VARICOCELE AND THE PUBLIC SERVICES.

VARICOCELE AND THE PUBLIC SERVICES.

1030 by rights appertained to the Association Générale de and could not, prevent the destruction wrought by the a purely benefit society, and has a v...

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1030

by rights appertained to the Association Générale de and could not, prevent the destruction wrought by the a purely benefit society, and has a very large waters, nor the poverty, the mental strain, and anxiety that membership ; but like these old-established institutions it is such a disaster must occasion. The danger that a widespread slow to move. It has its routine system of assisting the epidemic would ensue has been met and, there is every widows of medical men and various cases of exceptional reason to anticipate, successfully warded off. But there may distress among members of the profession, but it is too be an increased sick-rate and death-rate from ordinary ponderous a body to be able to move in response to a sudden, causes due to the weakening, the depressing effects of the unexpected emergency. The fighting unions alone had the trouble which has befallen so many people. The vital youth and energy necessary to rise to the occasion. The statistics of the inundated districts during the next few floods came just as the annual bills had been sent in by most years will be of special interest, but with the early advent of of the practitioners, and the greater part of the work they did the spring and summer sun to complete the process of drying last year has not been paid for, and some of it never will be. the houses we must hope that but little further harm will It will add to the distress in some of these outlying districts accrue. that several practitioners have determined to leave, but they cannot afford to remain in a place where all the likely clients VARICOCELE AND THE PUBLIC SERVICES. have been ruined. I make no attempt to describe the varying conditions in (BY A SPECIAL CORRESPONDENT.) relief

France, for it is

the suburbs affected, but the district within that loop of the Marne which encircles the commune of St. Maur was the IN a leading article in THE LANCET of March 26th subject of interesting treatment. Here the mayor at once (pp. 869-870) a plea was put forward that "varicocele should divided his commune into 16 sub-districts, and appointed a not of itself be a cause of rejection of candidates for the committee for each of these divisions consisting of at Services who are otherwise suitable, and candidates should least one medical man, one architect, and one municipal never be advised or required to submit themselves to operaThe mission of these committee men was tion for its cure." With regard to the first part of this councillor. to see that the instructions issued by the Paris police plea, it may not be generally known that quite a number of were duly carried out. They therefore had to visit every recruits are rejected annually for the army on first inspection house and report if it had been disinfected, and see if it was as suffering from varicocele. The accompanying table, properly disinfected. Only after this had been done did they give the necessary written sanction allowing the owners or occupiers to re-inhabit the houses examined. Disinfectants were provided gratuitously at the town hall, and chemists came from Paris to help. Practically no resistance was offered, though at least a quarter of the houses were flooded. The loop of the river Marne is very pretty at this point, and the inhabitants seek to live near to the water’s edge. Altogether there are seven miles of river front, and naturally the villas close to the water were flooded. There are no extreme poor here, and much of the furniture was too good to be destroyed. This was particularly the case in regard to the wool and horsehair or spring mattresses. Fortunately, behind the town hall there happened to be an unoccupied factory, and here 2800 mattresses were disinfected. The owners had to throw buckets of water upon the mattresses, and scrub and wash the outside. Then a municipal service of carts came to fetch the mattresses and placed Here there them in one of the rooms of the empty factory. were large brasseros, like those which are lighted on the terraces of cafes so that customers may sit out in the open air during compiled from the official returns of the last ten years cold winter months. When the mattresses were dried they issued to Parliament by the Secretary of State for War, were taken to another compartment which had been rendered shows very plainly the importance of the questions which airtight and 30 grammes of formalin per cubic metre of space have been raised. For instance, in the year 1904 out of 70,346 The mattresses were first partially recruits medically examined for the British army no less than were evaporated by hpat. unsewed so as to facilitate the penetration of the gas. After 1158 were rejected on first inspection as unfit from varibeing thus disinfected the mattresses were carried to a third cocele, giving a ratio per 1000 for this condition alone of In the ten years period between 1897 and 1906 room, where as many draughts as possible were created to free 16-46. them from odour. It was undoubtedly an excellent precau- of 712,309 recruits medically examined, 9524, or a ratio per tion to disinfect on so extensive a scale, for the whole district 1000 of 13-37, were rejected on first inspection, and 257, drains into cesspits. The older cesspits are not watertight, or a ratio of 0-36 per 1000, were rejected within and they caused no visible nuisance, but the contents of the three months of enlistment as medically unfit for the watertight cesspits came out for the most part in the flooded service as suffering from varicocele of sufficient degree gardens. Some of the one-storey houses had the water up to interfere materially with their proper performance to their roofs, others had four and five feet deep of water of military duty. In 1906 the army medical authorities, in the sitting-rooms. The fugitives went to the schools, apparently realising that the importance of varicocele had which were quickly converted into dormitories ; the greater been somewhat over-estimated in the past, began to take a part of the children were sent some distance away into the more lenient view of its presence. A definition of what country, where they were generally received as guests by they termed a"standard"for varicocele was formulated. people who were glad of an opportunity to render some In 1907, as a result of this standard, the rejections for the service. disability in otherwise suitable recruits became reduced to It will be seen from the above that the mayor of St. Maur 11-42 per 1000 of men inspected, and at the same time the acted with commendable energy and made good use of the ratio of discharges from the same cause within three months local facilities available. But the Government could not be of enlistment fell to 0-08 per 1000. These facts seem to certain that this would be the case in the 32 communes prove that the importance of the disability was formerly round and about Paris which had suffered from the floods. over-estimated. In 1908 there was also a slight diminution on Therefore special decrees were issued from Jan. 28th to in the number of rejections as compared with those that Feb. 16th by the sanitary departments of the Ministry occurred in 1906; the figures for 1909 are not at present of the Interior and of the Prefecture of Police bringing the available. The admission of soldiers with varicocele to the ranks authority of the Central Government to bear upon the local municipal or communal administration. Not only were of the army has, however, real difficulties. No defect the mayors told what should be done, but special inspectors is more useful to an unwilling soldier who wishes to evade his duty, especially a "fatigue " or a " route march," were appointed to watch over the local authorities and see He has only to report sick and comthat the instructions given by the Government and the than a varicocele. Prefecture of Police were duly carried out. Thus, it will be plain of pain in the region affected and be sent before a seen, very little was left to chance. This, however, will not, military medical officer, who cannot state definitely that the

