being tested. The material usually employed is after the formula of Metchnikoff. The tubes are on sale in drug stores.
Self-disinfection in Women. All authorities are agreed that self -disinfection in women under most circumstances is not likely to be attended by the same satisfactory results as in men, on account of the different anatomical construction of the genital organs. Dr. Morna Rawlins and Lady Barrett, in giving evidence before the Birth-Rate Commission in England, said that they would not recommend its use for several reasons. It would be employed for contraconception, and if the permanganate solution were used it might lead to the spread of the infection to the uterus. Sir Archdall Reid in his book discusses the subject, and refers to the opinion of Miss Ettie Rout, who was for years in France with the New Zealand and Australian forces. Although Miss Rout was not a doctor she had an extraordinary experience and knowledge of the subject. She points out that there is far more danger to women in outdoor relationships than in indoor relationships, and she supports this statement by the fact that the weekly average of soldiers infected was doubled and after- wards still further increased when the licensed houses in Havre were put out of bounds in April 1918, simply because immediate self -disinfection was not available to the women (or to the men) and they were not under medical supervision. Similarly in Amiens, Abbeville and other places, the amount of disease increased for the same reason. In her evidence before the Committee of the Birth-Rate Commission sh6 stated that a weak permanganate solution was in use at the St. Louis Hospital, Paris.
Syphilis and Pregnancy. Dr. Amand Routh, who has made a special study of this subject, estimates that at least 20% of the ante-natal and neo-natal deaths are due to congenital syphilis. Experience shows that treatment of the mother is very satis- factory, for she can be cured and the offspring prevented from becoming congenital syphilitics.
Modern Curative Treatment. Sufficient time has now elapsed since Ehrlich's great discovery of the arseno-benzol compound known as salvarsan or " 606 " to appraise the value of this drug or its equivalents in the treatment of syphilis. It was at first believed that it would entirely replace the old mercurial treat- ment, but the greatest success has been attended by a combina- tion of the two. Numerous other arseno-benzol compounds of a similar nature to the original " 606 " have since been introduced, and, although it is generally considered that they have not such a powerful influence on the disease, yet neo-salvarsan or its equiv- alent preparations are now almost universally employed, be- cause the technique of administration is so much simpler. When salvarsan was introduced, a misapprehension of its curative effect arose in the mind of the public and many members of the pro- fession; for it was believed that a few intravenous injections of the drug would suffice to effect a cure, and this might seem probable if, in conjunction with the patient showing no active symptoms, the blood previously positive in its reaction became negative. Under such circumstances the patient believed, and sometimes was led to believe, that no further treatment was necessary. Experience has shown that not infrequently serious consequences were the result. Therefore most authorities recom- mend what is termed " intensive treatment," namely a course of intravenous and intramuscular injection of an arseno-benzol compound combined with mercury in the form of intramuscular injections or inunctions. Periodic courses extending over two years are required. The Wassermann reaction, of the blood is taken before treatment is commenced and the strength of com- plement fixation estimated before and after each course of treat- ment. The curative effects of the drug can thus in a measure be estimated. For ill-effects of salvarsan treatment and standards of cure, see pp. 114-5, Annual Report of the Chief Medical Officer of Ministry of Health, 1920. It will be observed that of 193,411 persons dealt with during 1910-20 there were 59,328 who ceased to attend before completing a course of treatment. Many of these were still infective.
Evidence given before the British Royal Commission showed that energetic " intensive treatment " employed in the primary stage before the Wassermann reaction was positive and there-
fore the spirochaete had become generalized in the body, had led to a complete cure in a number of cases. This was shown by the fact that although the spirochaete of syphilis had been found in the sore yet the Wassermann reaction was negative and re- mained so. A still more convincing proof of cure, in such cases, was the fact that re-infection has been known to occur. It is necessary to state that, owing to faulty technique and short cuts in performing the Wassermann reaction, cases have been reported as negative by one observer and positive by another. In some of these cases the patients were obviously suffering from disease, the result of a previous infection, in others there was no clinical sign. The Commission rightly laid stress upon the necessity of employing a standardized method to avoid error and thus avert very serious consequences, medical and medicolcgal. Most authorities lay more stress upon the examination of the cerebro- spinal fluid than the blood in diseases of the nervous system, presumably of syphilitic origin, as a means of diagnosis. Ex- perience shows that many persons may be in good health or at any rate not suffering from any obvious clinical syphilitic disease, and yet give a positive Wassermann reaction of the blood, for the organism may be locked up in some functionally indifferent tissue, but a positive reaction of the fluid shows that the spirochaete is in the central nervous system and if it is not causing any clinically recognizable symptoms there is a positive danger that it may at any time do so. When once the cerebro- spinal fluid is found to give a positive Wassermann reaction it is doubtful whether any treatment will make it negative. This fact shows how extremely difficult it is for the drug to attack the organism when once it has gained access to the substance of the central nervous system. It was for this reason that Swift and Ellis introduced the treatment of general paralysis and tabes by spinal intrathecal injections of salvarsanized serum; but it was found to have no advantages over the usual methods of treatment, and only a few authorities now employ it and claim successful results.
All those who have had experience in the prevention and treatment of venereal disease consider gonorrhoea and its com- plications the most difficult to deal with. It is not implied there- fore that the effects of gonorrhoea are so serious as syphilis, but owing to the fact that the organism when it has invaded the deeper structures is not easily eradicated, a patient thinking himself cured, because he suffers no pain, may unwittingly infect his wife or other women. As there are immense numbers of these carriers it is easily seen how difficult is the problem of prevention of gonorrhoea; and this difficulty is greatly increased by the fact that this disease is not looked upon as serious; whereas all the evidence given before the Royal Commission showed that many serious diseases especially affecting women were due to gonor- rhoeal infection. It is a frequent cause of disease of the repro- ductive organs, and sterility is a result. Its ill-effect upon the health and happiness of the nation is far greater than is generally imagined. If the complex medical and social problem involved in venereal infection is to be dealt with nationally on sound lines it is essential that the full confidence and support of the public must be obtained. This can only be done by getting the people, as the late Sir William Osier said: " to realize that it is a great communicable disease, many of whose victims are innocent."
The following works may be consulted for further information: System of Syphilis (Oxford Press) ; The Report of the Royal Com- mission on Venereal Disease with appendices (1916) ; Report on the Prevention of Venereal Disease by the Special Committee of the Birth-Rate Commission; Manual of Military Urology (American Red Cross Association) ; Medical Science, abstracts and reviews, published by the Council of Medical Research (vols. i. and ii.)l Sir William Osier, " The Campaign against Syphilis," Lancet May 26 1917; Sir Archdall Reid, The Prevention of Venereal Disease; Reports of the Public Health Service, U.S.A., 1920; Report of the Chief Medical Officer of the Ministry of Health, 1920. (F. W. Mo.)
VENEZUELA (see 27.988). The permanent additions made to the population of Venezuela by immigration during 1910-20 were slight. The official year book for 1912 stated that the total number of persons arriving at Venezuelan ports in that year was 9,615, while the total departures were 7,981. It gave the approximate pop. of the republic as 2,632,754.
