THE TREATMENT OF VENEREAL DISEASES. MEETING AT CAMBRIDGE.

THE TREATMENT OF VENEREAL DISEASES. MEETING AT CAMBRIDGE.

356 real Special Articles. THE " Never send a fancied loss of his clients. patient to a specialist." "Specialist" and "consultant " were not quite...

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356

real

Special Articles. THE

"

Never send a fancied loss of his clients. patient to a specialist." "Specialist" and "consultant " were not quite synunymous terms h practice, though the specialist was much the saxntas a consulting surgeon in operating on patieatt. or

whereas a consulting physician’s activity was usually to prescriptions and verbal advice. The tfQf DISEASES. limited and most beneficial function of a specialist was. of course. to be the guide and co-worker of the medical MEETING AT CAMBRIDGE.

TREATMENT

OF VENEREAL

practitioner,

THE first provincial meeting of the Medical Society fur the Study of Venereal Diseases was held at Cambridge on Jan. 2f)th. Sir HUMPHRY ROLLESTON. President of the Society, took the chair and opened the proceedings with an address on SPECIALISM IN MEDICINE. The Society, he said, confined its energies to the medical aspects of a most important cause uf individual disease and of national deterioration. The qlwstion whether or not specialism was good or bad for medicine as a whole bad been settled long ago, but with the birth of each new specialty there was always a feeling of reluctance of the parent body to part with its offspring. There was, of course, a good deal to be said against the progressive of medicine entailed by the segregation of those specially interested in a particular organ or part of the body, for eventuall-v, if carried to its logical cunclusion. the iiiosaic of general medicine might be so broken up as to bring about a reversion to the state of affairs in ancient Egypt about 500 B.C., when each disease had its own expert who did not concern himself with anything else. With the ever-increasing scope of medicine and surgery the evolution of specialism had kept pace ; first came special hospitals, such as the Royal Ophthalmic Hospital, Moorfields (1804), the Royal Hospital for Diseases of the Chest (1814), the Royal Ear Hospital (1814) ; then special departments at general hospitals were started and were officered by their own general physicians and surgeons. The special hospitals had naturally been first in the field with medical officers who confined their activities to the diseases treated at the hospital, but he could remember the time when nearly all the surgeons at the Royal Ophthalmic Hospital were general surgeons on the staff of teaching hospitals. What were the reasons, asked tlie President, which should weigh in deciding what was and what The amount was not a real and legitimate specialty ? of special knowledge and experience must be so considerable a2 to make it extremely difficult, if not impossible, for a general physician, surgeon, (-)I, practitioner competently and conscientiously to undertake the work and responsibilities in addition to his other manifold duties. The second and probably the more important criterion was the degree of technical skill required for discharge of the methods of diagnosis and treatment of the conditions constituting the particular branch of medicine or surgery. In the early treatment of venereal disease, if it was to be efficiently carried out, the technique demanded considerable training and experience, and, in order to maintain the standard consistent with the best results, constant practice was essential. A third reason for the establishment of a specialty was to counteract, in the interests of the public, the activities of irregular practitioners. for any branch of the healing art which did not greatly interest the majority of medical men was likely to be neglected, and as a result there was an opening for irregular practitioners. In no branch of medicine was there more danger than in venereal disease that members of the public would resort to advertising quacks. The real function of a specialty was essentially to facilitate intensive study of the subject and to perfect technique. Those working in special departments, therefore, were leaders and courts of appeal for the rank and file of the profession, who necessarily had to deal with the bulk of the patients. To recall this might not be out of place in the light of the dictum of a practitioner, probably irritated by the

disintegration

and not to take his

place entirely.

