The Treatment of Venereal Diseases.

The Treatment of Venereal Diseases.

482 THE TREATMENT OF VENEREAL DISEASES. should be represented at all local discussions on the machinery to be employed by county and municipal autho...

331KB Sizes 5 Downloads 95 Views

482

THE TREATMENT OF VENEREAL DISEASES.

should be represented at all local discussions on the machinery to be employed by county and municipal authorities for the repression and This is surely eradication of these diseases. the obvious way to secure the cordial coöperation of the medical profession; we go further than this, and say that unless medical representatives are present when concrete schemes of administrative and pathological work are proin applying systematised research to industry is posed there will be a grave risk of the Govern. Germany, and her power and position have grown ment action in the matter proving of little value. out of the attitude of the official classes, who Unless the medical men, who will in any event have have always paid the utmost respect to the poten- to diagnose and treat venereal diseases, assist in tialities of science. All inquiries and reflections the institution of the methods therefor, we may show that in this direction our national neglect find that in the local schemes the proper facilities are not made available. Some county councils and has been marked. The first report of the Committee of Scientific some county boroughs are more enlightened than and Industrial Research makes a practical start others, while some localities have better opportowards reform by recommending for immediate tunities than others for setting on foot a real consideration the various branches of research crusade against disease of any sort. It is essential which should receive State aid, and they are that in every locality the services of the pathological perfectly justified in pointing out that the condi- laboratories of the area should be secured. Our tions for success are, first, a largely increased universities, hospitals, and scientific centres are supply of competent researchers, and, secondly, a not arranged according to a pattern that has hearty spirit of cooperation among all concerned- been decided either by density of population or by men of science, men of business, working men, facilities of intercommunication, so that it will and scientific universities societies, professional require sometimes considerable tact and skill to and technical colleges, local authorities, and equalise among the whole the advantages enjoyed Government departments. Neither condition will by some. Expert medical opinion would be very be effective without the other, and it remains to valuable on this point, which is definitely alluded to be seen how the spirit of research, as we have in the recommendations of the Royal Commission hitherto known it in this country, will be affected on Venereal Diseases. It was urged by the Comwhen the direction of research is dictated and missioners that measures should be taken to render aided by the State. The report says that " the the best modern treatment of venereal disease universities can and must be the main sources of readily available for the whole community, and research in pure science the discoveries in which only if medical men are present at the organising are at the root of all practical and technical meetings to explain what are the best methods and so that clearly the spirit of research to assist in the general arrangements, is it likely application"; which it suggests is quite opposed to German that persons affected by venereal disease will take methods. For the factories in Germany are the advantage without hesitation of the chances of centres of research, not the universities; and it treatment afforded. is this fact which has rendered Germany so The work of the Royal Commission on Venereal ingenious in much practical application of science. Diseases received remarkable endorsement in the This country should pursue the two methods. It is minds of all thinking persons as soon as the report the blend between the academic training of the was issued, and the recommendations of the Comuniversity and lecture room with the clinical teach- mission, as we know, have been largely adopted by ing in the ward that has produced for us our high the Government. At this moment the issue by the standard of medical practice and medical research; National Council for Combating Venereal Diseases similar training will produce the scientific advisers of a synopsis of the report, made by Captain that we need, and should secure for them properly DOUGLAS WHITE, is very opportune. Lord paid occupation. SYDENHAM, the chairman of the Commission, in a statement prefatory to the synopsis, expresses his hope that it will provide a convenient compendium The Treatment of Venereal of the whole subject of venereal disease as eluciDiseases. dated by the inquiry of the Commission, and we WE agree fully with the view expressed at the think it will exactly serve the purpose thus indilast annual Representative Meeting of the British cated. Captain WHITE has made his synopsis in Medical Association, that it is essential to the the right way. It is, as he says, "nothing but a satisfactory outcome of any schemes for the shortened report," for he has effected the reduction diagnosis and treatment of venereal diseases that by systematic abbreviations and not by wholesale the medical profession should be properly repre- omissions, while the statements dealing with the sented on all committees instituted to formulate economic effects of venereal diseases are given in these schemes. A circular was issued last week by full, and the summary of recommendations is the Local Government Board to local authorities included verbatim. By means of this volume commending a suggestion made by the Repre- the contents of the report, its scope, limitasentative Meeting that the local medical nrofession tions, and conclusions will become intelligible to

possess, at all events, the raw essentials of these products in considerable quantities. We produce as much coal-tar as, if not more than, any other country, and, as is well known, this is the starting point not only of dyes but of many drugs of great importance in medicine. But the large production of synthetics, antiseptics, and dyes abroad has been the outcome of systematised research, and the country which has been pre-eminent I

