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THE INSTRUCTION OF THE YOUNG WITH REGARD TO VENEREAL DISEASE.
944 from abundant leuoorrhoea after menstruation. For a year the discharge had been thick and yellowish and stained her linen. On the l8th the left knee was enveloped in cotton wool, tightly bandaged, and placed in a splint. Salicylate of sodium was given in daily doses of eight grammes and the dose was gradually diminished. This treatment was not efficacious and therefore on March 9th salophen in doses of five grammes daily was substituted for the salicylate. At this time the muscles of the left lower limb were much atrophied. The salophen also failed. All medication was stopped on the 25th and only the immobilisation and compression of the knee were maintained. On April 5th the temperature became normal but the knee remained tender. On the 23rd treatment by immobilisation and compression was changed to massage and passive movements. - The atrophy was so great that the circumferences of the thigh and the leg were two centimetres less than on the other side; on the other hand, the circumference of the knee was from two to three centimetres greater. Improvement took place and on May 14th movements of the knee could be performed without pain. On the 27th the patient was discharged able to walk but the muscular atrophy was undiminished. The important in the case is the point complete latency of the gonorrhoeal infection until it was stimulated into activity by the puerperium. It is also noteworthy that the history did not disclose the existence of gonorrhoea and no signs of it were found at the pelvic examination. Moreover, the child did not suffer from ophthalmia. The gonococcic arthritis, therefore, simulated the usual form of puerperal arthritis, the streptococcic. When the arthritis took a mono-articular phase confusion with puerperal arthritis The case shows the necessity of was no longer possible. careful bacteriological examination in the diagnosis of gonorrhceal arthritis. -
THE MORALITY OF THE DUTIES ON SPIRITS.
Monday next the Chancellor of the Exchequer will present the Budget in the House of Commons and it is generally known that the financial statement in regard to the year’s revenue is satisfactory and that there will be a balance of some millions to the good. An interesting feature of the year’s revenue, we learn, is that despite this surplus the income derived from the taxation of alcoholic liquors has very appreciably declined. This, of course, means a diminished consumption of wines and spirits which may be traced, perhaps, to a moral improvement in the nation’s temper or, as is more probable, to a reduced spending capacity of: the individual brought about by commercial depression. Personally, we should welcome a falling ofr in the revenue’ from alcoholic liquors if such a circumstance only helpedl to remove the reproach, as the forthcoming Budget appears; : to do, that our finances are largely supported by the nation’s indulgence in alcohol. The argument, moreover, that because wines and spirits are an important’ souree of revenue it would be inconvenient from a purely fiscal point of view to interfere with the activity and the: ON
’
,
.
.
,
custom of the trade would receive a healthy set-back. Itj is notorious that when Chancellors of the Exchequer have: had their attention drawn to the desirability of the Govern: ment exercising control over the purity and the quality of excisable liquors they have evaded the question, fearful lestj any action should interfere with a substantial source ofE revenue. The Government or its officials only care to collect the tax regardless entirely of the quality or the wholesomeness of the spirituous drink upon which that tax is imposed. There is thus no discrimination made between the genuinely described and the falsely described. In a word, all spirits are merely alcohol from the fiscal point of view and all question as to the materials from which the spirit :
-
-
has been made is completely ignored-that is to say, the tax is the same whether the foundation of the spirit has been malt, grapes, corn, molasses, sugar, potatoes, or, in fact, anything from which alcohol can be made, and the category may include a list of very undesirable materials. Surely this uncompromising method of taxatiop is a grave injustice to the consumer who, after all, bears the tax. Is it logical, is it just, to impose upon the consumer the same amount of tax on the genuine article as upon that which is incorrectly described? The principle that the consumer should be completely in the dark as to the genuineness of the article upon which he pays a heavy tax is surely unsound. It is all very well from the tax-gatherer’s point of view but morally it is wrong. The consumer is entitled to get genuine tea, coffee, or cocoa when he asks for them and he expects to participate in the tax in accordance with the adjustment of the customs tariff, but he naturally would resent having to bear the same rate of imposition on mixtures of tea, coffee, or cocoa. There is a duty on cocoa of 2d. per pound which, of course, the consumer indirectly pays, but there is no duty on starch. When, however, a mixture of cocoa and starch is sold to him as cocoa he is cheated and he has a remedy in the Sale of Food and Drugs Act. He is similarly cheated when on demanding a grape spirit (i.e., brandy) or a malt spirit (i.e., whisky) he is supplied with grain spirit or patent spirit which is obviously not of the nature, quality, or substance of the article demanded. Yet whatever spirit he may happen to be supplied with he pays the same duty and the reply of the Government is laconic enough, "It is all alcohol." Such an answer may satisfy fiscal needs but it is distinctly detrimental to the welfare and the health of the community. It is, in fact, time that the public received some consideration and protection in this matter and it is anomalous that a system of taxation should exist which deals with the genuine article on the same terms and level as it does with an article which is practically falsely described. It amounts to deriving revenue
THE
from
a
species
of fraud.
