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TREATMENT OF CONGENITAL SYPHILIS
A NATIONAL HOUSING PLAN.-TREATMENT OF CONGENITAL SYPHILIS
1123
ownership, and which under skilled management will provide a useful half-way house between slum conditions as they exist and the new cheap dwellings. One of the most interesting paragraphs,
THE LANCET LONDON:SATURDAY, MAY 26, 1934
A NATIONAL HOUSING PLAN A "Housing Commission" to take charge of the administrative and executive functions of the Ministry of Health in relation to housing is recommended in the interim report1 of an unofficial committee sitting under the chairmanship of Lord AMULREE. The Committee lays down the proposition as fundamental that "the provision of housing accommodation, not below a minimum standard, for every family in the United Kingdom, should be accepted as a public responsibility and a national service, as the provision of a pure water-supply or a minimum standard of education has been accepted," with the obvious corollary that the rents must be within the means of the lowest paid wage-earners. This is a proposition which the public opinion of the country may be said to have definitely approved, and there will be general acceptance of the Committee’s view that the object of policy must be to provide within the next ten years, in addition to houses needed to replace slum dwellings, at least a million new houses to be let at rentals (inclusive of rates) of 10s. a week and under. Only in this way is the overcrowding, which is the root-cause of slums, likely to be overcome. Nothing less than long-term planning on a national scale, however, would suffice to overtake such a programme, and the prospects of success would be brighter if it were found possible to take housing right outside party politics. With a view to securing continuity of policy, able to survive changes of Government, the proposed Housing Commission would be set up with a fulltime, independent, non-party chairman, and would be endowed with national scope and status after the model of the Central Electricity Board. One of its duties would be to stimulate the formation of public utility societies in suitable cases and to carry out the recommendation of the Moyne Committee with regard to a central public utility council and the wide adoption of educative
management. It is clear that the authors of this interim
report recognise the urgent need for the further housing legislation at present under consideration by the Government, including large scale acquisi-
tion of semi-slum overcrowded properties which are to be transferred to public or semi-public 1
Obtainable from the Honorary Secretary, National Housing 5 Duke-street, Adelphi, London, W.C.
Committee,
which concerns finance, will be read with relief by many people who, profoundly impressed and depressed as they are by the national evil of the slums and of overcrowding, have felt that the way to reform is blocked by the magnitude of the sums involved in any comprehensive plan of reform. It is suggested that the Housing Commission should have power to issue a National Housing Stock, carrying a full Government guarantee ; as long as such stock can be issued on a 31 per cent. basis, which is at present the case, it is pointed out that " the rents of minimum standard houses can be reduced to such a figure as to bring the economic rent within the ability to pay of the wage-earner in all but exceptional classes of cases." For a million new houses a capital sum of 400,000,000 would be ample, and of this not more than 60,000,000 would be required in any one year, and the issue of National Housing Stock on this scale should not adversely affect the gilt edged market. It can hardly be doubted that a building programme on the scale indicated would be one of the most constructive ways of dealing with unemployment, for over 80 per cent. of building costs, apart from site values, go directly or indirectly into wages. It does not seem likely that any liability would fall on the Exchequer, but even if a proportion of 16,000,000 a year did become a burden on the taxpayer it would be a small price to pay for the national benefits to be secured from the realisation of a housing programme on this scale. The Housing Commission would not itself be the owner or manager of any houses, ownership of all houses built under the national programme being vested either in the local authorities or in public utility societies. One of the most difficult aspects of the whole matter lies in the nature of the relationship between the Commission on the one hand and the local authorities on the other ; the report states merely that the Commission will work in full cooperation with the local authorities. It is to be hoped that in their final report the Committee will work out in some detail this part of their plan, because therein lies the real crux of the problem, and no plan will command general acceptance which does not afford assurance of smooth working.
