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Prophylaxis in Venereal Disease.
PROPHYLAXIS IN VENEREAL DISEASE.
575
Commission on Venereal Diseases the translation of whose conclusions into law was the reason for the creation of the Council. The Executive Committee urge upon the National Council the importance of the making of arrangements for the early treatment of venereal diseases, even = before the onset of symptoms, but they do not now, any more than in the past, advise any deparLONDON: SATURDAY, OCTOBER 13, 1917. ture from the original line taken up with regard to artificial prophylaxis. They will expect to be asked in Venereal Disease. to support the policy which they continue to advocate by facts, inasmuch as facts are being brought As we announced last week, the question of th< .e forward to make it doubtful if their policy is now artificial prophylaxis of venereal disease has beei the best, whatever it may have been two years ago. discussed recently by the National Council fo]l’ And it would probably be better if preventive treatCombating Venereal Diseases, and a special meeting° ment, for purposes of the discussion that must of the Council will be held on Monday next ensue, were divided into three headings, and that Oct. 15th, at the house of the Royal Society ojif under each the circumstances of the civilian popuMedicine, and will have before it a resolution, thEe lation were regarded as differing from those of fate of which is awaited with deep attention by thEa The three headings are : the Navy and Army. medical profession and the public. The resolution1 (1) artificial prophylaxis ; (2) early preventive treatwhich will be submitted to the National Council byy ment; and (3) the control of loose women in certain the Executive Committee of that body runs as3 It seems to us clear that the preventive areas. follows :treatment in relation to venereal disease among In view of the public attention now directed to3 troops should start earlier than it does now-that the whole subject of prophylaxis, the Executive is to that the form of prophylaxis alluded to Committee, after careful consideration, is not pre- in thesay, of the Executive Committee should report pared to depart from its original position, in which,’ no from. We published last be refrained longer in accordance with the spirit of the Royal Commisweek a brief account of the measures taken in sion’s Report, it refrained from recommending thej centres in and Australia to enlighten India of the of outgreat adoption prophylaxis-i.e., provision fits to men before sexual indulgence. The com- the public generally as to the incidence of venereal mittee strongly urge the importance of the making: disease, and especially to protect the soldiers; and of arrangements for the early treatment of venereal it is largely in the interest of the Colonial condisease even before the outset of symptoms. tingents of our Army that the National Council for Will the National Council remain of the opinion Combating Venereal Diseases may be inclined to expressed in the resolution ? depart from its original position. The Canadian, The whole question of the artificial prophylaxis Australian, and especially the New Zealand troops of venereal disease is thus introduced for debate have suffered greatly from venereal disease, and, by the National Council, but in considering that with regard to the last, we have been furnished question we are now regarding generally the with figures-supplied also, we understand, to health of the public in the fourth year of war, New Zealand newspapers-which almost justify the and especially the condition of our Imperial Armies, phrase employed in the communication that" London both as fighting men and as future citizens. We is the plague spot of the world." There can be no are not blind to the religious forces which coerce the doubt that the feeling among numerous officers of our vote of some consciences on all sexual matters; nor Colonial troops is that the facilitation of artificial do we write ignoring the claims made bymanypublic- prophylaxis is necessary for the safety of their men, spirited and enlightened women for an equality while many are convinced that the control of loose of treatment between the two sexes in regard women would greatly increase the fighting strength, to circumstances which surround mutual actions. and would annul the risk that the soldiers may These things have due weight with all who desire , carry back to their homes hereditary disease as well the right. They will certainly receive earnest as the glory of having fought for their country. To attention from the National Council when consider- these feelings every consideration is due; and, if the ing the resolution of the Executive Committee. views expressed can be supported statistically, the We do not discuss them here because all that is to country at large will hold that the National Council be said along the two lines indicated has been said for Combating Venereal Diseases have a responsiso often that our readers are familiar with the bility put upon them by the war that was not upon arguments and know exactly why the National them when they were created to carry out the Council has adopted the line of policy indicated in valuable conclusions of the Royal Commission. the resolution. Attention is called now to the We are in the face of military facts : all fact that the facilitation for men of artificial men are wanted, and venereal disease prevents a prophylaxis before sexual indulgence has been certain proportion of them from responding to the deliberately excluded from the scheme devised call. Measures might quite sensibly be taken now by the National Council. The Council, in de- which would have no justification in normal times; clining to recommend or to take cognisance nor would a change of attitude at such a juncture of any steps of the kind, has followed the mean a permanent return to discredited social lead given to it by the Report of the Royal tactics. We are at this moment reconciled, with a
THE
LANCET.
Prophylaxis
e ir
.
