ROYAL COMMISSION ON VENEREAL DISEASE.

White Ribbon, Volume 21, Issue 242, 18 August 1915, Page 9

ROYAL COMMISSION ON VENEREAL DISEASE.

Towards the end of 1913 a Royal Commission was appointed in England to enquire into the best means of dealing with venereal diseases with a view to their diminution. Its labours extended through a great part of the following year. The sittings were private, but brief summaries of the proceedings were supplied to the press, and from these we can glean a good indication of the trend of opinion. Up to the issue of last evidence 27 witnesses had been examined, most of them were medical men, and included three from the Medical ArmyCorps, two from the Naval Medical Service, two from the Society of Medical Officers of Health, two nurses; while three were statistical from tie* offices of the Registrar-General. We are glad to note that there is no desire on the part of these eminent men “to return to the policy or provisions of the C D. Acts,” and it is interesting to note the unanimity with which they recommend free treatment and education as the best means of combating these diseases.

Not one witness was in favour of notifying them as other infections are notified. Iwo favoured notification under careful restrictions and safeguards, two inclined to notification of certain forms of congenital disease, but the very large majority was absolutely opposed to notification, holding that it would prevent consultation in the c.irly whep the disease is most infective and most easily treated. We give extracts from the evidence of these eminent men, and they ought to strengthen our l nions in their demand for free treatment and education, and in their opposition to compulsory measures which would have the effect of re introducing all the horrors of the C.D. Acts. Ihe Report of Recommendations of this Royal Commission are being eagerly watched for. TREATMENT AND EDUCATION. (Dec., 1913, Ninth Sitting). Mr J. Ernest Lane, F.R.C.S., Senior Surgeon of St. Mary’s Hospital, and of the London Lock Hospital, and himself a member of the Royal Commission, laid stress on the necessity for improved and free hospital treatment, and said that every patient suffering from any form of venereal disease ought to be entitled to gratuitous treatment and medicine, and to bacterealogical and other tests. If it is desired to cure syphilis, anything that w >uld aid early diagnosis ought to be at a patient’s disposal without expense to him. On the subject of notification Mr Lane said that though he had formerly been in favour of notifying .ill cases of venereal disease to the sanitary authority he had now modified his view because he was convinced that notification wcu'd deter sufferers from seeking proper advice, and would lead to increased recourse to quack treatment. 11th Silting, January, 1914. Lieutenant Colonel T. \V. Gibbard, of the Royal Army Medical Corps, head of the Rochester Row Royal Military Hospital, said that the most important causes of the decrease of venereal disease in the army were the improved treatment and the instruction of the men by lectures and individual talks, greater temperance as regards alcohol, increased attractions of barracks, and the greater encouragement given to sports and outdoor games. The problem of the preven-

tion of the spread of venereal diseas es in the civil population could best be attacked by providing early diagnosis and treatment, by enlightening the public regarding the diseases by lectures, etc., and by promoting tempi ran e. Karlv diagnosis and treatment were of the greatest importance, and to provide for them it was necessary that arrangements should be made whereby microscopic examinations ar d blood tests could be carried out free of charge to private practitioners and patients. He was of opinion that special hospitals were not to be recommended; every general hospital should provide a certain number of beds for thi* treatment of these diseases, ar.d these beds should be in general wards. An out-patients’ department should also be organised so as to give patients every facility for early diagnosis and treatment, and the department (which should not be called venereal) should be kept open at hours suitable to the working classes. Colonel Gibbard thought that com* pulsory notification was most unde* sirable as it would, lead to conceal* ment of the disease. On the subject of education respecting venereal diseases he thought there would be advantage in lectures being given at all large factories by selected medical men (and women where the employees were women). 12th Sitting, January, 1914. Dr J. Kerr Love, Aural Surgeon to the Royal Infirmary, Glasgow, gave statistics relating to deafness due to syphilis. He held that treatment should be placed within the reach of all. lie was not in favour of compulsory and universal notification of venereal disease, but favoured notification of certain conditions which are often due to congenital syphilis. 15th Sitting, February, 1„14.

Evidence was given by Dr Helen Wilson, Hon. Sec. of the British Branch of the International Federation for the Abolition of State Regulation of Vice.

Dr Wilson said it was now generally recognised that it was quite futile to attempt for venereal diseases such isolation as was practised in regard to acute infectious diseases, the main reason being that in a large proportion of cases venereal diseases did not prevent the sufferer from following the ordinary avocation, and they were easily concealed, and there were strong motives for concealment.

The object to be aimed at were, firstly, to bring every sufferer under efficient treatment at the earliest possible moment, thereby shortening the infective period, and second, to secure his own intelligent co-operation, both for his own cure and that of his associates. She did not think ccmpulsory notification would ever be a material help in diminishing these diseases; but that any attempt to deal with them otherwise than on voluntary lines would create opposition. If voluntary methods were given a fair and intelligent trial, she was convinced that the residuum of cases would be comparatively small, and that probably means could be found for dealing with them. * Dr Wilson thought the hard and fast line which, has been drawn between these diseases and all others should be abolished, and the nursing and all other arrangements should be as good in the-wards'for the treatment of these diseases as in any others. Names like “Lock” and “Magdalene” for special wards or hospitals had a deterrent effect and should be avoided. She laid stress on the importance of providing night clinics for out patients. Dr Wilson was of opinion that further instruction was needed for medical students and nurses, and that education of the general public in matters of sex hygiene was of the highest importance. She doubted whether it would be wise to introduce systematic class instruction in elementary schools. In some schools in America the plan had been tried of inducing mothers to come ar.d hear about the subject in the first place, and afterwards of beginning a course of lessons to the girls, the mothers being invited to be present the whole time. Dr. Wilson considered this arrangement an admirable one as helping to secure what was most wanted, that the girls should be in n position to speak frankly to their mothers in private about the subject. 18th Bittlng. Sir Thos. Barlow, Bart., R.C.V.0., President of the Royal College of Physicians, dealt first with the importance of syphilis and its effects as a hindrance to the birth-rate and to healthy development. He thought there was a general improvement in the morality of the population, and that the higher standard obtained ought in time to produce less preva-

