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THE CONTROL OF VENEREAL DISEASES.
424
THE CONTROL OF VENEREAL DISEASES.
THE CONTROL OF VENEREAL DISEASES. Tlte Preventive Treatment of Venereal Diseases in Australia. Temporary Lieutenant- Colonel James W. Barrett, R.A.M.C., has sent us the following letter for publication :— In consequence of the appearance of a leading article in your issue of Jan. 13th on the subject of venereal prophylaxis, I venture to place your readers in possession of the facts relating to the steps which have already been taken in Australia. In the State of Victoria the Government has done much in the direction of investigating the extent of distribution and in educating the public respecting the nature of venereal diseases. The Governmental action was the result of a medical campaign of 20 years’ duration, details of which are set out in the Proceedings of the various sessions of the Australian Medical Congress and in an article written by myself and published in Bedrock early in 1913. It was the action of the Victorian
Government which, to some extent, influenced the appointment of the British Royal Commission. In 1914, however, it was found that the Government was hesitating respecting publication of the methods relating to prophylaxis, and consequently a small committee of medical men and women (of which I was a member) was formed and determined to take action on their own responsibility. They accordingly drafted the appended circular and arranged with the leading chemists in Melbourne to supply the articles necessary for the prophylaxis of venereal diseases, and to issue the leaflet with the articles purchased. Before doing so, however, information relating to the step proposed to be taken was sent to every medical practitioner in the State of Victoria and to every member of the clergy, with a request for an expression of opinion whether a better method could be devised. A conference with the representatives of the Council of Churches made it clear that, whilst the clergy disliked the proposal, they were unable to suggest any alternative method; action was accordingly taken. In the course of the discussion the medical representatives made it abundantly clear that the principles which must underlie the suppression of venereal diseases are: 1. The complete separation of the moral from the medical problem, and the clear recognition of the -fact that the world will not be rendered more or less moral by the abolition of venereal disease. 2. The fact that the fear of the acquisition of venereal disease is no effective deterrent to immorality; to such slight extent as it is a deterrent the advantages are more than counterbalanced by the wholesale infection of the innocent which goes on at present. 3. That as the organisms which cause venereal diseases grow almost exclusively in the genital passages of men and women, it is quite clear that the intelligent use of prophylaxis would in a very few years eliminate these diseases altogether ; in fact, it is doubtful whether there are any other contagious diseases which could be eliminated with greater certainty. It is to me an article of faith, fully discussed in the literature referred to, in the Australasian Medical Journal, in the columns of the Melbourne Argus, and elsewhere, that a resolute and straightforward attack on this problem on the lines of prophylaxis offers the only reasonable means of extirpating these diseases. The other and indirect means of dealing with it have a value, and education respecting the nature of the diseases is especially useful, and it is the lack of knowledge on the part of the public which has caused the failure of past campaigns. Yet these means alone are somewhat disappointing in their results as our experience indicates. The words used by Huxley in another connexion may be applied with great force to this colossal evil: "There is no alleviation for the suffering of mankind except veracity of thought and action, and the resolute facing of the world as it is, when the garment of make-believe by which pious hands have hidden its uglier features, is stripped off." May I commend the foregoing to the consideration of earnest men and women who are now publicly facing this disagreeable but vital undertaking. The Australian circular runs as follows :WARNING : VENEREAL DISEASES.
Irregular sexual intercourse involves a considerable liability to infection with gonorrhoea, or syphilis, or both. Of those who are infected a portion are never cured ; the consequences are serious so far as they are concerned. and still more serious as regards those to whom they may communicate these diseases later on. A single exposure to infection may result in life-long illness. Incontinence is not in any way necessary for purposes of health, and the advice the medical profession would give to all would be abstinence from intercourse other than in marriage. If you desire in the future healthy children and a healthy wife, you are strongly advised to remain continent; at the same time, if you determine to take the risk, it is your duty, not only for your own sake, but for that avoided or of other people, to avoid infection, and infection can lessened in frequency by following the procedure indicated in the
be
tollowing.