°
INSTRUCTION OF THE YOUNG WITH REGARD TO VENEREAL DISEASE.
series of five lecturesdelivered to the students of the University of Copenhagen by Professor Erik Pontoppidan with a view to instruct a general audience of young men, not necessarily intended for the medical profession, as to the significance and the prevention of venereal disease. These lectures were first given under the auspices of the International Conference " Pour la Prophylaxie Sanitaire et Morale " held at Brussels in 1899 and they have since been repeated in the autumns of 1900, 1901, and 1902, no doubt with the object of attracting the attention of junior students at the beginning of the academic year. The lecturer has aimed at imparting to his audience a measure of scientific knowledge of the hygienic aspect of venereal infection corresponding to the instruction sought to be made general with regard to tuberculosis during recent years. He explains at some length the nature and the causes of venereal disorders and the outlines of the treatment necessary to eradicate them from the infected person, dwelling upon the consequences to the individual of the neglect of adequate measures and upon the results to the community of the unchecked dissemination of the evil. This neglect, he points out, is due to ignorance and in a great measure also to other causes such as the desire for secrecy and he urges fuller knowledge accompanied by more open recognition of the danger together with prevention
WE have before
us a
1 What Venereal Diseases Mean and How to Prevent Them. By Professor Erik Pontoppidan, M.D., chief physician to the Western (Lock) Hospital, Copenhagen. Translated by W. Jessen. London: John Bale, Sons, and Danielsson, Limited. 1905. Pp. 79. Price 2s. net.
945 as it undoubtedly does do, calls forth the finest v only by medical and sanitary precautions but also by the war, c of human nature, the hideously effective action setting up of pure and healthy ideals of life. The subject qualities (’ modern methods of destruction sickens the heart. is one of great importance and the question as to how far it of J. its effects are not limited to the battlefield. As our can be broached publicly and discussed with a view to theAnd is in one master of English prose said (he is speaking of the conditions itself amelioration of existing f upongreat the and anxiety with which the casualty lists from Of distress are held. which diverse opinions prevailing ignorance 7 from which Flanders were studied in this country after Waterloo) : In more class the can doubt. none intelligent Professor Pontoppidan’s hearers were drawn it leads to ’ If such an interest could be felt in our country and about a battle where but twenty thousand of our people were medical aid being sought either not at all or too latea and to a want of perseverance which is equally un- engaged, think of the condition of Europe for 20 years 1 where people were fighting, not by thousands, but desirable. With regard to the ignorance of the less before, educated classes we note that the lecturer refers to 1by millions ; each one of whom as he struck his enemy wounded horribly some other innocent heart far away." the existence in Denmark of a hideous superstition, with which medical men and lawyers practising in criminal courts are familiar in this country, that sexual interDANGERS TO THE OPERATOR FROM THE course with a virgin, or the passing on of infection to a X RAYS.