576
unanimity that would have been quite inconceivable three years ago, to the distribution of bombs by aeroplanes upon German cities. Does anybody believe that the spirit thus indicated is likely to remain a permanent national spirit of this country ?-? In the same way, we do not for a moment suppose that, if it should be found wise to-day to control the action of certain women in certain military areas, or to recognise the existence of illicit coitus by instituting a system of supply to sailors and soldiers of prophylactic apparatus, we should be committed in the future to the lower state of public morals indicated by such methods. These are some of the more important points which the National Council for Combating Venereal Diseases will have before them at their meeting on Monday next. and we feel sure that they will be debated frankly, and that no restraint will be put upon the expression of opinion by the allegation that to depart from a line of conduct hitherto followed is either to do ill with the illogical hope that good may come, or to display a cowardly inconsistency. It requires knowledge to decide what an ill deed really is, and it requires courage to deal with facts which contravene an accepted course of
recovery,
if
it
takes
place, will
be
sudden.
Deafness, however, rarely remains total, and the common history is that nothing at all can be dis. tinguished for a few hours, that then hearing begins
to return, but that after some few weeks it still remains defective, often more so in one ear than the other. Further, some of these patients have experienced a greater or less degree of giddiness in the early stages, and some have vomited. Finally there is, we believe, hist6logical evidence that the cochlea may be extensively disorganised as the result of concussion by explosion, a condition which could hardly result in anything but total labyrinthine deafness. If we put these points by the side of the fact that patients with burst membranes do not exhibit serious labyrinthine types of deafness, it is probable that there is in many cases a real labyrinthine factor in these deafnesses. An inter. esting pair of cases, illustrating the extreme degree of suppression of cortical function, were recorded in THE LANCET of Oct. 6th by Major A. F. HURST and Captain E. A. PETERS, who are to be congratu. lated on obtaining recoveries which might have been long delayed. The employment of suggestion under light administration of an anaesthetic is well known, and in these cases the suggestion procedure. proved powerful. We feel a little doubtful, however, of the desirability of the frequent use of War Deafnesses. the method, having a prejudice against any proDURING the present war there have returned cedure which may lead in the long run to abuse, from the French front a very large number of and a consequent lowering of the status of officers and men who considered that their hearing surgery. We believe it likely, moreover, that had been damaged by gun-fire or shell explosion. any other powerful stimulus applied during The features of these cases differed from the the removal of the subconscious determination familiar gunners’ deafness of former times in against hearing would have been as effective as that the damage appeared to be the result of a suggestion proved. The clinical points of interest relatively short exposure to detonation, often to seem to be the completeness of the suppression of be the consequence of a single shell-burst, and reflex from the lower centres even in sleep, and tended almost uniformly to recovery, sometimes the fact, in view of this, that the voice was not sensibly complete, but in the majority of instances altered, showing that somewhere in the depths of partial. Tinnitus was not generally a prominent consciousness there still lay hidden the appreciaAs to the conIn the type case there was no visible tion of the patient’s own voice. feature. HURST and Captain clusion arrived at by Major damage. In addition to these cases there have been many of chronic or recurrent middle-ear suppura- PETERS that an apparently total deafness associated tion which we may put on one side, and a relatively with continued excitability of the posterior small class with evidence of recent bursting of the labyrinth is evidence of hysterical deafness, a membrana tympani. Within the experience of many doubt may reasonably be expressed, on the ground observers these cases with manifest middle-ear that two cases are quite an insufficient basis for damage have escaped with a middle-ear deafness such a generalisation, and on the further ground that cases of mild labyrinthitis occur in which only. The difficulties in classification and prognosis there appears to be total deafness but in which the attach to the group which presents no evidence of canal reflex can still be excited. The inquiry opened by Dr. T. B. JOBSON, whose local injury and with an apparent labyrinthine deafness, and they arise from the fact that with paper appears in another column, into the question our present of testing hearing we have of the effect of gun-fire on the generality of men no sure means of distinguishing the two factors exposed to it, and not aware of any resultant in hearing, the capacity of the peripheral instru- deafness, is an interesting one and worth, we think, ment in the cochlea and the performance of the further and much fuller pursuit. At present the cortical organ of consciousness operating with this. data appear to us to be altogether inadequate to From the experience following the testing and furnish conclusions. The apparent loss which Dr. watching of a large number of cases throughout JOBSON found for a C2 fork, if this be a fairly the war, it would seem that the cortical factor heavy one, is not greater than will be found in a may vary in intensity from a mere feebleness large proportion of average hospital patients, and of concentrated attention to a total inhibition appears to be largely due to the defect of training of any attention at all. The more complete in attention, and this holds for both air and bone the inhibition, the greater the likelihood that conduction. It has further to be remembered that ’