Instruction for men.-Immediately after intercourse thoroughly wash the genitals with soap and water, pass urine, and then dry the parts, especially the opening of the passage. The washing must include the parts under the foreskin, which must be drawn back. Then dip the wisp of cotton-wool into the liquid supplied and gently pass it into the opening by a twisting movement; pass it in for a quarter of an inch, and allow it to remain in ..position for three or four minutes before removal. If the opening or eye" of the penis is so small that this cannot be done a few drops should be inserted with a medicine-dropper. The ointment is then to be used by rubbing it in thoroughly and firmly over the whole penis, but more particularly the head, especially if a- crack, abrasion, or small tear is noticeanywhere. foreskin must be drawn back to allow of this being done properly. The small portion of the ointment should be allowed to remain in opening A of the canal. The value of these simple precautions depends on the rapidity with which they are adopted after intercourse. The sooner these steps are taken the less is the risk of infection. The applications should be made in the order indicated. The longer they are deferred the greater the risk. i Instr2cctioaxa for 1oomen.-If there has been any risk of infection as soon as possible after connexion douche well, using a quart of hot water and putting into it two teaspoonfuls of tinct. of iodine. Then smear the calomel ointment round the outside of orifice and well up over the front. The ointment : 30 per cent. calomel; the solution: 20 per cent. argyrol. (This may be made into a jelly with glyco-gelatine.) These articles are now sold by leading chemists.
Resolution of the Royal Society of Medioine. meeting of the Council of the Royal Society of Medicine the following resolution was unanimously passed :That, in view of the grave national dangers arising from the neglect, At
a
recent
or the improper treatment, of venereal diseases, the Council of the
Royal Society of Medicine is strongly in favour of legislation for the purpose of rendering it a penal offence for any person other than a registered medical practitioner to treat or advise concerning the treatment of these diseases, or to sell, supply, or dispence drugs asa remedy for venereal diseases, unless the said drugs are supplied on the prescription of a registered medical practitioner, and ooly for the exclusive use of the person for whom the said prescription was intended. Tke Y. M. C. A. and Venereal Diseases. The recent report of the Microscopical Section of the Y.M.C.A. to the National Council of Associations states that there is much evidence among the men in camp that venereal diseases are spread through ignorance and thoughtlessness. At the exhibitions one member of the party makes it his duty to exhibit bacteria, and amongst them the germ of syphilis, with a view of opening adiscussion among the men on the subject. The younger soldiers and sailors invariably put indicating a belief that brothels can be visited with impunity. Statements of fact illustrated by the microscope are then made by the exhibitor to show that such beliefs are unfounded and likely to lead to disaster. Outfit for the Treatment Centre. With commendable enterprise the Holborn Surgical Instrument Company (26, Thavies Inn, London, E.C.) have issued a 16-page catalogue of apparatus and remedies suitable for a venereal treatment centre. The cover describes the 606 Apparatus, Military Outfit," as used at the Military Hospital in Rochester-row ; two pages follow on syringes and needles; then the drugs, new and old, in various forms; general apparatus, urethral instruments, a special 606 table " with hinged arm rests ; ending with a complete estimate of the outfit required under three heads : (1) the 606 and mercurial injection room ; (2) the gonorrhoea treatment room; (3) apparatus for the Wassermann test and dark-ground work. The list will be of use to centres not already fully equipped.
questions
PARIS. (FROM
OUR OWN
CORRESPONDENT.)
The Aphonia of 1.Yar and Laryngeal Tuberculosis. AMONG the accidents attributable to the war one of the most unexpected and difficult to interpret is aphonia. It is not a rare accident. Dr. G. Li6bault, chief of an oto-rhinolaryngological centre, has made a special study of these cases. Some of them may be attributed to a nervous traumatism caused by the bursting of the shells, but the majority of patients state that their aphonia has followed on the fatigues and chills of trench life. The diagnosis of simple nervous aphonia has frequently been established, but many also are under suspicion of a commencing laryngitis. When transferred from service to service these men are incompletely treated and do not improve. They are as a rule exhausted ; they have often been several months in the trenches ; they are thin, physically depressed, and in need of rest; they have a cough and a hoarse voice. It is natural for the doctor who sees them to conclude that the bronchitis
THE CONTROL OF VENEREAL DISEASES.