not
c
c
"
cure venereal disease. When such ideas this require to be stamped out it can hardly be denied that more extended knowledge is desirable ; and when the desirability of discussing such topics with the young is disputed it must be borne in mind that this, as a rule, amounts to the substitution of sound and accurate knowledge imparted by one in the position of a teacher for such information as his hearers would otherwise gather from untrustworthy and tainted sources and would disseminate in unhealthy conversation among themselves. With reference to the lives led by young men in universities Professor Pontoppidan refers with approval to the influence of athleticism in the discouragement of sexual indulgence and pays a high, and let us hope deserved, compliment to English universities and to the attitude towards licentious talking and living which he finds prevailing in them. The conditions existing in the British army, on the other hand, fill him with surprise and horror which he does not disguise and he would no doubt point to the rank and file of our battalions as a suitable field for the development of knowledge as a prophylactic. His lectures, however, are for a different class and we would recommend their perusal and the consideration of the course suggested in them by teachers of those who when instructed are most likely to be able to influence others, if not by precept at least by their example.
child, will
THOUGH the injuries inflicted on the patient in the use of the x rays have been repeatedly recorded little attention has been directed to the dangers to the operator. However, some alarmist reports come from America and if at present the evidence is not sufficient to accept them absolutely at least a good case is made out for greater care in using the rays. According to a recent editorial article in the Medical News of New York Dr. Tilden Brown has demonstrated absence of spermatozoa (azoospermia) in the semen of a number of patients and physicians who had spent more or less time exposed to the x rays. They, however, were These obsernot conscious of any loss of potency. vations are supported by certain experiments made in Germany. About 18 months ago Albers-Schonberg found that if the abdominal surface of male guinea-pigs or rabbits was exposed for a prolonged time to the x rays the animals became sterile but their potency was unimpaired. This sterility was due to the development of azoospermia, which was shown by Seldin to depend on the disappearance of the epithelium of the seminiferous tubes. Recently Hulberstaedter has described experiments which show that the ovary is even more susceptible to the action of the rays than is the testis. In the Boston Medical and Surgical Journal of March 9th Dr. H. W. van Allen has discussed the dangers to the operator from exposure to the x rays and their prophylaxis. He has reported seven cases in which men were exposed to the action of the x rays AN INTERNATIONAL MEDICAL ASSOCIATION in the genital region with the production of more or less AGAINST WAR. dermatitis. The following is an outline of these cases :ON March 21st there assembled at the house of Dr. 1. 12 exposures, the last four months ago. Spermatozoa Rivière, in Paris, more than 200 medical men. The! normal. 2. 12 exposures, the last a year ago. Spermatozoa object of the meeting was the association of medical normal. 3. 35 exposures, the last five months ago. Sperin their power to matozoa absent. Sexual function apparently normal. Age men for the purpose of doing all It was decided to found an 38 years. 4. Ten exposures a year ago. Spermatozoa do away with war. International Medical Association against War and it was; normal. 5. 15 exposures four months ago. Spermatozoa proposed to hold a congress on the subject in two years’ absent. Age 56 years. 6. An x ray tube maker, aged 42 time. Those present were constituted the committee of the years, who had changed his occupation and not been exposed movement and officers were elected as follows. President:: for six months. No spermatozoa. 7. 45 exposures, last one Dr. Riviere. Vice-Presidents : Dr. Philippeau, Dr. SuarezB 14 months ago. Spermatozoa absent. Age 40 years. The de Mendoza, and Dr. Th. Mende Ernst. General Secretary :: cases of azoospermia were not those in which the dermatitis Dr. Mazery. Secretaries: Dr. Pokinotoff, Dr. Antonelli, Dr. was marked but the ones treated the longest. The observaCree, Dr. de Torres Mendiola, Dr. de Castro Soffia, and Dr. tions led Dr. van Allen to look for other effects. He found Cogrel. Treasurer: Dr. Marechal. Delegated secretaries: Dr. that in x ray workers of experience the skin and its appenMazery, Dr. Cree, and Dr. Cogrel. Dr. Riviere, who opened1 dages first suffer. The nails and the hair are brittle and of the proceedings in an able discourse, reminded his hearerss slow growth. The skin is dry and of a yellowish hue which of the horrors of war; he pointed out how the North Seai is almost characteristic. Indigestion, especially of the incident showed very well what arbitration could do intestinal kind, is present. The workers complain of inand argued that medical men who were so intimately ability to concentrate their thoughts for any length of acquainted with human misery, both physical and moral,, time and are drowsy, although many suffer from insomnia. were by that very fact the most fitted of the community y Their disposition is somewhat irritable. They complain to collaborate in the great work of substituting arbitra-I- of an abnormal sensation of cold. Radiographs of the tion for war. Dr. Riviere has set up a high ideal butt thinner parts of the body show premature sclerosis of there is no one who will not earnestly hope that this the arteries. To prevent such effects Dr. van Allen recoms ideal may be realised in the near future. Even though h mends that the operator should be entirely removed from
as
-
’
.
