154 



NATURE 



[A 



V. < J L' 7» i 



4. 1923 



health authority is on public education and public 

 co-operation for the effective control of any infectious 

 disease was well demon 'y the difficulties en- 



countered in dealing witli uu it. cat smallpox epidemic 

 at Gloucester, and yet smallpox is not usually a disease 

 easy of concealment, there is no transgression of social 

 standards implied in acquiring the disease, and it is of 

 limited duration. All these facts should make it easy 

 to control as contrasted with venereal diseases. In 

 the latter, concealment is further aided by there being 

 usually an absence of disablement from work ; indeed, 

 the symptoms may be so slight that the patient may be 

 ignorant of being infected. 



With these facts in mind, the conclusions of the com- 

 mittee on the question of notification of venereal 

 diseases will, we think, meet with approval by the 

 majority. The committee has reported against the 

 introduction of notification in any form, on the grounds 

 that as the disease can only become known to the 

 doctor by a voluntary act on the part of the patient, 

 concealment of disease is likely to follow notification, 

 and it would prove a backward step. A modified form 

 of notification, limited to those patients who, having 

 presented themselves for treatment, failed to continue 

 until cured, would impose a penalty on those who had 

 at least shown some care for their health while letting 

 the careless go scot-free. Another difficulty which is 

 emphasised is the absence of any generally accepted 

 standard of cure, and until this has been worked out, 

 insistence under compulsion on a long course of treat- 

 ment is wisely considered to be outside administrative 

 practicability. 



Turning to the controversial question of the preven- 

 tion of disease by disinfection, either self-disinfection or 

 skilled disinfection at the hands of a trained person, the 

 committee agree that disinfectants do disinfect, given 

 that the application is thorough^ prompt, and that the 

 disinfectant is appropriate. It stresses the fact that, 

 to a large extent, exposure to infection takes place 

 under conditions in which neither promptness nor 

 thoroughness are likely to be exercised, and that the 

 success of any public facilities for self-disinfection in 

 the civil community is Ukely to be very small. But 

 though in the opinion of the committee the majority 

 would fail, a minority should succeed, and no obstacle 

 should be placed in the way of private purchase 

 of appropriate disinfectants. The law does not 

 to-day permit the sale of ad hoc disinfectants. In order 

 to obtain them the public must have either a doctor's 

 prescription or be able to ask for what it wants by the 

 exact name. The report advises the alteration of the 

 law to allow of the sale of disinfectants in an approved 

 form, with instructions for use approved by some com- 

 petent authority. The suggestion that the Medical 

 NO. 2805, VOL. T J 2] 



Research Council should be invited to undertake this 

 task will, we hope, be received favourably. That body 

 is already responsible for the standardisation of the 

 arsenical compounds used in the treatment of syphilis, 

 and its authoritative and independent position would 

 make it particularly suitable for this undertaking. It 

 is specifically advised that the commercial advertise- 

 ment of such disinfectant should Ije prohibited. The 

 importance of self-disinfection will find expression first 

 among the educated classes, and from these will pene- 

 trate, as temperance did, into the minds of the com- 

 munity as a whole. 



The general application of a system of skilled disin- 

 fection, which would necessitate the establishment and 

 maintenance of buildings and also of attendants, is 

 dismissed on the grounds of impracticability and cost, 

 but in a later paragraph the committee shows an appre- 

 ciation of the value of an experiment such as was 

 made at the Manchester Ablution centres, and suggests 

 that local authorities should be assisted to carry out 

 experimental schemes for the prevention of venereal 

 diseases, as for example in dock areas, where local con- 

 ditions demand special measures. This, we think, is an 

 excellent method of gaining administrative experience 

 and of educating the public. It has already received 

 official sanction in the past, and we hope that energetic 

 local authorities will take advantage of the suggestion. 



In addition, however, to medical measures for pre- 

 venting disease in, or minimising the risk of disease 

 to, persons exposed to infection, there are those for 

 rendering non-infective, and curing, diseased persons. 

 With regard to the latter, the committee remarks that 



"speaking generally, the general medical practitioner 

 is not yet adequately equipped with the most advanced 

 knowledge of venereal diseases and their treatment to 

 enable him to deal competently with all the cases that 

 come before him, and that an improvement in medical 

 education in regard to venereal disease is necessary." 



The present clinic system receives a full measure of 

 approval, and extension and improvements are asked 

 for. The importance of the educative work that is done 

 in the clinic is stressed. The actual sufferer from the 

 disease is almost the most important person to teach 

 where limitation of the spread of disease depends so 

 greatly on voluntary individual action. The doctor's 

 words will always carry most weight with the patient, 

 and we believe that most medical officers of clinics 

 realise this and carry out this part of their work with 

 self-sacrificing devotion ; but patients may be stupid 

 and ignorant and need often repeated explanations, the 

 doctor's time and endurance are limited. Printed 

 instructions and warnings are less impressive than 

 the spoken word. The recommendation that trained 

 social workers should be attached to the staff of clinics 



