THE CONTAGIOUS DISEASES ACTS.

723 venereal disease is governed by certain circumstances which this confusion of terms wholly ignores. Some individuals of either sex arc from natural conformn.tion peculiarly liable to contract disease ; others are not. The influence of circumcision as a factor in preventing infection, is well known to from this enumeration that the annals record all the events those practitioners who treat venereal diseases. Hence the that may have had any relation to epidemics—earthquakes, contention that venereal diseases are a heaven-sent punishvolcanic eruptions, floods, droughts, famines, as well as the ment to vicious persons is not true. The Acts were applied various murrains. The information from the several pro- to a very limited area, the localities in England being Aldershot, Canterbury, Chatham, Colchester, Dartmouth, vinces and cities of Italy is so full that calamities of all Deal, Devonport, Dover, Folkestone, Gravesend, Maidstone, kinds, from influenza to plague, seem to follow each other Plymouth, Portsmouth, Shecrness, Shorncliffe, Southampton, So many famous cities of Walmer, Winchester, Windsor and Woolwich. In Ireland with bewildering frequency. Lombardy, Venetia, Tuscany and the other Italian States had the operation of the Acts was limited to The Curragh, Cork and Queenstown. Now, if the effects of the Acts were so a vigorous civic life at so early a period that their chronicles vicious as their opponents contend, we should have had both are more fully written or better preserved than is the case negative and positive evidence of this. The places just with regard to the rest of Europe. Italy was a century or two named would, during the application of the Acts, have been ahead in such matters, as well as in specially medical writings remarkable for an increase of flaunting vice ; while the like the classical work of Fracastori on Contagion. For these localities not subject to them would have presented a marked and other reasons the annals of epidemics in Italy afford contrast in this respect. But what are the facts ?7 The evidence of independent and thoroughly unbiased unequalled opportunities to the epidemiologist. Professor witnesses perfectly the Royal Commission and the Lords before given Corradi’s task has been exacting in proportion, and has and Commons’ Committees was that the effect of the Acts been executed with scrupulous fidelity. It would be in reducing the number of prostitutes and in promoting better interesting to know in what way so much erudition acquired order in all the districts subjected to them was most marked. condition of London and the other throughout a lifetime had coloured his views of contemporary On the other hand, the in towns and cities England and Ireland to which these large doctrines and controversies. At the end of his work he perActs have never been applied has altered but little as regards mits himself four pages of epilogue in which he indicates, not prostitution within the twenty-eight years which have elapsed without eloquence, the bearings of epidemiological study. since the first Act of 1864 was passed. Moreover, since the Among other points we observe that he appears to assign a Acts were repealed the towns formerly subjected to them On the contrary, so greatly has somewhat inferior part to specific living organisms in the have not improved. and increased, prostitution of particularly in its worst form of specific infections. He appears to refuse production that the local authorities would welcome juvenile prostitution, altogether the high parasitic doctrine: "La storia delle the re-enactment of these Acts. Turning again to the letter grandi epidemic di tifo, e in particolare le navali e le castrensi, we find that THE LANCET is abused for its article of Jan. 23rd si oppongono a si recisa sentenza. " praising the moral effects of the Acts, and speaking of their opponents as though they were enemies of morality and mercy." Various other journals, both professional and lay, come in for severe reprehension for defending these THE CONTAGIOUS DISEASES ACTS. Acts. THE LANCET being alluded to no less than five times in the course of the letter, we may briefly reIx the current number of a monthly journal there appears capitulate our reasons for the course adopted in these