Relatio)z of Syphilology to Othen Specialties. Venereal disease in the past, continued the President, had been more closely allied with what. in contradistinction to internal medicine, the province of the physician, might be called external medicine—namely, surgery and especially urology, so that genito-urinary departments had undertaken the treatment of syphilis and gonorrhoea. More recently dermatology, which more justly deserved the title " external medicine," had taken syphilis under its wing, as was shown by the names of various journals such a,s the Britisk Journal o,f Dermatology and Syphilis. Syphilis—which obviously had important relations with dermatology. as it had with all organs of the body—had thus bees separated from gonorrhcea, which had so few connexions with dermatology. This was an artificiat distinction, as it separated two diseases of venereal The position of venereal disease as a special branch of medicine based particularly on aetiologies! considerations was rather different from that of other specialties which dealt with the disorders, whatever their nature, of an organ, locality, or system. Further. the late results of syphilis, which might occur in practically every tissue and part of the body, brought it into close relation with all the divisions of medicine. But these late results of syphilis should be under the care of the general physician, surgeon, or practitioner rather titan exclusively of the specialist in venereal diseases. On the whole there was more to be said in favour of allying venereal diseases wdth genitourinary disease as a comprehensive specialty than for their association with dermatology. With some familiar exceptions gonorrhoea and syphilis in their early stages were local lesions on the genitals and so must be distinguished from non-venereal diseases in the same region, and the complications of gonococcal infection mainly came within the scope of genitourinary surgery. But genito-urinary workers had comparatively recently (1920) united with those interested in the medical diseases of the kidney to form a section of urology at the Royal Society of Medicine, so that there was an opportunity for a triple alliance and extended team-work. The study of venereal disease, said the President in conclusion, could not be a subordinate part of any other specialty, for this would narrow its outlook and activities ; it demanded intensive work, special technique, and thus, as t,he special departments and clinics for venereal diseases at the hospitals and under the Ministry of Health showed, had won its place as a recognised specialty. The opportunities for research were most attractive and its potentialities for good in improving the national health must appeal to all who had humanitarian and sociological ambitions. After the President’s address two films dealing with gonorrhoea and three films on syphilitic infection and the technique of its diagnosis were shown by Lieut.-Colonel L. W. HARRISON. Before showing --his films Colonel Harrison said that the primary object of the demonstration was to popularise a method of teaching by cinematograph demonstration. -

origin.

-

Cozzococczcs and Streptococcus. CHARLES SEARLE described three cases of septicaemia which arose after gonococcal infection. This form of septicaemia, he said, was commoner in men than in women, and in pregnant than in nonpregnant women, and was more often responsible for fatal puerperal septicasmia than was, perhaps,generally realised ; in fact, of the 6000 deaths every year in childbirth a very large proportion were froIP

Dr.

357 this cause. Infection occurred through an abrasion of the mucous membrane which in a man might be Dr. Searle due to the passage of a nietzil bougie. then -’howed specimens from two single young girls of 20 years of age who came from the country. The tirst girl came in desperately ill and practically 1IM,’I"lbund with a temperature of 103° F., which was rather anusual in such cases. She had been under treatment

ovately for six months for a vaginal discharge. When lie ordinary routine examination much to his surprise he found a foreign body in her posterior fornix gave her the

which turned out to be a hairpin. She admitted that site tuttt run risks, but would not admit that in order to procure abortion she had inserted a hairpin which had actually penetrated into the bladder. She died with streptococcal abscess in her kidneys and general septicaemia. The second girl tirst came to the clinic 15 months before her death, but ceased to attend before her course was completed. Seen 15 months later she had chronic gonorShe had also a conthoea and was ten months pregnant. Within traded pelvis which necessitated craniotomy. 56 hours of her continement she had a very slight rise of temperature, never much above 100’, and without much increase in pulsc-rate, and she died of spticæmia after 20 minutes’ unconsciousness.

,

they did get temperatures they usually occurred among the cases which they had not had under treatment or observation for any long time. Dr. D. NABARRO said that lie had great faith It was in the antenatal treatment of those cases. astounding to him, when he first started that work, to see the women who came up with tremendous discharges. After they had been treated they cleared He would like up and had a normal confinement. to urge that every town with a population large enough to support it should have a hospital for the treatment of such cases. After the meeting a dinner was held in the Old Library of Pembroke College, at which Sir Humphry Rolleston presided, and some 30 to 40 members and

their friends

were

present.

IRELAND. (FROM 01TR OwV CORRESPONDENT.)

