- Email: [email protected]
From Dr. E. M. Smith, M.O.H. York
I918.
PUBLIC HEALTH.
INFLUENZA EPIDEMIC. A letter addressed to Medical Officers of HeAth has been issued by Sir Arthur Newsholme, Chief Medical Officer of the Local Government Board. In this letter Sir Arthur Newsholme makes an appeal to which it is hoped all Medical Officers of Health will respond to the best of their ability. I t is only by such united efforts that useful results can be obtained, and the Medical Officer to the Board is to be congratulated in his prompt action in endeavouring to collect information concerning this extraordinary outbreak. The information required is as follows :-A. I. T h e r e p o r t s h o u l d give t h e d e a t h s f r o m i n f l u e n z a in t h e d i s t r i c t for each w e e k of t h e y e a r I918. 2. A t a b l e s h o u l d be p r e p a r e d g i v i n g t h e age a n d s e x d i s t r i b u t i o n of t h e d e a t h s f r o m influenza. 3. I n f o r m a t i o n s h o u l d be given as to t h e d a t e of t h e first a p p e a r a n c e of t h e e p i d e m i c in t h e district a n d of its cessation. 4- T h e r e s u l t s of a n y local p a t h o l o g i c a l e x a m i n a t i o n s able to be o b t a i n e d , i n c l u d i n g bacteriological e x a m i n a t i o n s o1 s p u t a s h o u l d be given. 5. I f t h e r e is a n y evidence t h r o w i n g light on t h e m e a n s of i n t r o d u c t i o n of t h e disease, t h i s s h o u l d be s t a t e d . 6. A n y f a c t s w o u l d be v a l u a b l e w h i c h b e a r o n - D u r a t i o n of i n c u b a t i o n period ; D u r a t i o n of i n f e c t i v i t y ; M e t h o d s of s p r e a d ; E v i d e n c e of possible p r o t e c t i o n b y a p r e v i o u s a t t a c k ; F r e q u e n c y of o c c u r r e n c e of s e c o n d a t t a c k s in 19t8. 7- A n y special clinical f e a t u r e s of t h e o u t b r e a k s h o u l d be s t a t e d . I t will be v a l u a b l e ff a c o m p a r i s o n b e t w e e n cases in r u r a l a n d u r b a n a r e a s c a n be m a d e . 8. H a s t h e r e b e e n a n y special incidence on p a r t i c u l a r occupations or districts ? I t is i m p o r t a n t t h a t a n e x a c t s t a t e m e n t s h o u l d be m a d e of a d m i n i s t r a t i v e action t a k e n b y t h e S a n i t a r y A u t h o r i t y , w i t h n o t e s on t h e possible influence of s u c h action. B. L D i s t r i b u t i o n of p r e c a u t i o n a r y advice to t h e public. H o w effeeted ? 2. A n y special m e a s u r e s t a k e n in r e s p e c t of__ School closure or e x c l u s i o n ; E x c l u s i o n f r o m or closure of places of public entertainment ; E x c l u s i o n , if a n y , f r o m o c c u p a t i o n s . 3- P r o v i s i o n of h o s p i t a l t r e a t m e n t . 4. Provision at p a t i e n t ' s h o m e of m e d i c a l assistance.
,, ,, nursing ,, . . . . domestic ~y 5. Provision of facilities for bacteriological examination of material from patients. 6. Prophylaxis by vaccine, if attempted. T I l E P R E V E N T I O N OF V E N E R E A L DISEASE. important facts published in the September T H Eissue of P U B L I C H E A L T H , and the subsequent correspondence in our columns in October and November, have aroused considerable interest, and the Editor has received numerous p e r s o n a letters from medical officers of h e a t h approving of the official adoption of prophylaxis. Such corn-
33
munications cannot be published without the consent of the writers, but it may be possible for some of them to appear in our next issue. Several letters for publication are, owing to reasons o~ space, unavoidably left over to January ; some of these letters oppose prophylaxis, and others are in favour of it. Everyone interested in this important subject is invited to join in the correspondence, but it is hoped that the writers will take into consideration our reduced space, refraining from vague generalities, and confining themselves as far as possible to the essential fact, which is the prevention of venereal disease. From several indirect sources we have been supplied with copies of a stencilled document purporting to be signed by five medical officers of health (three county and two county borough officers) opposing prophylaxis and supporting the policy of the National Council for Combating VenereA Disease. An accompanying letter (also stencilled), signed by one of the five, clams that the majority of MedicA Officers of Health, and of the Medical Profession, are opposed to prophylaxis, appeals for further signatures, and states that the document will be sent to this Journal for publication. Apparently a considerable number of these papers have been circulated. Up to the time of going to press it has not been received. The correspondence is open to all, so long as reasonable brevity is exercised, and no letter has been or is likely to be refused publication. CORRESPONDENCE. The Editor does not accept responsibility/or lhe opinions of correspondents. From Dr. E. M. SMITH, M.O.H, York.
