170 



NATURE 



[October 6, 192 1 



discontinued before final tests regarding cure were 

 completed, and only 21,540 were discharged after 

 completion of treatment and observation. 



The health authority of Pennsylvania has fore- 

 seen this important matter of discontinuance of 

 treatment, and it has enacted the following regula- 

 tions :— 



"When a patient discontinues treatment before 

 he (or she) is cured or rendered non-infectious, 

 the social service worker follows up the case and 

 sees that the patient returns to the clinic as long 

 as the disease is in the infective state. This is 

 accomplished first by sending him a notice to 

 return for treatment. If this does not effect a 

 return, the clinic makes use of the legal machinery 

 at the disposal of the Department of Health. 



" Venereally diseased patients in the infective 

 stage are subject to quarantine, when through 

 neglect of treatment, habits, occupation or failure 

 to protect others, thev are menaces to the public 

 health." 



In this country there are no legal measures of 

 this nature, and the very large percentage of 

 persons attending the clinics who discontinue 

 treatment and disregard the warning they receive, 

 or should receive, that they are still in'fective and 

 a menace to society, shows that some further 

 measures of a disciplinary nature are necessary 

 to make these clinics efficient. 



The following passage from the Report of the 

 Ministry of Health indicates that a number of 

 the clinics are not efficient. 



"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 dis- 

 approved by the Ministry. It is better to have 

 only a few clinics well organised and scientifically 

 controlled than a large number which are not thus 

 administered." 



The small percentage of persons attending the 

 clinics who were discharged as certainly non- 

 infectious, and the large percentage who do not 

 complete a cure and are still infective, is explained 

 if the service at a number of these clinics is casual, 

 superficial, and perfunctory. 



We entirely agree with the Report in the state- 

 ment : — 



"Whilst the V.D. clinic has proved in practice 

 the centre of the treatment, it is but part of the 

 national scheme for dealing with these diseases. 

 The other and more important part concerns pre- 

 vention." 



But how does the Ministry propose to carry it 

 out? By ablution treatment at the clinics. But 

 the Report shows dissatisfaction with the service 

 at a number of the clinics. Is it likely that ablu- 

 tion and irrigation will be efficiently carried out 

 NO. 2710, VOL. 108] 



where the treatment is liable to be "casual, super- 

 ficial and perfunctory " ? 



The Report gives the following reasons against 

 the advocacy of the practice of self-disinfection :■ — 



" The Ministry believe that thorough cleaning 

 and skilful disinfection of the body immediately 

 after risk of infection has been incurred tend 

 substantially to reduce the likelihood of disease, 

 but the Ministry are not prepared to recommend 

 a general practice of self-disinfection apart from 

 skilled advice and supervision. It is believed that 

 except under skilled control attempts at self- 

 disinfection are likely (i) to be ineffective; (2) to 

 create a false security and thus an increase in 

 promiscuity ; and (3) to lead to postponement of 

 treatment which thus becomes more difficult and 

 uncertain. It is impracticable to train the general 

 public in effective 5e//-di3infection by means of 

 leaflets of instruction. What is required in all 

 such cases is not general directions for self- 

 manipulation but prompt and skilled advice." 



We may ask, is this fear of failure the sole 

 reason? Are there not, in a great measure, the 

 same influences at work that interfered with pro- 

 phylaxis by self-disinfection being carried out 

 efficiently in the services during the war, viz. the 

 National Council and its supporters, which set 

 out to combat venereal disease and still finds it 

 increasing in spite of its moral propaganda and 

 curative treatment centres. 



We have no desire to dispute the fact that 

 " skilled disinfection " as carried out by the 

 American Army was efficient, but let us see what 

 the Commissioner of Health of Pennsylvania says 

 about skilled disinfection in civil life : — 



" Immediate treatment (venereal prophylaxis) 

 for those exposed to disease has been approved 

 by the Pennsylvania State Department of Health. 

 Prophylaxis as used in the army by means of 

 stations is impracticable in civilian life. Tubes 

 containing material for self-disinfection are given 

 the Department's approval, when after tests they 

 meet requirements. The material usually em- 

 ploved is after the formula of Metchnikoff. The 

 tubes are on sale in drug stores." 



Any unprejudiced thinking person must see 

 many grave defects in trusting to disinfection 

 stations to control venereal diseases effectively, 

 even if municipal authorities change their mind 

 and 'sanction the increased expenditure which such 

 stations would entail. 



It is certain that a large proportion of civilians 

 who expose themselves to infection could not, or 

 would not, seek skilled disinfection even if the 

 locality of the stations were favourable and even 

 if its efficiency were all that could be desired. 