TREATMENT OF CONGENITAL SYPHILIS THE treatment of syphilis varies widely from country to country and from clinic to clinic, and any attempt to arrive at standards which the
practitioner may have in mind in the care of his particular case is to be welcomed. Such an attempt was made, for congenital syphilis, by Dr. DAVID NABARRO at a recent meeting of the Medical Society for the Study of Venereal Diseases, of which he is president. A series of questions, intended to crystallise the discussion, had been circulated to the members, and these questions in
1124
themselves indicated- the difficulty of choosing the PITUITARY EXTRACT AND BLOOD PRESSURE ideal scheme. Several - important points were OLIVER and ScHAFEB in 1895 reported that the nevertheless broughtout in the discussion.l In blood pressure of anaesthetised animals rises on - the first place none of the speakers was satisfied to rely solely on the time-honoured mercury in injection of extracts of the pituitary gland, and - the treatment of congenital syphilis. It was later it was shown that this effect is due to an which is obtainable from the agreed that although the symptoms may clear up active principle or portion pars nervosa though formed, quite readily under its influence, the improvement posterior The effect of is often followed by relapse, both clinical and it is said, in the pars intermedia. has now been this on the blood , principle pressure serological. Of single drugs the best on the whole man and animals, by many both in investigated, are arsenobenzol derivatives which may be given either intravenously or intramuscularly. Very. workers. In man it seems to have no constant some observers reporting a rise of good results can be got with these, but their influence, and others a fall, after subcutaneous or effect is quicker and more lasting if they are used pressure, intravenous injections. The conflict of evidence, in conjunction with (or alternating -with) bismuth, does seem to be reflected in any preferably in the form of bismuth oxychloride. however, doubt not about its clinical efficacy. As This combination has very efficacious and general proved toxic effects are rare in infants and children. W. M. MOFFATT1 points out. the statement appears Dr. NABARRO also mentioned cases treated with in the latest edition of "New and Non-official arsenic by mouth in the form of Orasan or Remedies " that the " intravenous or subcutaneous Stovarsol, and was able to report good results, injections of preparations of the posterior lobe followed by an increase of blood pressure although- not yet prepared- to describe them as are which is maintained over a considerable period " ; cures. -Should this method prove adequate there and manufacturers of these preparations often is no -doubt that in many centres it will soon recommend their use in cases of hypotension and replace treatment by injection, as it seems to have shock with the object of raising the pressure. - done already in some continental clinics. The main disadvantage is that this remedy, like Similarly they suggest that the drug should be withheld where hypertension is already present. mercury inunctions, is administered by the parent In his own experience, MOFFATT finds no ground and may not reach its. destination in exactly the for supposing that pituitary extract ever causes quantities prescribed ; whereas injection of drugs blood pressure to remain at a high level for a at a clinic ensures that they will do so. considerable " period. In the investigation The question how much treatment is necessary his described in he gave intramuscular is in is paper for cure debate. Dr. NABARRO still pre1 of c.cm. of obstetrical pituitrin to pared to give the minimum necessary to render the injections to 56 62 in from 8 age years, with persons ranging patient free from symptoms and serologically initial between 82 and systolic pressures varying negative, provided he is certain of being able to 218 mm. and diastolic of 58 to 110. Hg pressures keep the case under observation several times a at for an were observed intervals frequent year, at least until puberty. If this is not possible They hour the and constant alteraafter no it is advisable, he thinks, to continue treatment injection, tions in the blood for at leasttwo pressure were found. In many vigorously years, irrespective was little or no change ; in a few there the clinical It also out condition. was patients of pointed in the discussion that it is wise to be guided by a there were conspicuous changes in pressure, but precipitation reaction of the blood, such as the more often a fall than a rise. Over the hour of Kahn, rather than by the Wassermann reaction, observation the general trend of the pressure, which usually becomes negative first. A routine after an initial temporary rise, was downward. examination of the cerebro-spinal fluid is highly This downward trend was characterised by a fall desirable in all cases, whether they exhibit nervous of the systolic rather than of the diastolic pressymptoms or not. Those with a positive C.S.F. sure, and consequently a slight constant decrease reaction should be treated with Tryparsamide of the pulse pressure was observed. In general intravenously and bismuth intramuscularly, and it was found that the higher the initial systolic if this is done only the more severe ones will require pressure the greater was the fall following the malariotherapy. The late Dr. DAVID LEES reported injection of pituitrin, which suggests that the excellent results with this routine, and also favour- drug is not necessarily contra-indicated in cases In this connexion MOFFATT able results in about 30 per cent. of juvenile general of hypertension. raises the with malaria. question whether in his cases arterioparalysis cases treated sclerotic changes were more extensive in the peri. Finally it cannot be pointed out too often than in the coronary vessels. If so, the that the ideal approach to the problems of con- pheral constriction would be genital syphilis is by way of prevention-by greater in theproduced bythanpituitrin in the peripheral detecting the syphilitic mothers and treating them vessels, and hecoronary this as a possible propounds this means each pregnancy. By adequately during it can be made almost certain that the child will explanation of the greater fall of pressure in be free from the disease at birth ; or if not entirely hypertensive cases. free that it will be so little affected as to be curable Using the preparation known as infundin, B. SACKS,2 in 1924, found that a small but disin a very short time. "