1031 of does not exist, and must of necessity the Lord Mayor, Aldermen, and Citizens), between impale a the man performing the work allotted to him, as Sun in splendour and an Open Book proper leaved and otherwise an injustice may be inflicted. The mere size of a clasped Or, and inscribed with the wordsNisi Quia varicocele is very little guide as to the probability of the pain Dominus,’ and in fesse to the dexter a Dolphin embowed, being really there. Again, instances still occasionally occur and to the sinister a Horse courant, both of the third." in recruits in which the men plead the presence of a Beneath the shield, upon a scroll, is the motto Vim varicocele as rendering them unable to carry out their drills promovet insitam." and preliminary training gymnastics, &c., and refuse remedial Tropical Medicine. The University of Bristol has appointed Dr. A. J. M. operation. If such duties are excused or modified these men when they become trained soldiers fall back on this their Bentley to deliver a series of 12 lectures on tropical diseases old excuse and continually ask to be excused fatigues, and in the buildings of the Faculty of Medicine for senior if so excused an injustice is done to their comrades by students and qualified practitioners. In many respects increasing the proportion of the harder duties of the Bristol would be a good centre for the establishment of a For these reasons it seems worth considering, if tropical school, and possibly the response to the latter. present step recruits are to be passed into the Army suffering from may be of such a nature as to warrant further progress. varicocele, whether it would not be well to stipulate for Gloucestershire -Royal Infirmary and Eye Institution. their consent at a later date to operative treatment should The annual meeting of the subscribers to the Gloucesterit become necessary. This could only be done when acceptshire Royal Infirmary and Eye Institution was held on and of the fact their to it would recruits, ing agreeing under the presidency of Colonel Curtis prevent malingering. It may be noted in passing that there March 31st The medical report showed that during 1909 is a widespread belief amongst the classes of the popula- Hayward. tion from which recruits for the army are drawn that even a the in-patients numbered 1591, and 9051 out-patients were small varicocele produces impotence, and so a demand for treated, both of these numbers being in excess of any record. The financial statement showed the income operative treatment has been prominent in young men about previous amounted to £7024, the expenditure was R.7744, and the this account and not because the condition causes to enlist on deficit on the year’s working was £720. The chairman stated pain. any Coming next to consider the question of the pre- that with the object of increasing their income a league had valence of varicocele amongst serving soldiers the following been formed in order to bring the claims of the charity before statistics have been compiled from the official blue-books. the public. Adding together the average strengths of the European Somerset County Education Committee and the Eyesight of School Children. British troops of the regular army serving in all parts of the world, we find the army in 1907 consisted of 225,266 At the last meeting of the Somerset education committee men; of these, 118,429 were admitted to hospital during the it was decided, owing to the large number of children whose year for treatment, and of the latter 2635 were finally eyes had to be examined, to supplement the work of the invalided from the service. Of the admissions to hospital ophthalmic school medical officer (Dr. J. H. Bendle) by 214 were cases of varicocele, and of these but 2 were finally the appointment for three months of a qualified medical discharged from the army as unfit for service. The corre- assistant. The salary will be £100, in addition to travelling sponding figures for 1908 show that of an average strength and out-of-pocket expenses. of 223,774 European British troops of the Regular Army Didworthy Sanatorium, Devonshire. 121,388 were admitted to hospital ; of these, 2310 were The annual of the subscribers to this sanaeventually invalided, and of those admitted to hospital 311 torium was heldmeeting last week under the presidency of Dr. R. were treated for varicocele, of which 5 were finally discharged from the army as medically unfit. In 1908 out of 2797 Hogarth Clay. The medical report stated that during 1909 been treated. 102 patients were disout at all stations carried excluding India, 178 133 patients had operations the charged during year ; of this number 50 per cent. were were operations for the relief of varicocele. In India for the same year 38 cases of varicocele were operated on. As the " much improved," and 21 per cent." very much improved." effects of climate have been stated to favour the production The sanatorium has 35 beds, and the cost of three months’ Several beds are of varicocele it may be of interest to quote the proportionate treatment has now been fixed at &18. In 1907, of the 214 cases of maintained by local authorities at a cost of R.70 per annum. occurrence by commands. varicocele above noted, 139 occurred in the United Kingdom The committee urges the importance of sending incipient pulmonary tuberculosis, and states that during 1909 (average strength 118,521), of which 2 cases were finally cases 17ofcases were admitted in the earlier stage. The report invalided. Mediterranean Command, 10 cases out of an only states that the scheme of receiving certain patients for one average strength of 15,611 ; South Africa, 8 cases (average month for educational treatment has been continued. 50 cases

