There are many facts which show that there has been, in
consequence of the war, and in spite of the application of the
measures recommended by the Royal Commission, a very
considerable increase in the prevalence of venereal diseases in
the United Kingdom (see evidence by Dr. Sequeira, Miss Ettie
Rout and others in the report of the Committee of the Birth-
Rate Commission).
Table i, taken from the Annual Report of the Chief Medical Officer of the Ministry of Health for 1920, indicates the extent to which the clinics were utilized in 1920. From this table it
TABLE I. Experience of British Clinics, 1920.
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Number of persons dealt with for the
b
"o
a
first time.
^8
'o'
CO
0.2 c a
9
O
J-> U
a
8
Q
c
5X
b c
gi
3"O
2 O <
c u o u
1*3
J3
y
"Q
E ui >*
c
Q.
<8j|
o c
"3
l>
rt rt
2<
30
Z'c
W
U
o
O
H
O
H
H-o
8
1917
29,036
204,692
113
1918
26,912
806
17,635
45,353
6,622
51.975
488,137
134
1919
42,134
2,164
38,499
82,797
15,447
98,244
1,002,791
160
1920
42,805
2,442
40,284
85.53 1
19,654
I".S,I,S
1,488,514
190
appears: (a) that in the fourth year of the scheme there were approximately 85,00x3 cases of venereal disease and 19,000 cases which proved not to be venereal disease, the total number of new cases being 105,000 and the attendances 1,488,000; (6) that there was a rapid increase of " new " cases of venereal disease in 1918 and 1919 and a stationary position in 1920. The term " new cases " can only be relative, and does not afford a basis for calculations of incidence; (c) that if the army estimate of the relative frequency of gonorrhoea and other venereal diseases (2$ to i) be correct for the civil community, only a small propor- tion of the cases of gonorrhoea in the country came under treat- ment at the clinics; (d) that the total attendances (and the ratio of attendances to patients) had increased greatly, and that the number of persons who were apprehensive of their condition and who came to the clinics for diagnosis had increased two facts which suggest that the clinics were better appreciated.
The total expenditure of British local authorities was 116,000 in 1917-8, 214,000 in 1918-0, 287,000 in 1910-20; towards which the Ministry of Health provided grants of 84,000, 145,232, and 224,716.
Owing probably to financial reasons and inefficiency of some of the clinics there were indications of a change of policy by the Ministry of Health, for in the above-mentioned report it was stated:
" It cannot be too clearly understood that the best way of dealing with most cases of these diseases is through the skilful private prac- titioner. For a substantial portion of this problem the public clinic should be looked upon as a temporary organization pending the time when the practitioner is ready, available, competent, and properly equipped to undertake effective treatment. Certain patients re- quire hospital treatment, but the authority should not needlessly establish institutions if and when the ordinary channels of medical practice are available and reliable, or can be made so." . . . .
" I am bound to advise that if the work of these clinics is not properly done if it is casual, superficial or perfunctory they should be disapproved by the Ministry. It is better to have only a few clinics well-organized and scientifically controlled than a large number which are not thus administered. These statements indicative of a change of policy in the future may find an explanation in a study of the statistics (see Table 2) relating to the number of patients dis- charged from venereal disease centres as having completed treat- ment. This table shows that 29 % of syphilitics and 33 % of persons suffering from gonorrhoea ceased to attend before completing a course of treatment. Nearly three times as many as those who were discharged after completion of treatment and observation and accordingly can be definitely tabulated as cured and non-infective. These facts seem to show the necessity of adopting some disciplinary measures to combat the evil, such as exist in the United States."
Prevention. Sir Archdall Reid, in his work on the prevention of venereal disease, complains that no reference was made in the report of the Royal Commission of the value of Metchnikoff' s discovery. The National Council strenuously opposed what they termed " the packet system " but the facts had to be faced.
TABLE 2. Patients at British Treatment-Centres.
Syph-
ilis
Gonor- rhoea
Total
(l) Number of persons dealt with dur-
ing 1919 and 1920 (2) Number of persons who ceased to
105,619
87,792
193,4"
attend :
(a) before completing a course of
treatment .... (6) after completion of a course of
30,459
28,869
59,328
treatment, but before final
tests as to cure (3) Number of persons discharged after
9-35
6,481
15,831
completion of treatment and
observation (4) Number of persons who on the ist
8,240
13,300
21,540
of Jan. 1921 were under treat-
ment or observation
47,894
28,822
76,716
Early curative treatment and moral suasion by propaganda and lectures had not effected the purpose which most of the members of the Royal Commission believed and desired they would. Sir Bryan Donkin, in a letter to The Times in Jan. 1917, first called attention to the necessity of the adoption of immediate self- disinfection in accordance with the discovery of Metchnikoff. He cited the remarkable success attending the simple measures of immediate self-disinfection adopted at Portsmouth by Sir Archdall Reid. Reid states in his book that one in 1,000 solu- tion of permanganate of potash, carried in a flat screw-stoppered bottle with a swab of cotton wool, proved a simple and cheap means by which he obtained successful results. The directions were that the soldier should immediately after exposure to infection thoroughly swab the exposed surfaces with the fluid; and he states on p. 130: " Immediately venereal disease vanished from my units. For six months not a single case occurred. In two years and four months, during which quite 20,000 men must have passed through my hands, only seven men were infected. Of the seven cases, six of gonorrhoea and one of syphilis, all could be accounted for by drink or negligence."
A controversy as to the right or wrong of such treatment thus arose which eventuated in a number of eminent medical men leaving the National Council for Combating Venereal Diseases to form the Society for the Prevention of Venereal Disease by immediate self-disinfection. While not discouraging continuance of efforts by moral persuasion, athletics, education and early curative treatment, this Society realized that immediate self- disinfection either by calomel cream or permanganate solution, was essential supplement to the before-mentioned measures; recognizing as the members of this Society do, that a large proportion of the adult population are not, and in our present social conditions, cannot or will not remain continent. It may be assumed that both the societies are animated with the same desire, and it was hoped that by the establishment of a special committee of the Birth-Rate Commission in June 1920, in order to take expert evidence on the value of the various measures for the prevention of venereal diseases, unanimity on the part of the two societies might arise. A report on " The prevention of venereal disease " by this Committee was issued in Feb. 1921. The report states (p. 21): " The Committee is of opinion that any administrative or legal difficulties that may at present prevent individuals, who desire to do so, from purchasing such disinfectants from chemists, on their own initiative as a pro- tection against venereal disease should be removed; and that the section of the Act dealing with this matter should be rendered more explicit and amended if necessary; " but up to June 1921 no result had been achieved as regards action by the Government or by way of settling the essential point of difference between the two societies.
The supporters of the S.P.V.D. maintain that if 183 curative treatment centres (which cost the State 300,000 in 1920) are necessary, a similar number of prophylactic centres are more necessary. Now the National Council advised the Government to establish what they call Early Ablution Centres where skilled but delayed disinfection would be carried out. There are so many obvious defects in this system when applied to the civil