1 Brit. Jour. Vener. Dis. 1934, x., 1.
1 Amen Jour. Med. Sci., 1933, clxxxvi., 854. 2 Heart, 1924, xi., 353.
’
1123
ownership, and which under skilled management will provide a useful half-way house between slum conditions as they exist and the new cheap dwellings. One of the most interesting paragraphs,
THE LANCET LONDON:SATURDAY, MAY 26, 1934
A NATIONAL HOUSING PLAN A "Housing Commission" to take charge of the administrative and executive functions of the Ministry of Health in relation to housing is recommended in the interim report1 of an unofficial committee sitting under the chairmanship of Lord AMULREE. The Committee lays down the proposition as fundamental that "the provision of housing accommodation, not below a minimum standard, for every family in the United Kingdom, should be accepted as a public responsibility and a national service, as the provision of a pure water-supply or a minimum standard of education has been accepted," with the obvious corollary that the rents must be within the means of the lowest paid wage-earners. This is a proposition which the public opinion of the country may be said to have definitely approved, and there will be general acceptance of the Committee’s view that the object of policy must be to provide within the next ten years, in addition to houses needed to replace slum dwellings, at least a million new houses to be let at rentals (inclusive of rates) of 10s. a week and under. Only in this way is the overcrowding, which is the root-cause of slums, likely to be overcome. Nothing less than long-term planning on a national scale, however, would suffice to overtake such a programme, and the prospects of success would be brighter if it were found possible to take housing right outside party politics. With a view to securing continuity of policy, able to survive changes of Government, the proposed Housing Commission would be set up with a fulltime, independent, non-party chairman, and would be endowed with national scope and status after the model of the Central Electricity Board. One of its duties would be to stimulate the formation of public utility societies in suitable cases and to carry out the recommendation of the Moyne Committee with regard to a central public utility council and the wide adoption of educative
management. It is clear that the authors of this interim
report recognise the urgent need for the further housing legislation at present under consideration by the Government, including large scale acquisi-
tion of semi-slum overcrowded properties which are to be transferred to public or semi-public 1
Obtainable from the Honorary Secretary, National Housing 5 Duke-street, Adelphi, London, W.C.
Committee,
which concerns finance, will be read with relief by many people who, profoundly impressed and depressed as they are by the national evil of the slums and of overcrowding, have felt that the way to reform is blocked by the magnitude of the sums involved in any comprehensive plan of reform. It is suggested that the Housing Commission should have power to issue a National Housing Stock, carrying a full Government guarantee ; as long as such stock can be issued on a 31 per cent. basis, which is at present the case, it is pointed out that " the rents of minimum standard houses can be reduced to such a figure as to bring the economic rent within the ability to pay of the wage-earner in all but exceptional classes of cases." For a million new houses a capital sum of 400,000,000 would be ample, and of this not more than 60,000,000 would be required in any one year, and the issue of National Housing Stock on this scale should not adversely affect the gilt edged market. It can hardly be doubted that a building programme on the scale indicated would be one of the most constructive ways of dealing with unemployment, for over 80 per cent. of building costs, apart from site values, go directly or indirectly into wages. It does not seem likely that any liability would fall on the Exchequer, but even if a proportion of 16,000,000 a year did become a burden on the taxpayer it would be a small price to pay for the national benefits to be secured from the realisation of a housing programme on this scale. The Housing Commission would not itself be the owner or manager of any houses, ownership of all houses built under the national programme being vested either in the local authorities or in public utility societies. One of the most difficult aspects of the whole matter lies in the nature of the relationship between the Commission on the one hand and the local authorities on the other ; the report states merely that the Commission will work in full cooperation with the local authorities. It is to be hoped that in their final report the Committee will work out in some detail this part of their plan, because therein lies the real crux of the problem, and no plan will command general acceptance which does not afford assurance of smooth working.