THE CONTROL OF VENEREAL DISEASES. Tlte Preventive Treatment of Venereal Diseases in Australia. Temporary Lieutenant- Colonel James W. Barrett, R.A.M.C., has sent us the following letter for publication :— In consequence of the appearance of a leading article in your issue of Jan. 13th on the subject of venereal prophylaxis, I venture to place your readers in possession of the facts relating to the steps which have already been taken in Australia. In the State of Victoria the Government has done much in the direction of investigating the extent of distribution and in educating the public respecting the nature of venereal diseases. The Governmental action was the result of a medical campaign of 20 years’ duration, details of which are set out in the Proceedings of the various sessions of the Australian Medical Congress and in an article written by myself and published in Bedrock early in 1913. It was the action of the Victorian
Government which, to some extent, influenced the appointment of the British Royal Commission. In 1914, however, it was found that the Government was hesitating respecting publication of the methods relating to prophylaxis, and consequently a small committee of medical men and women (of which I was a member) was formed and determined to take action on their own responsibility. They accordingly drafted the appended circular and arranged with the leading chemists in Melbourne to supply the articles necessary for the prophylaxis of venereal diseases, and to issue the leaflet with the articles purchased. Before doing so, however, information relating to the step proposed to be taken was sent to every medical practitioner in the State of Victoria and to every member of the clergy, with a request for an expression of opinion whether a better method could be devised. A conference with the representatives of the Council of Churches made it clear that, whilst the clergy disliked the proposal, they were unable to suggest any alternative method; action was accordingly taken. In the course of the discussion the medical representatives made it abundantly clear that the principles which must underlie the suppression of venereal diseases are: 1. The complete separation of the moral from the medical problem, and the clear recognition of the -fact that the world will not be rendered more or less moral by the abolition of venereal disease. 2. The fact that the fear of the acquisition of venereal disease is no effective deterrent to immorality; to such slight extent as it is a deterrent the advantages are more than counterbalanced by the wholesale infection of the innocent which goes on at present. 3. That as the organisms which cause venereal diseases grow almost exclusively in the genital passages of men and women, it is quite clear that the intelligent use of prophylaxis would in a very few years eliminate these diseases altogether ; in fact, it is doubtful whether there are any other contagious diseases which could be eliminated with greater certainty. It is to me an article of faith, fully discussed in the literature referred to, in the Australasian Medical Journal, in the columns of the Melbourne Argus, and elsewhere, that a resolute and straightforward attack on this problem on the lines of prophylaxis offers the only reasonable means of extirpating these diseases. The other and indirect means of dealing with it have a value, and education respecting the nature of the diseases is especially useful, and it is the lack of knowledge on the part of the public which has caused the failure of past campaigns. Yet these means alone are somewhat disappointing in their results as our experience indicates. The words used by Huxley in another connexion may be applied with great force to this colossal evil: "There is no alleviation for the suffering of mankind except veracity of thought and action, and the resolute facing of the world as it is, when the garment of make-believe by which pious hands have hidden its uglier features, is stripped off." May I commend the foregoing to the consideration of earnest men and women who are now publicly facing this disagreeable but vital undertaking. The Australian circular runs as follows :WARNING : VENEREAL DISEASES.
Irregular sexual intercourse involves a considerable liability to infection with gonorrhoea, or syphilis, or both. Of those who are infected a portion are never cured ; the consequences are serious so far as they are concerned. and still more serious as regards those to whom they may communicate these diseases later on. A single exposure to infection may result in life-long illness. Incontinence is not in any way necessary for purposes of health, and the advice the medical profession would give to all would be abstinence from intercourse other than in marriage. If you desire in the future healthy children and a healthy wife, you are strongly advised to remain continent; at the same time, if you determine to take the risk, it is your duty, not only for your own sake, but for that avoided or of other people, to avoid infection, and infection can lessened in frequency by following the procedure indicated in the
be
tollowing.