methods
575
Commission on Venereal Diseases the translation of whose conclusions into law was the reason for the creation of the Council. The Executive Committee urge upon the National Council the importance of the making of arrangements for the early treatment of venereal diseases, even = before the onset of symptoms, but they do not now, any more than in the past, advise any deparLONDON: SATURDAY, OCTOBER 13, 1917. ture from the original line taken up with regard to artificial prophylaxis. They will expect to be asked in Venereal Disease. to support the policy which they continue to advocate by facts, inasmuch as facts are being brought As we announced last week, the question of th< .e forward to make it doubtful if their policy is now artificial prophylaxis of venereal disease has beei the best, whatever it may have been two years ago. discussed recently by the National Council fo]l’ And it would probably be better if preventive treatCombating Venereal Diseases, and a special meeting° ment, for purposes of the discussion that must of the Council will be held on Monday next ensue, were divided into three headings, and that Oct. 15th, at the house of the Royal Society ojif under each the circumstances of the civilian popuMedicine, and will have before it a resolution, thEe lation were regarded as differing from those of fate of which is awaited with deep attention by thEa The three headings are : the Navy and Army. medical profession and the public. The resolution1 (1) artificial prophylaxis ; (2) early preventive treatwhich will be submitted to the National Council byy ment; and (3) the control of loose women in certain the Executive Committee of that body runs as3 It seems to us clear that the preventive areas. follows :treatment in relation to venereal disease among In view of the public attention now directed to3 troops should start earlier than it does now-that the whole subject of prophylaxis, the Executive is to that the form of prophylaxis alluded to Committee, after careful consideration, is not pre- in thesay, of the Executive Committee should report pared to depart from its original position, in which,’ no from. We published last be refrained longer in accordance with the spirit of the Royal Commisweek a brief account of the measures taken in sion’s Report, it refrained from recommending thej centres in and Australia to enlighten India of the of outgreat adoption prophylaxis-i.e., provision fits to men before sexual indulgence. The com- the public generally as to the incidence of venereal mittee strongly urge the importance of the making: disease, and especially to protect the soldiers; and of arrangements for the early treatment of venereal it is largely in the interest of the Colonial condisease even before the outset of symptoms. tingents of our Army that the National Council for Will the National Council remain of the opinion Combating Venereal Diseases may be inclined to expressed in the resolution ? depart from its original position. The Canadian, The whole question of the artificial prophylaxis Australian, and especially the New Zealand troops of venereal disease is thus introduced for debate have suffered greatly from venereal disease, and, by the National Council, but in considering that with regard to the last, we have been furnished question we are now regarding generally the with figures-supplied also, we understand, to health of the public in the fourth year of war, New Zealand newspapers-which almost justify the and especially the condition of our Imperial Armies, phrase employed in the communication that" London both as fighting men and as future citizens. We is the plague spot of the world." There can be no are not blind to the religious forces which coerce the doubt that the feeling among numerous officers of our vote of some consciences on all sexual matters; nor Colonial troops is that the facilitation of artificial do we write ignoring the claims made bymanypublic- prophylaxis is necessary for the safety of their men, spirited and enlightened women for an equality while many are convinced that the control of loose of treatment between the two sexes in regard women would greatly increase the fighting strength, to circumstances which surround mutual actions. and would annul the risk that the soldiers may These things have due weight with all who desire , carry back to their homes hereditary disease as well the right. They will certainly receive earnest as the glory of having fought for their country. To attention from the National Council when consider- these feelings every consideration is due; and, if the ing the resolution of the Executive Committee. views expressed can be supported statistically, the We do not discuss them here because all that is to country at large will hold that the National Council be said along the two lines indicated has been said for Combating Venereal Diseases have a responsiso often that our readers are familiar with the bility put upon them by the war that was not upon arguments and know exactly why the National them when they were created to carry out the Council has adopted the line of policy indicated in valuable conclusions of the Royal Commission. the resolution. Attention is called now to the We are in the face of military facts : all fact that the facilitation for men of artificial men are wanted, and venereal disease prevents a prophylaxis before sexual indulgence has been certain proportion of them from responding to the deliberately excluded from the scheme devised call. Measures might quite sensibly be taken now by the National Council. The Council, in de- which would have no justification in normal times; clining to recommend or to take cognisance nor would a change of attitude at such a juncture of any steps of the kind, has followed the mean a permanent return to discredited social lead given to it by the Report of the Royal tactics. We are at this moment reconciled, with a
THE
LANCET.
Prophylaxis
e ir
.