.
.
THE MORALITY OF THE DUTIES ON SPIRITS.
Monday next the Chancellor of the Exchequer will present the Budget in the House of Commons and it is generally known that the financial statement in regard to the year’s revenue is satisfactory and that there will be a balance of some millions to the good. An interesting feature of the year’s revenue, we learn, is that despite this surplus the income derived from the taxation of alcoholic liquors has very appreciably declined. This, of course, means a diminished consumption of wines and spirits which may be traced, perhaps, to a moral improvement in the nation’s temper or, as is more probable, to a reduced spending capacity of: the individual brought about by commercial depression. Personally, we should welcome a falling ofr in the revenue’ from alcoholic liquors if such a circumstance only helpedl to remove the reproach, as the forthcoming Budget appears; : to do, that our finances are largely supported by the nation’s indulgence in alcohol. The argument, moreover, that because wines and spirits are an important’ souree of revenue it would be inconvenient from a purely fiscal point of view to interfere with the activity and the: ON
’
,
.
.
,
custom of the trade would receive a healthy set-back. Itj is notorious that when Chancellors of the Exchequer have: had their attention drawn to the desirability of the Govern: ment exercising control over the purity and the quality of excisable liquors they have evaded the question, fearful lestj any action should interfere with a substantial source ofE revenue. The Government or its officials only care to collect the tax regardless entirely of the quality or the wholesomeness of the spirituous drink upon which that tax is imposed. There is thus no discrimination made between the genuinely described and the falsely described. In a word, all spirits are merely alcohol from the fiscal point of view and all question as to the materials from which the spirit :
-
-
has been made is completely ignored-that is to say, the tax is the same whether the foundation of the spirit has been malt, grapes, corn, molasses, sugar, potatoes, or, in fact, anything from which alcohol can be made, and the category may include a list of very undesirable materials. Surely this uncompromising method of taxatiop is a grave injustice to the consumer who, after all, bears the tax. Is it logical, is it just, to impose upon the consumer the same amount of tax on the genuine article as upon that which is incorrectly described? The principle that the consumer should be completely in the dark as to the genuineness of the article upon which he pays a heavy tax is surely unsound. It is all very well from the tax-gatherer’s point of view but morally it is wrong. The consumer is entitled to get genuine tea, coffee, or cocoa when he asks for them and he expects to participate in the tax in accordance with the adjustment of the customs tariff, but he naturally would resent having to bear the same rate of imposition on mixtures of tea, coffee, or cocoa. There is a duty on cocoa of 2d. per pound which, of course, the consumer indirectly pays, but there is no duty on starch. When, however, a mixture of cocoa and starch is sold to him as cocoa he is cheated and he has a remedy in the Sale of Food and Drugs Act. He is similarly cheated when on demanding a grape spirit (i.e., brandy) or a malt spirit (i.e., whisky) he is supplied with grain spirit or patent spirit which is obviously not of the nature, quality, or substance of the article demanded. Yet whatever spirit he may happen to be supplied with he pays the same duty and the reply of the Government is laconic enough, "It is all alcohol." Such an answer may satisfy fiscal needs but it is distinctly detrimental to the welfare and the health of the community. It is, in fact, time that the public received some consideration and protection in this matter and it is anomalous that a system of taxation should exist which deals with the genuine article on the same terms and level as it does with an article which is practically falsely described. It amounts to deriving revenue
THE
from
a
species
of fraud.
