice. In order comparison with the notifications in five other large to set an explanation of the low incidence rate of with 248 notifications per 100 deaths, venereal disease in France a questionnaire was sent out towns shows that, comes first, the ratio of notifications to Birmingham to obtain information on the following subjects : (1) 100 deaths being as low as 167 in Manchester, and What is the percentage of chaste men among soldiers?’? 176 in Leeds. A table showing the incidence of, (2) What is the average number of unprotected venereal and mortality from, tuberculosis at various ages brings contacts to each case of venereal disease’?(3) What the incidence and out the curious fact that whereas proportion of men have been exposed to venereal mortality are about equal in the two sexes up to the age of More or less disease without using prophylaxis? at every age-period over 15 the incidence and mortality complete answers were obtained from 13,648 men 15, much higher in the male-often more than twice located in four base sections, principally at Bordeaux, are Those who maintain that bad housing is the as high. St. Nazaire, Brest, and Tours. It was found that in producing tuberculosis will 34 per cent., or about a third, had abstained most important factor to find that in 1918, as in previous years, be surprised from sexual intercourse while in France. Another third of all the men had indulged in intercourse so the incidence of the disease among males aged 35 to 45 was 7’69 1000 living at these ages, as compared infrequently as to make their chance of acquiring with 3’33 per per 1000 females of the same age. Again, disease quite small, so that relative continence was the rates at these ages for males was 4’46, probably next in importance to real chastity in keeping as mortality with compared only 1’55 per 1000 for females. Yet down venereal disease. From a study of the replies women at these ages spend far more of their time in and from collateral evidence Ashburn came to the conThe report clusion that in France there were about 30 unprotected the dwelling-house than do the men. an account by Mr. J. Malcolm, M.R.C.V.S., of includes contacts with women of promiscuous sexual habits for each case of resulting venereal disease, while tuberculosis with reference to the milk-supply. prophylaxis reduced the incidence to about one-third of Borough of Poplar Dispensary. what it was without prophylaxis. ’The much greater The report of this dispensary, which was founded as relative frequency of soft chancre in France, approxi- a memorial to King Edward VII., is for the years mately two-fifths of all venereal disease, and the lesser 1917-18. Many pages are devoted to tables showing relative frequency of gonorrhoea suggested that prophy- the amount and -nature of the work done. The scope laxis was less effective against chancroid than against of this work is ever widening and bringing the disgonorrhoea or syphilis. The contact rate among men pensary into some new official relationship or other. on leave was very high. 50 to 70 per cent. of the venereal But the lack of suitable institutional accommodation for disease in the army came from leave areas, and from advanced cases of pulmonary tuberculosis is deplored, towns en route thereto. According to statements made and the fact that such cases are still dependent on the. by 614 men with venereal disease alcohol seems to have Poor-law infirmary is recognised as a grave flaw in the played a smaller part as a factor predisposing to venereal antituberculosis campaign. disease in the American Expeditionary Force than Sanatorium Benefit in Ayr. might-have been supposed. Of the 614 only 215 admitted In the report for 1918, the Insurance Committee for 1 Journal of the American Medican Association, Dec. 13th, 1919. Ayr reviews the results of institutional and domiciliary
partly