pain complained excuse

(average strength, 69,332). (average strength, 6328). In 1908 Royal Cornwall Infirmary, Truro. corresponding figures for the United Kingdom show 192 cases of The male patients of the Royal Cornwall Infirmary have a varicocele, of which 5 were finally discharged as unfit for army convalescent home provided for them at Perranporth but the service out of an average strength of 118,474 ; Mediterranean female patients have none. The want of a convalescent command 18 cases (average strength, 15,548) ; South Africa, home for the women has been much felt, and Mr. T. L. 7 cases (average strength, 14,075) ; India, 85 cases (average Dorrington has promised E1500 for the erection of a suitable strength, 68,522); and other commands 9 cases (average building. The committee of the infirmary thinks that the strength, ’1155). From consideration of these figures it home could be furnished for about R.200, and that the total appears that varicocele when it develops in serving soldiers annual expenditure would be about R.200. It has been decided causes but very little wastage, and if the crux of malingering to call a meeting shortly to consider the generous offer of be got over by making it understood that those who suffer Mr. Dorrington. from their varicoceles will have to be relieved by operation, Pro_posed University Settlement. there appears no valid reason why candidates for the ranks A committee has been formed, representing every faculty should per se be rejected for varicocele alone. In no case, and every type of University member, to promote the forhowever, where the condition is associated with varicose veins mation of a university settlement. In a circular note the of the legs or piles should it be lightly looked upon. committee states that the aims of such a settlement would be, first, to promote the general welfare of the neighbourhood in which it is situated; and, secondly, to provide a centre for BRISTOL AND THE WESTERN COUNTIES. the systematic study of social and industrial conditions. The committee is of opinion that the settlement should include a (FROM OUR OWN CORRESPONDENTS.) residence for women under a warden, with library, and

strength, 15,474) ; India, Other commands, 7

cases

Bristol: the Coat of Arms. A SKETCH of the design which has been prepared for the University coat of arms has been published. It combines the ship and castle of the City of Bristol with the arms of Colston, Wills, and Fry. The heraldic description is as follows :- " Argent on a Cross quadrant Gules, a representation of the Arms of the City of Bristol (with the consent of

University of

lecture- and club-rooms for both men and women workers. The increasing importance of training experts in social work is alluded to and the sympathy of students is asked for. The initial outlay would be about L1000 and the annual cost of maintenance about £300. No appeal has been made as yet, but R.220 have been promised towards the initial outlay, as well as some annual subscriptions.

April 5th.