°
INSTRUCTION OF THE YOUNG WITH REGARD TO VENEREAL DISEASE.
series of five lecturesdelivered to the students of the University of Copenhagen by Professor Erik Pontoppidan with a view to instruct a general audience of young men, not necessarily intended for the medical profession, as to the significance and the prevention of venereal disease. These lectures were first given under the auspices of the International Conference " Pour la Prophylaxie Sanitaire et Morale " held at Brussels in 1899 and they have since been repeated in the autumns of 1900, 1901, and 1902, no doubt with the object of attracting the attention of junior students at the beginning of the academic year. The lecturer has aimed at imparting to his audience a measure of scientific knowledge of the hygienic aspect of venereal infection corresponding to the instruction sought to be made general with regard to tuberculosis during recent years. He explains at some length the nature and the causes of venereal disorders and the outlines of the treatment necessary to eradicate them from the infected person, dwelling upon the consequences to the individual of the neglect of adequate measures and upon the results to the community of the unchecked dissemination of the evil. This neglect, he points out, is due to ignorance and in a great measure also to other causes such as the desire for secrecy and he urges fuller knowledge accompanied by more open recognition of the danger together with prevention
WE have before
us a
1 What Venereal Diseases Mean and How to Prevent Them. By Professor Erik Pontoppidan, M.D., chief physician to the Western (Lock) Hospital, Copenhagen. Translated by W. Jessen. London: John Bale, Sons, and Danielsson, Limited. 1905. Pp. 79. Price 2s. net.
945 as it undoubtedly does do, calls forth the finest v only by medical and sanitary precautions but also by the war, c of human nature, the hideously effective action setting up of pure and healthy ideals of life. The subject qualities (’ modern methods of destruction sickens the heart. is one of great importance and the question as to how far it of J. its effects are not limited to the battlefield. As our can be broached publicly and discussed with a view to theAnd is in one master of English prose said (he is speaking of the conditions itself amelioration of existing f upongreat the and anxiety with which the casualty lists from Of distress are held. which diverse opinions prevailing ignorance 7 from which Flanders were studied in this country after Waterloo) : In more class the can doubt. none intelligent Professor Pontoppidan’s hearers were drawn it leads to ’ If such an interest could be felt in our country and about a battle where but twenty thousand of our people were medical aid being sought either not at all or too latea and to a want of perseverance which is equally un- engaged, think of the condition of Europe for 20 years 1 where people were fighting, not by thousands, but desirable. With regard to the ignorance of the less before, educated classes we note that the lecturer refers to 1by millions ; each one of whom as he struck his enemy wounded horribly some other innocent heart far away." the existence in Denmark of a hideous superstition, with which medical men and lawyers practising in criminal courts are familiar in this country, that sexual interDANGERS TO THE OPERATOR FROM THE course with a virgin, or the passing on of infection to a X RAYS.
not
c
c
"
cure venereal disease. When such ideas this require to be stamped out it can hardly be denied that more extended knowledge is desirable ; and when the desirability of discussing such topics with the young is disputed it must be borne in mind that this, as a rule, amounts to the substitution of sound and accurate knowledge imparted by one in the position of a teacher for such information as his hearers would otherwise gather from untrustworthy and tainted sources and would disseminate in unhealthy conversation among themselves. With reference to the lives led by young men in universities Professor Pontoppidan refers with approval to the influence of athleticism in the discouragement of sexual indulgence and pays a high, and let us hope deserved, compliment to English universities and to the attitude towards licentious talking and living which he finds prevailing in them. The conditions existing in the British army, on the other hand, fill him with surprise and horror which he does not disguise and he would no doubt point to the rank and file of our battalions as a suitable field for the development of knowledge as a prophylactic. His lectures, however, are for a different class and we would recommend their perusal and the consideration of the course suggested in them by teachers of those who when instructed are most likely to be able to influence others, if not by precept at least by their example.