columns with reference to this legislation. We maintain that letter from a correspondent on "The Solidarity of Vicious it made an attempt to deal with what religion and Methods." In it the probability of the Contagious Diseases philanthropy had failed to do-the social evil in its worst Acts being restored is pointed to, and the various indi- aspects. What notice had been taken of the wretched viduals living and dead, together with the medical and women in Portsmouth and Plymouth, in Chatham and in Cork and The Curragh ?What attempt had been lay papers which have defended these Acts and deprecated Windsor, made either to cure their diseases or to attempt their moral their repeal, are held up to public ignominy. The late reclamation ? Either nothing at all or so little that it had Mr. J. Fenimore Cooper, the American novelist, warned not even scratched the surface of this great evil. By the critics, in his preface to I I The Pilot,"that as a sailor means of the Acts these women were brought under he possessed the privilege of including them all under the kindly notice of the visiting and hospital surgeons, the sweeping title of "lubbers." Similarly we might regard who examined them with every regard to their feelings and the writers of those many articles and letters which have ministered to them in hospital until they were cured. Being became in a better condition to gradually humanised, appeared in the lay press denouncing us and our advocacy of become reformed. By they the kindly assistance of the chaplains these Acts as ignoramuses and treat their foolish effusions and matrons, supplementing the work already begun by the with silent contempt. We prefer, however, to adopt a more surgeons, these women in numerous instances forsook their courteous tone and at least to endeavour to show these writers previous wretched life and eagerly embraced the facilities their errors. The letter before us places us in doubt as to afforded them of commencing a better one. All these are facts whether the writer belongs to the sterner or the weaker which cannot be disputed or denied, and so the term " Statesex. In the second sentence of the letter the repealed Acts regulated prostitutionsimply recoils on those who use it, not " are termed the "ghastly State regulation of prostitution." from knowledge, but from ignorance of these Acts and their It has been shown over and over again that the State working. These diseases are acquired not from sin merely, Those who never proposed or attempted to regulate prostitution, but to but from sin committed with a diseased person. prevent certain contagious diseases at certain military and naval are really virtuous and wish to remain so can do this whether stations. This j jumblingtogether of vice and disease is a favourite the Acts are in force or not. No man or woman need sin device of the opponents of these Acts, since it has the effect against his or her will. For all these reasons we shall conof securing the support of that large number of members of tinue to support these Acts and to urge their restoration, both sexes who possess neither logical reasoning powers nor amended as circumstances may require, to the statute-book lucidity of argument. Men and women of the world who do of this country. possess these know that vice and disease are not necessarily cause and effect. A man who keeps a mistress is quite as PROPOSED ISOLATION HOSPITALS.- At a vicious or immoral as a man who resorts to a prostitute, yet the former may commit deliberate fornication with impunity of the Epsom Local Board last week it was resolved that a for a lifetime, while the man who yields to the wiles of a pro- permanent isolation hospital be built on land belonging to stitute may contract a disease which will infect his constitu- the Board at Kingston-lane, and that application be made to tion for years. If he be a married man he may infect his the Local Government Board to sanction a loan of £ 1000 wife and unborn child; if a single man he ought to be warned for that purpose. The rural sanitary authority of Redruth against marrying for years to come ; and in either case much is making arrangements for the erection of a hospital for the annoyance and suffering are involved. Again, infection with isolation of patients suffering from infectious diseases.