Instruction for men.-Immediately after intercourse thoroughly wash the genitals with soap and water, pass urine, and then dry the parts, especially the opening of the passage. The washing must include the parts under the foreskin, which must be drawn back. Then dip the wisp of cotton-wool into the liquid supplied and gently pass it into the opening by a twisting movement; pass it in for a quarter of an inch, and allow it to remain in ..position for three or four minutes before removal. If the opening or eye" of the penis is so small that this cannot be done a few drops should be inserted with a medicine-dropper. The ointment is then to be used by rubbing it in thoroughly and firmly over the whole penis, but more particularly the head, especially if a- crack, abrasion, or small tear is noticeanywhere. foreskin must be drawn back to allow of this being done properly. The small portion of the ointment should be allowed to remain in opening A of the canal. The value of these simple precautions depends on the rapidity with which they are adopted after intercourse. The sooner these steps are taken the less is the risk of infection. The applications should be made in the order indicated. The longer they are deferred the greater the risk. i Instr2cctioaxa for 1oomen.-If there has been any risk of infection as soon as possible after connexion douche well, using a quart of hot water and putting into it two teaspoonfuls of tinct. of iodine. Then smear the calomel ointment round the outside of orifice and well up over the front. The ointment : 30 per cent. calomel; the solution: 20 per cent. argyrol. (This may be made into a jelly with glyco-gelatine.) These articles are now sold by leading chemists.
Resolution of the Royal Society of Medioine. meeting of the Council of the Royal Society of Medicine the following resolution was unanimously passed :That, in view of the grave national dangers arising from the neglect, At
a
recent
or the improper treatment, of venereal diseases, the Council of the
Royal Society of Medicine is strongly in favour of legislation for the purpose of rendering it a penal offence for any person other than a registered medical practitioner to treat or advise concerning the treatment of these diseases, or to sell, supply, or dispence drugs asa remedy for venereal diseases, unless the said drugs are supplied on the prescription of a registered medical practitioner, and ooly for the exclusive use of the person for whom the said prescription was intended. Tke Y. M. C. A. and Venereal Diseases. The recent report of the Microscopical Section of the Y.M.C.A. to the National Council of Associations states that there is much evidence among the men in camp that venereal diseases are spread through ignorance and thoughtlessness. At the exhibitions one member of the party makes it his duty to exhibit bacteria, and amongst them the germ of syphilis, with a view of opening adiscussion among the men on the subject. The younger soldiers and sailors invariably put indicating a belief that brothels can be visited with impunity. Statements of fact illustrated by the microscope are then made by the exhibitor to show that such beliefs are unfounded and likely to lead to disaster. Outfit for the Treatment Centre. With commendable enterprise the Holborn Surgical Instrument Company (26, Thavies Inn, London, E.C.) have issued a 16-page catalogue of apparatus and remedies suitable for a venereal treatment centre. The cover describes the 606 Apparatus, Military Outfit," as used at the Military Hospital in Rochester-row ; two pages follow on syringes and needles; then the drugs, new and old, in various forms; general apparatus, urethral instruments, a special 606 table " with hinged arm rests ; ending with a complete estimate of the outfit required under three heads : (1) the 606 and mercurial injection room ; (2) the gonorrhoea treatment room; (3) apparatus for the Wassermann test and dark-ground work. The list will be of use to centres not already fully equipped.
questions
PARIS. (FROM
OUR OWN
CORRESPONDENT.)
The Aphonia of 1.Yar and Laryngeal Tuberculosis. AMONG the accidents attributable to the war one of the most unexpected and difficult to interpret is aphonia. It is not a rare accident. Dr. G. Li6bault, chief of an oto-rhinolaryngological centre, has made a special study of these cases. Some of them may be attributed to a nervous traumatism caused by the bursting of the shells, but the majority of patients state that their aphonia has followed on the fatigues and chills of trench life. The diagnosis of simple nervous aphonia has frequently been established, but many also are under suspicion of a commencing laryngitis. When transferred from service to service these men are incompletely treated and do not improve. They are as a rule exhausted ; they have often been several months in the trenches ; they are thin, physically depressed, and in need of rest; they have a cough and a hoarse voice. It is natural for the doctor who sees them to conclude that the bronchitis