PRECIPITATION TESTS FOR SYPHILIS.

LOCAL HEALTH ADMINISTRATION.

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these

THE

proposals cannot be carried out without opposition. Every small local authority has a vested interest in continued existence, though Parliament should be strong enough to resist the pressure of opinion inimical to reform. The transfer of the work

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of local insurance committees to committees of the authority implies a change in the original plan of the National Insurance (Health) Act, removing the redundant insurance committees while arranging for the cooption on the insurance committee of LOCAL HEALTH ADMINISTRATION. the local authority of members of bodies specially SPEAKING at the annual banquet of the British in this work. The proposed transfer of the Medical Association last week, Captain WALTER interested of functions parish councils to the county councils and ELLIOT said that one of the great tasks of Britain now councils town will simplify considerably the work of was to restore local administration, once the pride of assistance and eliminate much of the overthis island. The peculiar qualities of the English, public of public health and Poor-law work which the Scottish Secretary added, might be best seen in lapping now exists. the genius they displayed in getting other people to The medical profession are much concerned in the work for them. The issue of the report by consultareforms proposed in this report. It is greatly to their tive councils of the Scottish Board of Health on a and much more so of their patients that reformed local authority for health and public assist-I with official bodies should be simplified, relationships ance1 is a reminder that although an English Ministry that official medical work should be more accurately a and Scottish Board of Health have been formed, whether parochial or insurance work or defined, to a certain extent central unifying administration, local public health administration remains in an un- public health work proper, and that medical men and settled condition. The necessity for reform was madeItheir organisations should be able to approach a single manifest by the reports of the Royal Commission on authority competent to deal with all the branches of the Poor Laws. Both minority and majority reports work in which the medical profession are specially of this Commission recommended abolition of the concerned. Here and there, no doubt, a forceful and boards of guardians, and had there not been disagree- tactful personality makes up for the shortcomings of ment on important points of detail the subsequent a bad system : in one place, as at Portsmouth, a local surgeon is chairman of the health committee ; history of public health insurance in this country hospital a general practitioner presides over the in another, might have differed greatly from the actual course insurance committee ; in a third, the medical officer of events. By means of the Maclean Committee of health is the of all the health activities of the pivot a modus vive7tdi between these reports was agreed area. But mind cannot so triumph everyupon, but although promises were made of action sanitary over recalcitrant matter, and a remodelling of where in the direction of the report of this Committee, health is a first necessity for little yet has been done of which the public know. the framework of public a community that desires medical knowledge and The report of this Scottish Committee may, it of is hoped, bring the problem once more within experience to be translated into the elements of the that We know healthier Ministry living. the range of practical politics, and Scotland, as has but we have a feeling happened not infrequently in the past, may show Health is making headway, the centralisation of entailed the that by problems England the way to more efficient and therefore more are not appreciated and varied activities such great economical public health administration. But it must by our readers-and certainly not by the public. be remembered that the difficulties in

LONDON: SATURDAY, AUGUST 4, 1923.

new

advantage

England are immeasurably larger, because of the numbers concerned, and the complexities left by previous good and pioneer work.

PRECIPITATION TESTS FOR SYPHILIS.

The two main needs for reform, as stated in the report, are exemplified as fully in English as in Scottish local authorities. There is overlapping and waste, due to the distribution of the local administration of the health services among several different authorities in each area, and many of the administrative units are too small to carry out efficiently the powers and duties laid on them by Parliament. The drastic character of the recommendations of this Consultative Council may be gathered from the fact that their proposals would eliminate for the major purposes of health administration 98 district committees and 194 out of 201 boroughs having a population of less than 50,000, while 869 parish councils and1 27 district boards of control would cease altogether. It is very properly pointed out that so far from these proposals interfering with local administrative autonomy, more representative and more powerful local authorities would be created, justifying greater freedom in the exercise of their functions. Evidently

FAIRLY soon after the introduction of the Wassermann test, in the endeavour to elucidate its mechanism and as part of the controversy which arose as to its nature, it became apparent that out of a mass of work the general fact was emerging that under many conditions syphilitic sera would give precipitates more readily than would normal sera. The possibilities of this fact are considerable. Though one of the most trustworthy of all clinical-pathological diagnostic measures, the Wassermann test contains a large number of variable factors, which must be carefully adjusted to render results of constant accuracy. The test consists of two parts. In the first syphilitic serum and antigen are brought together in the presence of complement, and in the second the existence, or disappearance, of this complement is sought for by adding blood corpuscles and the appropriate specific hsemolytic serum. We hold the view that the essential of the test is the production of a precipitate between the syphilitic serum and the antigen, which is a colloidal suspension of lipoid particles. In the presence of syphilitic serum the state of this colloid differs in an only partially

