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Medical aspects of contraception
t00
PUBLIC HEALTH.
which carl be quickly and easily read will put every practitioner who consults it abreast of the most modern developments in the immunology of these infectious diseases. The Schick test is described first, and {he four possible types of reaction--negative, positive, negative-pseudo, and pseudo-comb i n e d - a r e detailed and their significance explained. The same procedure is adopted in the case of the Dick test for scarlet fever. Thereafter for each disease the author narrates the experience that has been gained of the tests, and the respective methods of immunisation, in Aberdeen, Glasgow, Edinburgh and Dufidee. The use and significance of the Dick test in scarlet fever follows in its description similar lines to that of the Schick test. An important section is that in which its use in relation to the prevention of return cases is described. After removal of a scarlet fever case to hospital, the home contacts are offered the Dick test, and immunisation of those found susceptible, so that, on dismissal from hospital, the original case returns to a house where the contacts are immune. The number of rettirn cases among non-immunised households has been 2 per cent, which figure has been reduced to 0"4 per cent in immunised households. The general conclusion is that some time will yet have to pass before the efficacy of the methods of immunisation against diphtheria can be judged, but that there is reason to believe that the results will be satisfactory. In the case of the Dick test and immunisation against scarlet fever, the absence of animal methods of controlling the dosage "of toxin is regretted, and it is questioned whether t h e immunity conferred is as lasting as in diphtheria. The issue of the reprint on Ultra-Violet R a y Therapy is timely in that it contains a summary of the present state of knowledge on this subject in Scotland. The report contains quotations from various experts in this branch of work in different parts of the country. The merits of the carbon arc and mercury vapour lamps are compared, and as yet it is undecided which is to be preferred. The results obtained by light treatment in tuberculosis--both pulmonary and nonp u l m o n a r y ~ c h i l d welfare cases, certain infectious diseases and in convalescence, a r e reviewed.
JANUARY,
"file general conclusion is that in the less severe forms of non-pulmonary tuberculosis, the value of ultra-violet ray treatment is unquestioned; t h a t in pulmo.nary tuberculosis the results are not discouraging, and that in child welfare work the results are most encouraging. Like the others, this report is admirably done, and the Scottish Board is deserving of gratitude for having published all three in this form.
Medical Aspects of Contraception. N 1925 there appeared a report issued by a Committee o.f the National Council of Public Morals, on the Ethical Aspects of Birth Control. This report was discussed in these pages, and in the course of that discussion it was shown that important as it might be to have a pronouncement on the ethics of contraception, and helpful as the statements in the report might be to certain individuals, the ethical was only one of the aspects, and for the sake of completeness there must be an examination from the medical and the economic sides. That there were such needs was recognised by the National Council also, and one of the first steps taken after the completion of the work of the Ethical Committee was to set up a Medical C'ommittee. In its turn this b o d y prepared a report* and this has now been issued under the title of " Medical Aspects of Contraception." Unlike the previous publication, probably it cannot claim to be unique, several publications purporting to deal with the question from the medical side, and prepared b y one or more medical writers, having already made their appearance. T o the extent that it is the result of a more or less judicial enquiry, however, it differs from these other publications, and may claim to be at least exceptional. The Committee that made the enquiry was presided over by Mr. Gibbs, Senior Surgeon to Charing Cross Hospital and the Lock Hospital, and i n c l u d e d - i n addition to a number of obstetricians and gynaecologists~ physiologists, surgeons, and members of the
I Special
CMEDIOAL ASPECTS OF CONTRACEPTION, Being the Report of the Medical Committee appointed by the National Council of Public Morals in connection with the investigations of the National Birth-rate Commission. London : Martin, Hopkinson and Co., Ltd., 1977. pp. 183. Price 10s. 6d. net.
1928.
PUBLIC HEALTH.