Paying Patients and Public Hosl)it(tls. I)r. Searle’s experience was that they only found the THE Department of Local Government and Public genococcus in one case out of 20, and that the gono- Health has recently circulated to county boards of There health throughout the Free State a draft copy of coccus paved the way for the streptococcus. were several things they had to learn from those regulations to cover the admission of paying patients cases ; it was quite certain that prenatal treatment to public For such patients to be hospitals. would do a great deal to save such women if caught admitted, regulations must be adopted by the county The Society could do a great deal board of health and approved by the Minister. It at an early stage. by propaganda among midwives and general practi- is to be noted that in some counties it was one of tioners, urging them to send any cases of possible the terms of appuintnrent of the surgeon to the gonorrhœa. Hy 1.’) days’ in-patient treatment they county hospital that he should be permitted to treat could very often cure these patients, but it was very paying patients in the hospital, but in few areas diffieult to tell whether they were clear or not. In regulations have been adopted to give legal sanction Cambridge they had not the proper facilities for to this arrangement. The draft regulations now dealing with these cases, nor Hie. necessary lying-in issued are carefully framed. They provide that a beds. county board of health may set aside a ward or wards Dr. J. K. C. CANNEY thought that it had been rather as paying wards, for the reception, maintenance, lost sight of that the gonococcus made the way easy and treatment of persons not eligible for relief; fHI’ the streptucoccus to do its worst. Of late a big that any person seeking admission to such wards move had been made to try to reduce the incidence must apply to the surgeon, or if lie is absent, in "f puerperal septicæmia, and some interesting work case of urgency, to the matron ; that any person so liaci been done with regard to the bacteriology of shall pay a certain arranged sum for the vagina and cervix during pregnancy. In quite each day lie is in hospital, together with appropriate a large proportion of pregnant women it had been additional charges for any special nursing or other found that virulent streptococci were actually growing expenses incurred in connexion with his treatment ; It was, therefore, not, difficult that the surgeon may agree with such person as to the in the cervical canal. to understand, if those conditions were present, why terms upon which fie shall be treated, but that he septicæmia was common. lie did not say that all shall out of any such sunxs received by him make such cases with infected genital tracts had previously good to the board of health any sums due by the been infected with gonorrhœa, but a very mild patient to the board of health, and not paid to or unrecognised attack of it might have been a pre- recovered by the hospital ; that the surgeon, if the disposing cause in a fair proportion of cases. patient so requires, shall permit any duly qualified Colonel HARRISON had long been convinced that medical practitioner to have access to such patient, the gonococcus was responsible for a good deal of and shall, so far as possible, act in consultation with puerperal septicæmia. It had been found that in such practitioner. the venereal wards the maternity cases ran at a more The draft regulations appear to meet the claims level temperature than in the other wards of a put forward on behalf of the medical profession at maternity hospital. He thought that was due to the different times. In particular, the provision which fact that they had had antenatal treatment. If permits a paying patient to retain the services of beds were wanted locally, and they could prevail his own doctor, meets the objection, often raised, on the local authority to apply to the Ministry of to the privileged position which the right to admit Health, they would find that the Ministry was very paying patients to a public hospital gives to the surgeon sympathetic. of the hospital. With goodwill between the hospital Dr. D. C. LOGAN had been informed by one of the surgeon and his medical neighbours the regulations Ministry of Health inspectors of the venereal diseases should work well. block of the maternity hospital of which she was in The Training of Nurses. charge that the morbidity was on the whole less than in the clean blocks of the hospital. They usually got Miss K. Price, secretary of the Irish Nurses’ Union, their cases at that particular hospital a good long gave evidence last week before the Commission on The hospital was Technical Education. She pointed out that where time before conimement was due. associated witli hostels, and they often had the oppor- candidates had only national school education, the tunity of getting the cases when the patients were gap between the school-leaving age of 14: and the only about five months pregnant. In a large propor- entry to hospital at 18 to 21 was injurious. She tion of cases the gonococcus could not be found. suggested that the gap might be filled by a preliminary The clinical history was often suggestive and they course in domestic service, hygiene, and physiology. found that a very large proportion of the cases they She thought the profession of nursing much overdealt with were originally gonorrhœal, secondary stocked in Ireland. There was no general pension infection resulting in many cases. On the whole they scheme for nurses, and nurses had to continue had been very fortunate, and she thought it was; working till they dropped. Salaries were lower in because they managed to get early treatment. Where Ireland than in England.

admitted

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