child, will
THOUGH the injuries inflicted on the patient in the use of the x rays have been repeatedly recorded little attention has been directed to the dangers to the operator. However, some alarmist reports come from America and if at present the evidence is not sufficient to accept them absolutely at least a good case is made out for greater care in using the rays. According to a recent editorial article in the Medical News of New York Dr. Tilden Brown has demonstrated absence of spermatozoa (azoospermia) in the semen of a number of patients and physicians who had spent more or less time exposed to the x rays. They, however, were These obsernot conscious of any loss of potency. vations are supported by certain experiments made in Germany. About 18 months ago Albers-Schonberg found that if the abdominal surface of male guinea-pigs or rabbits was exposed for a prolonged time to the x rays the animals became sterile but their potency was unimpaired. This sterility was due to the development of azoospermia, which was shown by Seldin to depend on the disappearance of the epithelium of the seminiferous tubes. Recently Hulberstaedter has described experiments which show that the ovary is even more susceptible to the action of the rays than is the testis. In the Boston Medical and Surgical Journal of March 9th Dr. H. W. van Allen has discussed the dangers to the operator from exposure to the x rays and their prophylaxis. He has reported seven cases in which men were exposed to the action of the x rays AN INTERNATIONAL MEDICAL ASSOCIATION in the genital region with the production of more or less AGAINST WAR. dermatitis. The following is an outline of these cases :ON March 21st there assembled at the house of Dr. 1. 12 exposures, the last four months ago. Spermatozoa Rivière, in Paris, more than 200 medical men. The! normal. 2. 12 exposures, the last a year ago. Spermatozoa object of the meeting was the association of medical normal. 3. 35 exposures, the last five months ago. Sperin their power to matozoa absent. Sexual function apparently normal. Age men for the purpose of doing all It was decided to found an 38 years. 4. Ten exposures a year ago. Spermatozoa do away with war. International Medical Association against War and it was; normal. 5. 15 exposures four months ago. Spermatozoa proposed to hold a congress on the subject in two years’ absent. Age 56 years. 6. An x ray tube maker, aged 42 time. Those present were constituted the committee of the years, who had changed his occupation and not been exposed movement and officers were elected as follows. President:: for six months. No spermatozoa. 7. 45 exposures, last one Dr. Riviere. Vice-Presidents : Dr. Philippeau, Dr. SuarezB 14 months ago. Spermatozoa absent. Age 40 years. The de Mendoza, and Dr. Th. Mende Ernst. General Secretary :: cases of azoospermia were not those in which the dermatitis Dr. Mazery. Secretaries: Dr. Pokinotoff, Dr. Antonelli, Dr. was marked but the ones treated the longest. The observaCree, Dr. de Torres Mendiola, Dr. de Castro Soffia, and Dr. tions led Dr. van Allen to look for other effects. He found Cogrel. Treasurer: Dr. Marechal. Delegated secretaries: Dr. that in x ray workers of experience the skin and its appenMazery, Dr. Cree, and Dr. Cogrel. Dr. Riviere, who opened1 dages first suffer. The nails and the hair are brittle and of the proceedings in an able discourse, reminded his hearerss slow growth. The skin is dry and of a yellowish hue which of the horrors of war; he pointed out how the North Seai is almost characteristic. Indigestion, especially of the incident showed very well what arbitration could do intestinal kind, is present. The workers complain of inand argued that medical men who were so intimately ability to concentrate their thoughts for any length of acquainted with human misery, both physical and moral,, time and are drowsy, although many suffer from insomnia. were by that very fact the most fitted of the community y Their disposition is somewhat irritable. They complain to collaborate in the great work of substituting arbitra-I- of an abnormal sensation of cold. Radiographs of the tion for war. Dr. Riviere has set up a high ideal butt thinner parts of the body show premature sclerosis of there is no one who will not earnestly hope that this the arteries. To prevent such effects Dr. van Allen recoms ideal may be realised in the near future. Even though h mends that the operator should be entirely removed from
as
-
’
.
.
.