TRENCH WARFARE AND THE RENAL FUNCTION

those in charge of the local schemes; indeed, it should serve as a handbook to such deliberations. With the presence of medical men to explain technical points and to elucidate pathology, there should be no great difficulty in understanding exactly the advice given by the Commission, and in appreciating the arguments which have led to the expression of the various opinions. Local committees, armed in this way with information as to what to aim at and what to avoid, should be in a favourable position to secure methods of treatment both properly directed, and devised so as to secure the minimum of inconvenience and of undesirable publicity to the patients. In this way success must follow the national endeavour to minimise the evils of venereal diseases, and we may find ourselves, sooner than we have hitherto dared to hope, looking forward confidently to their eradication. At the first annual meeting of the National Council for Combating Venereal Diseases, held in June last, Dr. FREDERICK TAYLOR, the President of the Royal College of Physicians of London, who is the chairman of the Medical Committee of the National Council, explained in a few words the attitude of the medical profession towards this enormously important campaign, and his views have received general endorsement. Alluding to the work of the Medical Committee of the National Council which has for one of its objects an inquiry into medical education in relation to venereal diseases, Dr. FREDERICK TAYLOR pointed out that medical education is the lifelong occupation of medical men, who always remain students of disease. But he suggested that, in regard to venereal diseases, medical education could be more actively conducted, alluding to the fact that circumstances had conspired to produce in the clinical schools a shortage of material upon which instruction in venereal diseases could It is The observation is very just. be based. well known that at certain of our general hospitals the wards ’reserved for cases of venereal diseases have been closed, while it is an unfortunate fact that at some institutions a narrow idea has prevailed that venereal diseases ought the expense of the not to be treated at The result of this piece of charitable public. medioavalism has been that while excellent research has been carried on at the hospitals into the latermanifestations of venereal diseases, the patients having secured entrance for the treatment of terribly damaging sequelaa, attention has been much withheld from early cases. This is a position of affairs which must be removed. We have now methods of treatment available whose arresting effects are remarkable. There is not an exact consensus of opinion about all the details of these methods-the fact that we do not pride ourselves at having arrived at finality within a few years of the initial discovery is thoroughly hopeful from a scientific point of view-but we know that recently weapons have been placed in our hands which should be used at once on early cases everywhere, including the general ,hospitals and all institutions for the treatment of

483

the sick. When this is done, students will grow up well informed not only in the pathology and the literature of venereal diseases, but also in the technique for their relief in the early and curable stages. While the medical education of the students would thus be provided for, that of the general practitioner should be insured by his receiving every facility for attending the outpatient and in-patient practice at all centres of treatment, and by his being in the position to ensure his patient’s access to institutional treatment when he considers that course desirable.

Annotations. "Ne

quid nimis."

TRENCH WARFARE AND THE RENAL FUNCTION.

WE

publish

in another column

some

interesting

observations by Captain J. W. McLeod and Medecinaide-Major P. Ameuille on the effect of trench warfare on renal function, which aim at throwing light on the outbreak of nephritis among our troops in France. It is useful to have these observations on the urine of healthy soldiers as a basis for comparison. They believe the occurrence of symptomless albuminuria is the result of fatigue. This is probable ; Dr. William Collier discovered albumin in the urine of every one of the Oxford crew of 1906 after rowing a course, while it was even more pronounced in the case of men after running a race. Captain McLeod and Major Ameuille found that this symptomless albuminuria was more prevalent among the troops undergoing training in England who were habitually carrying out physical exercises. Yet, as they observe, nephritis is not prevalent among these, or, indeed, among

recruits at any time, so that some other factor must be sought for the outbreak among the troops in France. The number of men who developed nephritis subsequently to a negative examination for albumin was exactly the same as of those who developed nephritis after a positive observation. The authors admit the probability, but not the certainty, that acute nephritis is due to a sudden change in a healthy kidney. They do not consider exposure the cause of the change. They conclude that diet is the most likely explanation of the excess of transitory albuminuria and mild nephritis, and that it may contribute towards the development of the more severe cases. The chief factors they hold responsible -in the diet are excess of protein combined with lack of fresh vegetables. Yet, as Mackenzie Wallis showed, the chemical evidence is against the existence of an intestinal toxemia, which might in that case have been anticipated. It would be important to know whether similar dietetic conditions obtained in the American Civil War, the only other campaign in which nephritis assumed epidemic proportions. It would also be useful to know whether the rations of our troops while training in this country differ widely from those which they get while fighting in France, for otherwise it is difficult to see why nephritis should be rare under the former conditions and common the latter. The authors appear to consider that transitory albuminuria shades off into mild nephritis, though this is not in accord with Dukes’s observations on the albuminuria of boys at Rugby

under