To the Editor of PUBLIC HEAL¢I~. SI~,--I was delighted to see Dr. Robertson's letter in your October issue, for I had intended writing a similar protest for that issue, but was prevented by pressure of other urgent work. I, also, deplore the attitude of the said article in the September issue of this Journal, and I very much regret that the " official organ " of the Society of MedicM Officers of Health should have published Miss Ettie Rout's communications; I think that their publication does not redound to the credit of either the Society or its official organ. I fully agree with the contents of Dr. Robertson's letter, and go further, for all the educated people, lay and medical, with whom I have discussed the question, and who have given it careful ~hought, agree with me in supporting the N.C.C.V.D.'s policy of opposition to the issue of prophylactic outfits, even to soldiers " in these abnormal days." During the War, the N.C.C.V.D. and other agencies have made immense efforts in the instruction of the men in the A r m y in sex morality and sex pathology, and it is profoundly regrettable, and
34
PUBLIC HEALTH;
has probably been grievously fatal, t h a t t h a t admirable work should have been antagonised to any extent, however little, b y either action or teaching in respect of prophylaxis before illicit intercourse--a course which cannot fail to act as a gross incentive to immorality. We can no more divorce morals from medicine in connection with venereal disease, than in connection with drunkenness or gluttony, and we do not administer medical prophylactics either before or after either of those last-named transgressions of the laws of health. I can assure Dr. Joseph t h a t there is at least one IVI.O.H. who will have nothing to do with giving such prophylactic advice or outfits as he suggests in the article which is the subject of this protest. May I also say t h a t I am by no means the only /vI.O.H. who gravely doubts the wisdom of giving public pronouncement to the so-called " early preventive treatment " policy now proposed b y the N.C.C.V.D., and the York Branch of t h a t body is so far opposed to it. We see little distinction in principle between the policy of giving preventives before immoral intercourse and that of systematically providing facilities for personal disinfection immediately after the event. Either policy tacitly admits the continuance of prostitution (professional or otherwise), as an inevitable institution, and indirectly, must act more or less as an incentive to intercourse with prostitutes. Whereas, surely, all our present preventive and educational work aims indirectly at the extinction of such degradation. If our efforts are persistent we should be able to look forward to a great diminution in the prostitute supply, because we have diminished tile demand. I n t h a t direction ties the possibility o f - - a t l e a s t - - a great reduction in prostitution .... an " institution " which all humanitarians and sanatarians can only regard as horrible, since it involves the degradation of our sisterhood of woman. I n a case such as Sir J. Crichton Browne's " foolish boy " (vide PUBLIC ITEALa:IL November, 1917 , page 26), who had exposed himself to infection, we agree we should administer such treatment as would tend to prevent the development of his infection and its possible communication to innocent persons, but to provide widespread systematic facilities for such personal disinfection, and to publish their arrangement broadcast, appears to us to be a very different matter, and one which we cannot but regard as unwise and even dangerons, not merely from the moral point of view, but also from the medical point of view, for we must not forget t h a t either form of prevention is by no means absolutely reliable. Surely, as custodians of the Public Health, we cannot agree with any policy which opposes the combined moral, biological, and pathological educational campaign, which is now being pursued so vigorously and which is so full of hope. I trtlst t h a t the Society of M.O.H.'s
DEC~B~I~,
and its Journal will not continue to support Sir Bryan Donkin's policy. If they do, verily reconstruction of the Society is urgently required. I am, Sir, Yours faithfully,
EDMUND From
" Another
M. SA~IITH,
M.O.H."