lance of these diseases. lie was of opinion that special education or instruction on these subjects was very desirable. It might begin possibly in the University period. More generally he thought that instruction should be given directly young people were sent to work. In any educational measures he would urge that medical practitioners, and, if possible, family doctors, should be the backbone of the organisation. H« was was no? In favour of compulsory notification of venereal diseases, and it was his opinion that there was much more to hope for from general enlightenment and education. Apart from education, he considered that what was required v;as the provision for facilities for effective and complete treatment in the early stages, and the improvement of those facilities to the utmost. 19th Sitting. Dr. Carl Borning, Director of Clinical Pathology and Lecturer in the Glasgow' l T niversity, advocated free treatment to secure the earliest diagnosis of these diseases. He was opposed to notification of venereal disease, because he feared that It mlghl deter people from coming for treatment. He was inclined to agree with Dr. Kerr Lane that some of the manifestations of congenital syphilis might with advantage be made notifiable.

21st Sitting. Dr. Brian O’Brien, Medical Inspector for the Local Government Board for Ireland, gave evidence regarding conditions in Ireland. He was op* posed to the notification of venereal disease. He did not think the medical profession would be willing to notify, and if they did fewer people would go to them for treatment. Mr D’Arcy Power, Surgeon and Lecturer on Surgery at St. Bartholomew’s Hospital, and one of the representatives before the Commission of the Royal College of Surgeons and the Royal Society of Medicine, said that from the surgeon’s point of view he looked upon gonorrhoea as the more serious disease for the individual, and syphilis for the race. He • advocated better instruction for medical students, and the establishment of special departments at each general hospital for the treatment of these diseases, which should be free. Successful treatment of syphilis depended on early diagnosis, and prolonged

attendance. The expense would be~ but he thought the State would be more than repaid by results. He was not In favour of notification of venereal diseases, at any rate not for the present. v . v vfk.* v , 1 23rd Sitting. The Honourable Alhinia Brodrick, jCfipresenting the Irish Association and * the National Council of Trained Nurses of Great Britain and Ireland, dealt With the importance of educate ,w ith regard to venereal disease, and the importance of a special course of instruction for nurses. The education of the general public should include the education of children in the laws of sex. This might be done in the primary school through the medium of botany, and this would prepare the way for teaching at a later stage regarding the human subject. Special teachers would be required. A great factor in the spread of these diseases was the ignorance in which women have designedly been kypt in regard to them. She condemned the practice of the medical profession of treating women without allowing them to know the nature of the disease. She thought greater facilities for treatment should be provided, including evening clinics, and that in the case of women especially the disease should be stated openly, and the results to the offspring clearly pointed out. She recommended notification of venereal diseases, confidentially, at present, but later on as in the case of other infectious diseases.* 24th Sitting. Dr. Armand Routte, Consulting Physician to the Charing Cross Hospital and the Samaritan Free Hospital for Women and Children, gave evidence relating to the effects of this disease on the birth of children. H® was not in favour of compulsory notification of venereal diseases, for many men and most women would not consul a doctor, but wouM either remain untreated or consult venereal quacks. Dr. Chalmers, Medical Officer of Health for Glasgow, and Dr. Parkes, Medical Officer of Health for Chelsea, representing their Society, were agreed that compulsory notification w'ould defeat the ob ert in view, early diagnosis . *nd tarly treatment. Speaking for their Society, they would empower all local authorities to offer full facilities for treatment

for any person applying therefor, whether resident or not within the district of such local authority. —From “The Shield,” April, 1914.

A Few of the Measures Being Taken for the Reduction of Venereal Disease. England is not waiting for the report of the Royal Commission before taking active steps to combat the inroads of venereal disease. The London Hospital intends to build a wellequipped wing for the modern treatment of syphilis. The Grocers’ Company have offered the ,£IO,OOO needed to build this department. Its upkeep will require some £2OOO a year At Glasgow the Corporation has undertaken to apply the Wassermann test to samples of blood sent them by doctors within the city boundaries. No doctor required to give any name or indication of the patient. A similar arrangement is being introduced at Wimbledon.

The Sheffield Infirmary has established an evening clinic for the treatment of venereal disease. Four beds have been set apart lot venereal patients, and efforts are being made to admit such for week-end treatment, so as not to interfere with theii work. These facilities are only for men, presumably because so manymore men than women are affected, but it seems a pity that women cannot have like facilities. The Sheffield University is arranging a course of post-graduate cturcs on venereal disease. The ! ondon Lock Hospital has had an evening clinic for v.mc time, and has just announced .* post-graduate course of lectures. Glasgow- University has established a Lectureship on Venereology, the .'.rst of its kind, we believe, in Britain.

The Health announces lectures on the subject, some of a technical character for doctors, and others more general for the ordinary public. The March (1Q14) number of the Institute’s organ, “The Journal of State Medicine,” has a remarkable article on Sexual Disease and the Individual; an International Problem, by A. Corbett Smith. It concludes with the assertion, “The solution of the problem lies in the education of the individual.”