the

1 Reports by Consultative Councils on a Reformed Local Authority for Health and Public Assistance, price is. 3d.

physical

236 known fashion from its state in the presence of normal with illustrations necessary for the information of serum, and in the former case it is particularly favour- those for whose education or information the work able to the adsorption and inactivation of complement, is intended may, in a certain sense, be obscene, and which thus disappears from the mixture so far as yet will not give rise to criminal proceedings, though, its subsequent demonstration is concerned. It is if such illustrations are " exhibited for anyone, therefore obvious that if we could detect this alteration boys and girls, to see as they pass," it may constitute in the antigen visually we should be able to dispense an offence. The immunity, in fact, depends upon with complement, h2amolysin, and blood cells, all the circumstances of the publication. Certain observavariable factors, and not only simplify the test but tions during the recent libel action are a judicial probably render it more accurate. This is the end recognition of a relaxation of the public standard striven for by precipitation te"ts, which were first of what tends to deprave. In 1877 CHARLES t opularised in practicable form by SACHS and GEORGI BRADLAUGH was convicted, along with Mrs. BESANT, and have since been modified in various directions by of the criminal offence of publishing KNOWLTON’s others. The essential question which remain, to be tract " The Fruits of Philosophy," an essay on the answered, assuming the above theoretical explanations restriction of the population. The jury declared to be correct, is : Is the visual method as delicate a that the book was calculated to deprave public one for detecting the formation of a precipitate morals, and the Lord Chief Justice of the day conbetween serum and antigen as is the fixation of demned both defendants to be imprisoned for six complement ? This is the main point of interest in months, to pay a fine of E200, and to enter into comparisons of the two tests, such as those we recently recognisances for five years to be of good behaviourpublished. It is an important point since upon its good behaviour including the withdrawal of the book. answer will depend the form of the serum test for Now let us listen to something said by Lord Justice syphilis which should be adopted in the immediate SCRUTTON the other day " future. In this connexion we would point out that In 1877 it would have been almost impossible to it is already abundantly proven that a strongly discuss publicly a subject of admitted importance, positive Wassermann reaction corresponds, for all the causes, effects of, and remedies for venereal practical purposes, to a strongly positive precipitation diseases, but since the war the most respectable test, but that in both cases the shading-offfrom the newspapers have opened their columns to the plainest of these matters and the most respectable positive into the negative is not an abrupt process. discussion have taken part in those discussions. The persons Research therefore should be directed not only to the merits and methods of artificial birth prevention seem finding of conditions which will magnify the positive to me to stand in a similar position. In 1877 it would reaction and minimise such change as occurs in have been impossible to discuss them publicly ; in negative cases, but towards the weakly positive, the 1923 there is probably a great change in public opinion evolving, and declining cases. Comparison of the two as to the necessity of discussion coupled with great tests with the clinical condition, which must always difference of opinion as to the desirability of such be closely watched, will yield information of the most methods." If CHARLES BRADLAUGH had published KNOWLTON’S value as to their relative merit. book to-day, would he have been prosecuted, much less convicted and sentenced to imprisonment Doubtless the answer would depend on the circumPUBLICATIONS WHICH "TEND TO stances of the publication. Propagandists do not DEPRAVE." always discriminate, and the old tag maxima debetur A FEW days ago in the Court of Appeal Mrs. Marinepueris reverentia is not yet obsolete. If we protect I STOPFS succeeded in obtaining the fruits of her libelour schoolboys from the attentions of betting touts action against Dr. H. SUTHERLAND and his publishers. and money-lenders, we need not expose them to There is no occasion now to reopen the controversy those of the booksellers who specialise in furtive over what is popularly known as birth control; pornology. Writings on birth control which are the views of both sides were sufficiently expounded very far from belonging to that discreditable traffic at the original trial by witnesses of considerable have in recent years been treated by police-court weight and known sincerity. Nor is there any need magistrates as having a tendency to deprave. Such to comment on this unfortunate litigation wherein, decisions are not easily harmonised with the greater when the jury had duly answered the questions latitude to which Lord Justice SCRUTTON gives submitted to it, what should have been the end of testimony. As every magistrate is entitled to take the case proved to be merely the starting-point his own standard in these matters, the position is for fresh legal argument. The controversy, however, none too clear. The policy of Parliament seems to bore indirectly upon a point of some interest- be towards greater control. It will be remembered namely, the immunity of technical publications from that in 1917, in suppressing quack treatment of the criminal law as to the publication of matters venereal disease, the circulation of advertisements obscene or indecent. Dr. SUTHERLAND had inter dealing with such treatment was prohibited. The alia written of certain of Mrs. STOPES’S publications proposed Judicial Proceedings (Regulations of Reports) the remark that " CHARLES BRADLAUGH was con- Bill, designed to eliminate indecent details from the demned to jail for a less serious crime." The com- reports of divorce and other proceedings, is a signifiparison is a reminder of the change in public standards cant movement in the direction of suppressing matters To publish any " tending to deprave." over the period of half a century. obscene or immoral book is a criminal offence-a common-law misdemeanour. The judicial test of PHYSICAL TRAINING IN THE NAVY. obscenity is " whether the tendency of the matter THE Navy has, as we know, done a great deal to is to deprave and corrupt those whose minds are openI the British Medical Association meeting of this help to such immoral influences and into whose hands and in the afternoon of July 25th the members year, a publication of this soit may fall." of the Association were invited to the Royal Naval Legal authorities of repute still lay down the of Physical and Recreational Training to principle, enunciated more than 50 years ago by witness a demonstration of the education there given. Chief Justice COCKBURN, that a medical treatise In a fine gymnasium, on a floor whose boards recalled

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