and naval

epidemics ; (6) epizootics ; (7) principal meteorological phenomena; (8) other public calamities ; (9) occasions of public assistance-distribution of food, medical aid, &c. ; (10) index of all other notable things. It will be seen

meeting

724

COLLEGE OF PHYSICIANS AND ITS PRESCRIPTIONS AGAINST CHOLERA. able to select model houses for residence, with drainage and all appurtenances complete, rather than for the poor.

THE LANCET. LONDON: SATURDAY, SEPTEMBER 24, 1892.

The prescriptions are as good as general prescriptions for individual cases could be and fairly represent present therapeutic views as to the best measures to be taken for the

prevention of cholera in cases the ingenuity with which the treatment

IT is easy to be critical or even cynical over the instructions of the Royal College of Physicians for the treatment of "patients suffering from cholera, choleraic diarrhoea or

tions of

are

conciliated,

of diarrhoea.

We even admire advocates of rival methods of and with which the general indica-

experience and common sense are respected. It is refreshing to see the ancient College alive to the virtues of coto, which has as yet no place in our pharmacopoeia, and which, it diarrhoea"; but admitting, for the sake of argument, that may safely be assumed, is still an unknown drug to many chethe College was obliged to formulate some instructions (and mists and even too many Fellows of the College. There are as we said last week they appear to us to be plain and pracalso cognisant of the still more recently discovered powers tical and in accordance with the line which we ourselves of enemata of tannin, of which a very interesting account recommended to be adopted by the profession) we do not see will be found in THE LANCET of last week, p. 682. But the that it could very well have done better than it has done. question still remains whether it is a dignified position in This is, however, a considerable admission. The College which to place the College of Physiciansto ask it to be might have taken different ground and given different a party to the preparation of two or three huge bottles advice. We are disposed to think that it would have acted or reservoirs of medicine out of which practically the wisely in doing so. The Royal College of Physicians is a whole community is to be doctored. There is no disease representative and responsible body. It is not entitled at a which can be treated with advantage in such a general great crisis of national sickness to withhold its sympathy and fashion, and cholera especially defies all routine prescriptions, its help from the people. When called on by the Local It may seem very natural to some minds that the State should Government Board, representing the State, for its contribu- undertake a general treatment of the cholera of the comtion of wisdom and counsel, it is under a very grave obli- munity, and that without charge." The ease and cheapgation to do its best. It must be admitted further that ness of the scheme are fascinating, and so is the idea of there is precedent for going into detailed prescriptions, though bringing the humblest citizen into the advantage of being scarcely, perhaps, in such detail as in the suggestions just prescribed for by the College of Physicians. Still we gravely issued by the College. We have before us a report of the question the advantage. It is the undoubted duty of the action of the College in similar circumstances in 1866. Local Government Board to see that the poorest section of On that occasion the College was set in motion by the Lords the community in the remotest parts is medically provided of Her Majesty’s Privy Council, as represented by their dis- for at all times, and especially in times of great and urgent tinguished medical officer, Mr. (now Sir JOHN) SIMON. Sir sickness. But it cannot discharge its responsibility by applyJOHN SiMON’s request was limited and modest as compared ing for a few prescriptions to the College of Physicians, to be with that of the President of the Local Government Board. It dispensed mechanically for cases and in circumstances which simply raised the question of the expediency of issuing instruc- the College never contemplated. The only efficient way in tions to captains of merchant vessels as to how they should act which the Local Government Board can secure medical aid to when proper medical attendance could not be procured so as to the poor is to use its influence over local sanitary authorities provide for the health of their crews against attacks of cholera. in the direction of perfecting the arrangements for proTheir lordships wished particularly for the suggestions of the curing easy and early medical and nursing attendance. College-first, as to the necessity of avoiding purgative medi- These arrangements should include provision for house-tocines, and, secondly, ar to the measures to be adopted when house visitation in poor neighbourhoods under any suspicion cholera appeared on board ship. On the present occasion the of harbouring the disease or the conditions favourable to it. Local Government Board propose to issue Regulations for the What is wanted is not so much physic as physicians who can guidance of local sanitary authorities, requiring them, amongst attend promptly to individual cases and give them the parother things, to provide and dispense without charge medi- ticular treatment which each case requires. We are concines and medical appliances for the sick, and they apply to fident that in this view we shall have the concurrence of the It is not only that general instructions the College for instructions and prescriptions, with the College itself. that in a routine remark believe the local authorities will flattering they applied way cannot be relied on, but the tenattach great value to the medicines which the Royal dency of such action on the part of the Collegeis to diminish College of Physicians consider best adapted to patients individual earnestness and the sense of individual responsisuffering from cholera, choleraic diarrhoea or diarrhoea. bility. The function of a College of Physicians is to qualify This is a much larger request than that of the Privy Council men to treat disease and then to throw the responsibility for in 1866, and one which involves much more serious considera- its treatment on them-not to supply chemists and medical tion. The reply of the College is perhaps a very natural one, men with ready-made prescriptions. This is the way to and, as we have said, if it had to undertake instructions and hinder therapeusis rather than to help it. So much as prescriptions could not well be better. The instructions for regards even the poor. It is essential to supply them not so the maintenance of general health indeed suggest that they much with medicine as with medical men. One way in were framed by practitioners who cater for that section of the which the Local Government Board can best effect this community who command any number of meals they please] supply without undue strain on the local authorities is to of any quality, including choice wines, and who are equally restrict it to the poor. We seem to see in the letter of Sir