576
unanimity that would have been quite inconceivable three years ago, to the distribution of bombs by aeroplanes upon German cities. Does anybody believe that the spirit thus indicated is likely to remain a permanent national spirit of this country ?-? In the same way, we do not for a moment suppose that, if it should be found wise to-day to control the action of certain women in certain military areas, or to recognise the existence of illicit coitus by instituting a system of supply to sailors and soldiers of prophylactic apparatus, we should be committed in the future to the lower state of public morals indicated by such methods. These are some of the more important points which the National Council for Combating Venereal Diseases will have before them at their meeting on Monday next. and we feel sure that they will be debated frankly, and that no restraint will be put upon the expression of opinion by the allegation that to depart from a line of conduct hitherto followed is either to do ill with the illogical hope that good may come, or to display a cowardly inconsistency. It requires knowledge to decide what an ill deed really is, and it requires courage to deal with facts which contravene an accepted course of
recovery,
if
it
takes
place, will
be
sudden.
Deafness, however, rarely remains total, and the common history is that nothing at all can be dis. tinguished for a few hours, that then hearing begins
to return, but that after some few weeks it still remains defective, often more so in one ear than the other. Further, some of these patients have experienced a greater or less degree of giddiness in the early stages, and some have vomited. Finally there is, we believe, hist6logical evidence that the cochlea may be extensively disorganised as the result of concussion by explosion, a condition which could hardly result in anything but total labyrinthine deafness. If we put these points by the side of the fact that patients with burst membranes do not exhibit serious labyrinthine types of deafness, it is probable that there is in many cases a real labyrinthine factor in these deafnesses. An inter. esting pair of cases, illustrating the extreme degree of suppression of cortical function, were recorded in THE LANCET of Oct. 6th by Major A. F. HURST and Captain E. A. PETERS, who are to be congratu. lated on obtaining recoveries which might have been long delayed. The employment of suggestion under light administration of an anaesthetic is well known, and in these cases the suggestion procedure. proved powerful. We feel a little doubtful, however, of the desirability of the frequent use of War Deafnesses. the method, having a prejudice against any proDURING the present war there have returned cedure which may lead in the long run to abuse, from the French front a very large number of and a consequent lowering of the status of officers and men who considered that their hearing surgery. We believe it likely, moreover, that had been damaged by gun-fire or shell explosion. any other powerful stimulus applied during The features of these cases differed from the the removal of the subconscious determination familiar gunners’ deafness of former times in against hearing would have been as effective as that the damage appeared to be the result of a suggestion proved. The clinical points of interest relatively short exposure to detonation, often to seem to be the completeness of the suppression of be the consequence of a single shell-burst, and reflex from the lower centres even in sleep, and tended almost uniformly to recovery, sometimes the fact, in view of this, that the voice was not sensibly complete, but in the majority of instances altered, showing that somewhere in the depths of partial. Tinnitus was not generally a prominent consciousness there still lay hidden the appreciaAs to the conIn the type case there was no visible tion of the patient’s own voice. feature. HURST and Captain clusion arrived at by Major damage. In addition to these cases there have been many of chronic or recurrent middle-ear suppura- PETERS that an apparently total deafness associated tion which we may put on one side, and a relatively with continued excitability of the posterior small class with evidence of recent bursting of the labyrinth is evidence of hysterical deafness, a membrana tympani. Within the experience of many doubt may reasonably be expressed, on the ground observers these cases with manifest middle-ear that two cases are quite an insufficient basis for damage have escaped with a middle-ear deafness such a generalisation, and on the further ground that cases of mild labyrinthitis occur in which only. The difficulties in classification and prognosis there appears to be total deafness but in which the attach to the group which presents no evidence of canal reflex can still be excited. The inquiry opened by Dr. T. B. JOBSON, whose local injury and with an apparent labyrinthine deafness, and they arise from the fact that with paper appears in another column, into the question our present of testing hearing we have of the effect of gun-fire on the generality of men no sure means of distinguishing the two factors exposed to it, and not aware of any resultant in hearing, the capacity of the peripheral instru- deafness, is an interesting one and worth, we think, ment in the cochlea and the performance of the further and much fuller pursuit. At present the cortical organ of consciousness operating with this. data appear to us to be altogether inadequate to From the experience following the testing and furnish conclusions. The apparent loss which Dr. watching of a large number of cases throughout JOBSON found for a C2 fork, if this be a fairly the war, it would seem that the cortical factor heavy one, is not greater than will be found in a may vary in intensity from a mere feebleness large proportion of average hospital patients, and of concentrated attention to a total inhibition appears to be largely due to the defect of training of any attention at all. The more complete in attention, and this holds for both air and bone the inhibition, the greater the likelihood that conduction. It has further to be remembered that ’
methods