TREATMENT OF CONGENITAL SYPHILIS THE treatment of syphilis varies widely from country to country and from clinic to clinic, and any attempt to arrive at standards which the
practitioner may have in mind in the care of his particular case is to be welcomed. Such an attempt was made, for congenital syphilis, by Dr. DAVID NABARRO at a recent meeting of the Medical Society for the Study of Venereal Diseases, of which he is president. A series of questions, intended to crystallise the discussion, had been circulated to the members, and these questions in
1124
themselves indicated- the difficulty of choosing the PITUITARY EXTRACT AND BLOOD PRESSURE ideal scheme. Several - important points were OLIVER and ScHAFEB in 1895 reported that the nevertheless broughtout in the discussion.l In blood pressure of anaesthetised animals rises on - the first place none of the speakers was satisfied to rely solely on the time-honoured mercury in injection of extracts of the pituitary gland, and - the treatment of congenital syphilis. It was later it was shown that this effect is due to an which is obtainable from the agreed that although the symptoms may clear up active principle or portion pars nervosa though formed, quite readily under its influence, the improvement posterior The effect of is often followed by relapse, both clinical and it is said, in the pars intermedia. has now been this on the blood , principle pressure serological. Of single drugs the best on the whole man and animals, by many both in investigated, are arsenobenzol derivatives which may be given either intravenously or intramuscularly. Very. workers. In man it seems to have no constant some observers reporting a rise of good results can be got with these, but their influence, and others a fall, after subcutaneous or effect is quicker and more lasting if they are used pressure, intravenous injections. The conflict of evidence, in conjunction with (or alternating -with) bismuth, does seem to be reflected in any preferably in the form of bismuth oxychloride. however, doubt not about its clinical efficacy. As This combination has very efficacious and general proved toxic effects are rare in infants and children. W. M. MOFFATT1 points out. the statement appears Dr. NABARRO also mentioned cases treated with in the latest edition of "New and Non-official arsenic by mouth in the form of Orasan or Remedies " that the " intravenous or subcutaneous Stovarsol, and was able to report good results, injections of preparations of the posterior lobe followed by an increase of blood pressure although- not yet prepared- to describe them as are which is maintained over a considerable period " ; cures. -Should this method prove adequate there and manufacturers of these preparations often is no -doubt that in many centres it will soon recommend their use in cases of hypotension and replace treatment by injection, as it seems to have shock with the object of raising the pressure. - done already in some continental clinics. The main disadvantage is that this remedy, like Similarly they suggest that the drug should be withheld where hypertension is already present. mercury inunctions, is administered by the parent In his own experience, MOFFATT finds no ground and may not reach its. destination in exactly the for supposing that pituitary extract ever causes quantities prescribed ; whereas injection of drugs blood pressure to remain at a high level for a at a clinic ensures that they will do so. considerable " period. In the investigation The question how much treatment is necessary his described in he gave intramuscular is in is paper for cure debate. Dr. NABARRO still pre1 of c.cm. of obstetrical pituitrin to pared to give the minimum necessary to render the injections to 56 62 in from 8 age years, with persons ranging patient free from symptoms and serologically initial between 82 and systolic pressures varying negative, provided he is certain of being able to 218 mm. and diastolic of 58 to 110. Hg pressures keep the case under observation several times a at for an were observed intervals frequent year, at least until puberty. If this is not possible They hour the and constant alteraafter no it is advisable, he thinks, to continue treatment injection, tions in the blood for at leasttwo pressure were found. In many vigorously years, irrespective was little or no change ; in a few there the clinical It also out condition. was patients of pointed in the discussion that it is wise to be guided by a there were conspicuous changes in pressure, but precipitation reaction of the blood, such as the more often a fall than a rise. Over the hour of Kahn, rather than by the Wassermann reaction, observation the general trend of the pressure, which usually becomes negative first. A routine after an initial temporary rise, was downward. examination of the cerebro-spinal fluid is highly This downward trend was characterised by a fall desirable in all cases, whether they exhibit nervous of the systolic rather than of the diastolic pressymptoms or not. Those with a positive C.S.F. sure, and consequently a slight constant decrease reaction should be treated with Tryparsamide of the pulse pressure was observed. In general intravenously and bismuth intramuscularly, and it was found that the higher the initial systolic if this is done only the more severe ones will require pressure the greater was the fall following the malariotherapy. The late Dr. DAVID LEES reported injection of pituitrin, which suggests that the excellent results with this routine, and also favour- drug is not necessarily contra-indicated in cases In this connexion MOFFATT able results in about 30 per cent. of juvenile general of hypertension. raises the with malaria. question whether in his cases arterioparalysis cases treated sclerotic changes were more extensive in the peri. Finally it cannot be pointed out too often than in the coronary vessels. If so, the that the ideal approach to the problems of con- pheral constriction would be genital syphilis is by way of prevention-by greater in theproduced bythanpituitrin in the peripheral detecting the syphilitic mothers and treating them vessels, and hecoronary this as a possible propounds this means each pregnancy. By adequately during it can be made almost certain that the child will explanation of the greater fall of pressure in be free from the disease at birth ; or if not entirely hypertensive cases. free that it will be so little affected as to be curable Using the preparation known as infundin, B. SACKS,2 in 1924, found that a small but disin a very short time. "
1 Brit. Jour. Vener. Dis. 1934, x., 1.
1 Amen Jour. Med. Sci., 1933, clxxxvi., 854. 2 Heart, 1924, xi., 353.
’