To the Editor of Pum,IC HEALTH,
SIR, I desire to add m y congratulations to the m a n y which must have reached Miss Ettie Rout upon the subject of he~ timely exposure of the methods of the National Council for Combating Venereal Diseases. A recent writer in the Lancet suggested the formation of a real Society for Preventing Venereal Diseases, and offered to contribute a substantial sum towards the initial expenses thereof. There must be m a n y Medical Officers of Health who would join such a society, and I suggest that the M.O.H. Society should consider the desirability of creating such an organization. At all events, I hope to see announced in an early issue of PUBLIC HEALTH the necessary preliminary steps towards the establishment of a Council or Society capable of dealing with this vital and national subject in a scientific and broadminded manner. I am, Sir, Yours faithfully, ANOTHER M.O.H.
P R O C E E D I N G S OF T H E SOCIETY OF 1VfEDICAL O F F I C E R S OF H E A L T H . COUNCIL MEETING, OCTOBER ISTH, 1918. I. The Minutes of the Council Meeting held Sept. 2oth, 1918, were approved (vide PUBLIC HEALTH, October, 1918, p. 8.) 2. Correspondence. The Hon. Secretary read a letter of invitation addressed to the Society, asking the Society to appoint a representative to act on the Executive Committee formed at a meeting of the Medical Profession, held at Steinway Hall, Lower Seymour Street, on Oct. Ist, 1918, under the chairmanship of Sir H e n r y Morris, for the election of representative medical men to the House of Commons. Resolved : T h a t the President (Dr. Kenwood) be appointed as the SocietY's representative. 3. Election of Committees. The following Committees were appointed : - (a) HOUSE A2qD LIBR&R¥ CO~IMIT'rEE.--Drs. E. H. Snell, J. Tubb Thomas, and T. Ridley Bailey.
PUBLIC HEALTH.
INFLUENZA EPIDEMIC. A letter addressed to Medical Officers of HeAth has been issued by Sir Arthur Newsholme, Chief Medical Officer of the Local Government Board. In this letter Sir Arthur Newsholme makes an appeal to which it is hoped all Medical Officers of Health will respond to the best of their ability. I t is only by such united efforts that useful results can be obtained, and the Medical Officer to the Board is to be congratulated in his prompt action in endeavouring to collect information concerning this extraordinary outbreak. The information required is as follows :-A. I. T h e r e p o r t s h o u l d give t h e d e a t h s f r o m i n f l u e n z a in t h e d i s t r i c t for each w e e k of t h e y e a r I918. 2. A t a b l e s h o u l d be p r e p a r e d g i v i n g t h e age a n d s e x d i s t r i b u t i o n of t h e d e a t h s f r o m influenza. 3. I n f o r m a t i o n s h o u l d be given as to t h e d a t e of t h e first a p p e a r a n c e of t h e e p i d e m i c in t h e district a n d of its cessation. 4- T h e r e s u l t s of a n y local p a t h o l o g i c a l e x a m i n a t i o n s able to be o b t a i n e d , i n c l u d i n g bacteriological e x a m i n a t i o n s o1 s p u t a s h o u l d be given. 5. I f t h e r e is a n y evidence t h r o w i n g light on t h e m e a n s of i n t r o d u c t i o n of t h e disease, t h i s s h o u l d be s t a t e d . 6. A n y f a c t s w o u l d be v a l u a b l e w h i c h b e a r o n - D u r a t i o n of i n c u b a t i o n period ; D u r a t i o n of i n f e c t i v i t y ; M e t h o d s of s p r e a d ; E v i d e n c e of possible p r o t e c t i o n b y a p r e v i o u s a t t a c k ; F r e q u e n c y of o c c u r r e n c e of s e c o n d a t t a c k s in 19t8. 7- A n y special clinical f e a t u r e s of t h e o u t b r e a k s h o u l d be s t a t e d . I t will be v a l u a b l e ff a c o m p a r i s o n b e t w e e n cases in r u r a l a n d u r b a n a r e a s c a n be m a d e . 8. H a s t h e r e b e e n a n y special incidence on p a r t i c u l a r occupations or districts ? I t is i m p o r t a n t t h a t a n e x a c t s t a t e m e n t s h o u l d be m a d e of a d m i n i s t r a t i v e action t a k e n b y t h e S a n i t a r y A u t h o r i t y , w i t h n o t e s on t h e possible influence of s u c h action. B. L D i s t r i b u t i o n of p r e c a u t i o n a r y advice to t h e public. H o w effeeted ? 2. A n y special m e a s u r e s t a k e n in r e s p e c t of__ School closure or e x c l u s i o n ; E x c l u s i o n f r o m or closure of places of public entertainment ; E x c l u s i o n , if a n y , f r o m o c c u p a t i o n s . 3- P r o v i s i o n of h o s p i t a l t r e a t m e n t . 4. Provision at p a t i e n t ' s h o m e of m e d i c a l assistance.