public health service. Evidence was given by physicians, physiologists, health officers and medical officers of birth control clinics. In the volume the evidence of the various witnesses is given in extenso, and makes an addition to the literature of the subject, much of it peculiarly valuable, since it comes from individuals who have devoted themselves deeply to the study of the subject. T h o u g h they were probably much more obvious when spoken, there are still to be noted in the printed word the intense seriousness and enthusiasm of the contributors to the e n q u i r y ; a real desire to help not only the Committee, but the people, more parlicularly those in need and in doubt. Possibly this is most evident in the case of tile workers in the clinics, but it is to be found even in the more scientific contributions of the physiologists, gynmcologists and physicians. Summarising the evidence put before them, the Committee have provided, as they were expected m do, a great deal of information with regard to contraceptives and ~ e t h o d s of contraception, and views as to the relative value of each, and the ~effect upon the health of individuals practising these methods. Also, while endeavouring to escape reference to aspects other than medical--a task obviously of the greatest difficulty--they have endeavoured to offer guidance as to indications for contraception and the methods most suitable, certain and safe. Speaking generally, the conclusion would appear to be the same as that reached by a majority of the medical profession that of all the methods, those open for adoption by the male are probably those most likely to be successful, and possibly, least likely--with certain exceptions and reservat i o n s - t o be associated with risks of bodily damage. So far as methods that may be practised by the female are concerned, there is more trouble as well as more of risk involved. Also, though they admit the extreme difficulty of " ascertaining success," the suggestion more or less offered is that the procedures of the female are more open to failure. Perhaps the most important pronouncement in the report is one which would appear to have been ahnost wrung from the members, that it is their opinion " that no impediment should be placed in the way of those married couples who desire information as to contraceptives, when this is needed for medical reasons or because of excessive childbearing or poverty." So far as the public health service is concerned, this i s probably
101
the view most commonly held, and the fact that, after investigation by individuals ot whom they know something, and of whom they have something of an opinion, a question that has given them some concern has been answered in this way will afford satisfaction. As to the source from which the information is to come, the Committee has an even more definite statement. " Under present conditions," they .say, " birth (control ?) clinics can be started and carried on by irresponsible persons, or by those whose only purpose is the sale of some particular apparatus. In our opinion, such clinics ought to be under the guidance and control of experienced and judicious medical practitioners; and, further, hospitals should be centres for advice and instruction on the subject. W h e n a hospital has an obstetric and gynmcological department, this would be the most suitable place." That there is value in this pronouncement for health officers and authorities cannot be doubted, and it is recommended for consideration, as is the whole report for study. •
•
•
•
•
Annual Reports. H E usual circular from the Minister of Health with regard to annual reports, addressed to local authorities, is by now in the hands of most. It indicates that the report for 1927 is to be an " ordinary report," and repeats the usual suggestion that it should be " completed and sent to the appropriate authorities not later than the middle of May." So far as contents are concerned, there are a few modifications to be noted. If the council are a local supervising authority under the Midwives Acts, particulars of the action taken during the year under Part II of the Midwives and Maternity Homes Act, 1926, or any local Act providing for the registration of maternity homes, are to be given under certain definite heads. Information is also to be given as to action taken under the Public Health (Pre-' vention of Tuberculosis) Regulations, 1925, and if no action has been taken, then the medical officer of health must so indicate. In respect of notifiable diseases, an attempt is to be made to measure the influence of domestic overcrowding upon the incidence of any notified diseases which have been extensively prevalent. Also, if it is possible, tables are to be prepared showing for invaded houses the
T
PUBLIC HEALTH.
which carl be quickly and easily read will put every practitioner who consults it abreast of the most modern developments in the immunology of these infectious diseases. The Schick test is described first, and {he four possible types of reaction--negative, positive, negative-pseudo, and pseudo-comb i n e d - a r e detailed and their significance explained. The same procedure is adopted in the case of the Dick test for scarlet fever. Thereafter for each disease the author narrates the experience that has been gained of the tests, and the respective methods of immunisation, in Aberdeen, Glasgow, Edinburgh and Dufidee. The use and significance of the Dick test in scarlet fever follows in its description similar lines to that of the Schick test. An important section is that in which its use in relation to the prevention of return cases is described. After removal of a scarlet fever case to hospital, the home contacts are offered the Dick test, and immunisation of those found susceptible, so that, on dismissal from hospital, the original case returns to a house where the contacts are immune. The number of rettirn cases among non-immunised households has been 2 per cent, which figure has been reduced to 0"4 per cent in immunised households. The general conclusion is that some time will yet have to pass before the efficacy of the methods of immunisation against diphtheria can be judged, but that there is reason to believe that the results will be satisfactory. In the case of the Dick test and immunisation against scarlet fever, the absence of animal methods of controlling the dosage "of toxin is regretted, and it is questioned whether t h e immunity conferred is as lasting as in diphtheria. The issue of the reprint on Ultra-Violet R a y Therapy is timely in that it contains a summary of the present state of knowledge on this subject in Scotland. The report contains quotations from various experts in this branch of work in different parts of the country. The merits of the carbon arc and mercury vapour lamps are compared, and as yet it is undecided which is to be preferred. The results obtained by light treatment in tuberculosis--both pulmonary and nonp u l m o n a r y ~ c h i l d welfare cases, certain infectious diseases and in convalescence, a r e reviewed.
JANUARY,
"file general conclusion is that in the less severe forms of non-pulmonary tuberculosis, the value of ultra-violet ray treatment is unquestioned; t h a t in pulmo.nary tuberculosis the results are not discouraging, and that in child welfare work the results are most encouraging. Like the others, this report is admirably done, and the Scottish Board is deserving of gratitude for having published all three in this form.