,, ,, nursing ,, . . . . domestic ~y 5. Provision of facilities for bacteriological examination of material from patients. 6. Prophylaxis by vaccine, if attempted. T I l E P R E V E N T I O N OF V E N E R E A L DISEASE. important facts published in the September T H Eissue of P U B L I C H E A L T H , and the subsequent correspondence in our columns in October and November, have aroused considerable interest, and the Editor has received numerous p e r s o n a letters from medical officers of h e a t h approving of the official adoption of prophylaxis. Such corn-
33
munications cannot be published without the consent of the writers, but it may be possible for some of them to appear in our next issue. Several letters for publication are, owing to reasons o~ space, unavoidably left over to January ; some of these letters oppose prophylaxis, and others are in favour of it. Everyone interested in this important subject is invited to join in the correspondence, but it is hoped that the writers will take into consideration our reduced space, refraining from vague generalities, and confining themselves as far as possible to the essential fact, which is the prevention of venereal disease. From several indirect sources we have been supplied with copies of a stencilled document purporting to be signed by five medical officers of health (three county and two county borough officers) opposing prophylaxis and supporting the policy of the National Council for Combating VenereA Disease. An accompanying letter (also stencilled), signed by one of the five, clams that the majority of MedicA Officers of Health, and of the Medical Profession, are opposed to prophylaxis, appeals for further signatures, and states that the document will be sent to this Journal for publication. Apparently a considerable number of these papers have been circulated. Up to the time of going to press it has not been received. The correspondence is open to all, so long as reasonable brevity is exercised, and no letter has been or is likely to be refused publication. CORRESPONDENCE. The Editor does not accept responsibility/or lhe opinions of correspondents. From Dr. E. M. SMITH, M.O.H, York.
To the Editor of PUBLIC HEAL¢I~. SI~,--I was delighted to see Dr. Robertson's letter in your October issue, for I had intended writing a similar protest for that issue, but was prevented by pressure of other urgent work. I, also, deplore the attitude of the said article in the September issue of this Journal, and I very much regret that the " official organ " of the Society of MedicM Officers of Health should have published Miss Ettie Rout's communications; I think that their publication does not redound to the credit of either the Society or its official organ. I fully agree with the contents of Dr. Robertson's letter, and go further, for all the educated people, lay and medical, with whom I have discussed the question, and who have given it careful ~hought, agree with me in supporting the N.C.C.V.D.'s policy of opposition to the issue of prophylactic outfits, even to soldiers " in these abnormal days." During the War, the N.C.C.V.D. and other agencies have made immense efforts in the instruction of the men in the A r m y in sex morality and sex pathology, and it is profoundly regrettable, and
34
PUBLIC HEALTH;
has probably been grievously fatal, t h a t t h a t admirable work should have been antagonised to any extent, however little, b y either action or teaching in respect of prophylaxis before illicit intercourse--a course which cannot fail to act as a gross incentive to immorality. We can no more divorce morals from medicine in connection with venereal disease, than in connection with drunkenness or gluttony, and we do not administer medical prophylactics either before or after either of those last-named transgressions of the laws of health. I can assure Dr. Joseph t h a t there is at least one IVI.O.H. who will have nothing to do with giving such prophylactic advice or outfits as he suggests in the article which is the subject of this protest. May I also say t h a t I am by no means the only /vI.O.H. who gravely doubts the wisdom of giving public pronouncement to the so-called " early preventive treatment " policy now proposed b y the N.C.C.V.D., and the York Branch of t h a t body is so far opposed to it. We see little distinction in principle between the policy of giving preventives before immoral intercourse and that of systematically providing facilities for personal disinfection immediately after the event. Either policy tacitly admits the continuance of prostitution (professional or otherwise), as an inevitable institution, and indirectly, must act more or less as an incentive to intercourse with prostitutes. Whereas, surely, all our present preventive and educational work aims indirectly at the extinction of such degradation. If our efforts are persistent we should be able to look forward to a great diminution in the prostitute supply, because we have diminished tile demand. I n t h a t direction ties the possibility o f - - a t l e a s t - - a great reduction in prostitution .... an " institution " which all humanitarians and sanatarians can only regard as horrible, since it involves the degradation of our sisterhood of woman. I n a case such as Sir J. Crichton Browne's " foolish boy " (vide PUBLIC ITEALa:IL November, 1917 , page 26), who had exposed himself to infection, we agree we should administer such treatment as would tend to prevent the development of his infection and its possible communication to innocent persons, but to provide widespread systematic facilities for such personal disinfection, and to publish their arrangement broadcast, appears to us to be a very different matter, and one which we cannot but regard as unwise and even dangerons, not merely from the moral point of view, but also from the medical point of view, for we must not forget t h a t either form of prevention is by no means absolutely reliable. Surely, as custodians of the Public Health, we cannot agree with any policy which opposes the combined moral, biological, and pathological educational campaign, which is now being pursued so vigorously and which is so full of hope. I trtlst t h a t the Society of M.O.H.'s
DEC~B~I~,
and its Journal will not continue to support Sir Bryan Donkin's policy. If they do, verily reconstruction of the Society is urgently required. I am, Sir, Yours faithfully,
EDMUND From
" Another
M. SA~IITH,
M.O.H."
To the Editor of Pum,IC HEALTH,
SIR, I desire to add m y congratulations to the m a n y which must have reached Miss Ettie Rout upon the subject of he~ timely exposure of the methods of the National Council for Combating Venereal Diseases. A recent writer in the Lancet suggested the formation of a real Society for Preventing Venereal Diseases, and offered to contribute a substantial sum towards the initial expenses thereof. There must be m a n y Medical Officers of Health who would join such a society, and I suggest that the M.O.H. Society should consider the desirability of creating such an organization. At all events, I hope to see announced in an early issue of PUBLIC HEALTH the necessary preliminary steps towards the establishment of a Council or Society capable of dealing with this vital and national subject in a scientific and broadminded manner. I am, Sir, Yours faithfully, ANOTHER M.O.H.
P R O C E E D I N G S OF T H E SOCIETY OF 1VfEDICAL O F F I C E R S OF H E A L T H . COUNCIL MEETING, OCTOBER ISTH, 1918. I. The Minutes of the Council Meeting held Sept. 2oth, 1918, were approved (vide PUBLIC HEALTH, October, 1918, p. 8.) 2. Correspondence. The Hon. Secretary read a letter of invitation addressed to the Society, asking the Society to appoint a representative to act on the Executive Committee formed at a meeting of the Medical Profession, held at Steinway Hall, Lower Seymour Street, on Oct. Ist, 1918, under the chairmanship of Sir H e n r y Morris, for the election of representative medical men to the House of Commons. Resolved : T h a t the President (Dr. Kenwood) be appointed as the SocietY's representative. 3. Election of Committees. The following Committees were appointed : - (a) HOUSE A2qD LIBR&R¥ CO~IMIT'rEE.--Drs. E. H. Snell, J. Tubb Thomas, and T. Ridley Bailey.