Medical Aspects of Contraception. N 1925 there appeared a report issued by a Committee o.f the National Council of Public Morals, on the Ethical Aspects of Birth Control. This report was discussed in these pages, and in the course of that discussion it was shown that important as it might be to have a pronouncement on the ethics of contraception, and helpful as the statements in the report might be to certain individuals, the ethical was only one of the aspects, and for the sake of completeness there must be an examination from the medical and the economic sides. That there were such needs was recognised by the National Council also, and one of the first steps taken after the completion of the work of the Ethical Committee was to set up a Medical C'ommittee. In its turn this b o d y prepared a report* and this has now been issued under the title of " Medical Aspects of Contraception." Unlike the previous publication, probably it cannot claim to be unique, several publications purporting to deal with the question from the medical side, and prepared b y one or more medical writers, having already made their appearance. T o the extent that it is the result of a more or less judicial enquiry, however, it differs from these other publications, and may claim to be at least exceptional. The Committee that made the enquiry was presided over by Mr. Gibbs, Senior Surgeon to Charing Cross Hospital and the Lock Hospital, and i n c l u d e d - i n addition to a number of obstetricians and gynaecologists~ physiologists, surgeons, and members of the
I Special
CMEDIOAL ASPECTS OF CONTRACEPTION, Being the Report of the Medical Committee appointed by the National Council of Public Morals in connection with the investigations of the National Birth-rate Commission. London : Martin, Hopkinson and Co., Ltd., 1977. pp. 183. Price 10s. 6d. net.
1928.
PUBLIC HEALTH.
public health service. Evidence was given by physicians, physiologists, health officers and medical officers of birth control clinics. In the volume the evidence of the various witnesses is given in extenso, and makes an addition to the literature of the subject, much of it peculiarly valuable, since it comes from individuals who have devoted themselves deeply to the study of the subject. T h o u g h they were probably much more obvious when spoken, there are still to be noted in the printed word the intense seriousness and enthusiasm of the contributors to the e n q u i r y ; a real desire to help not only the Committee, but the people, more parlicularly those in need and in doubt. Possibly this is most evident in the case of tile workers in the clinics, but it is to be found even in the more scientific contributions of the physiologists, gynmcologists and physicians. Summarising the evidence put before them, the Committee have provided, as they were expected m do, a great deal of information with regard to contraceptives and ~ e t h o d s of contraception, and views as to the relative value of each, and the ~effect upon the health of individuals practising these methods. Also, while endeavouring to escape reference to aspects other than medical--a task obviously of the greatest difficulty--they have endeavoured to offer guidance as to indications for contraception and the methods most suitable, certain and safe. Speaking generally, the conclusion would appear to be the same as that reached by a majority of the medical profession that of all the methods, those open for adoption by the male are probably those most likely to be successful, and possibly, least likely--with certain exceptions and reservat i o n s - t o be associated with risks of bodily damage. So far as methods that may be practised by the female are concerned, there is more trouble as well as more of risk involved. Also, though they admit the extreme difficulty of " ascertaining success," the suggestion more or less offered is that the procedures of the female are more open to failure. Perhaps the most important pronouncement in the report is one which would appear to have been ahnost wrung from the members, that it is their opinion " that no impediment should be placed in the way of those married couples who desire information as to contraceptives, when this is needed for medical reasons or because of excessive childbearing or poverty." So far as the public health service is concerned, this i s probably
101
the view most commonly held, and the fact that, after investigation by individuals ot whom they know something, and of whom they have something of an opinion, a question that has given them some concern has been answered in this way will afford satisfaction. As to the source from which the information is to come, the Committee has an even more definite statement. " Under present conditions," they .say, " birth (control ?) clinics can be started and carried on by irresponsible persons, or by those whose only purpose is the sale of some particular apparatus. In our opinion, such clinics ought to be under the guidance and control of experienced and judicious medical practitioners; and, further, hospitals should be centres for advice and instruction on the subject. W h e n a hospital has an obstetric and gynmcological department, this would be the most suitable place." That there is value in this pronouncement for health officers and authorities cannot be doubted, and it is recommended for consideration, as is the whole report for study. •
•
•
•
•
Annual Reports. H E usual circular from the Minister of Health with regard to annual reports, addressed to local authorities, is by now in the hands of most. It indicates that the report for 1927 is to be an " ordinary report," and repeats the usual suggestion that it should be " completed and sent to the appropriate authorities not later than the middle of May." So far as contents are concerned, there are a few modifications to be noted. If the council are a local supervising authority under the Midwives Acts, particulars of the action taken during the year under Part II of the Midwives and Maternity Homes Act, 1926, or any local Act providing for the registration of maternity homes, are to be given under certain definite heads. Information is also to be given as to action taken under the Public Health (Pre-' vention of Tuberculosis) Regulations, 1925, and if no action has been taken, then the medical officer of health must so indicate. In respect of notifiable diseases, an attempt is to be made to measure the influence of domestic overcrowding upon the incidence of any notified diseases which have been extensively prevalent. Also, if it is possible, tables are to be prepared showing for invaded houses the
T