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CONTROL OF VENEREAL DISEASE.

The Staffing of Venereal Clinics.ALTHOUGH only eight pages have been allotted to the

subject of venereal diseases in the annual report ofthe chief medical officer to the Ministry of Health, yetthis short account touches upon matters of the greatestinterest. Dr. F. J. H. Coutts, who is responsible forthe work both of the tuberculosis and V.D. sections ofthe Medical Department, in dealing with the causes ofadministrative ineffectiveness, lays stress upon theunsatisfactory plan of appointing a roster of the wholemedical staff to take charge of the treatment centresattached to hospitals. "Frequently," he says, "it isfound that these officers have no particular interest inthe treatment of venereal disease, and undertake thework merely as a duty to be performed perfunctorily."We hope that such a system will soon lapse, for it isinimical to the welfare of the patients and it tends toengender a lack of system and enthusiasm amongst thejunior members of the venereal clinic staff. If a similarplan were suggested for any other special departmentof a hospital, such as the ophthalmic or the aural, itsdangerous absurdity would at once be realised.

Hutments as Clinics.An interesting diagram in the same report shows how

a 60 x 30 ft. military hut may be converted into a V.D.clinic. While the general plan is commendable it is

noteworthy that no provision appears to be made forthe examination of female patients or for their dailytreatment by irrigation or otherwise. The arrange-ments for men have been made on the assumption thatthe patients will irrigate themselves. Having regardto prevailing divergencies of opinion, an alternative

plan might have been given showing how the hut couldbe adapted for irrigation administered by someoneother than the patient. We see no provision for

patients to rest after receiving an intravenous injec-tion. The general waiting-room is unsuitable for sucha purpose. The position of the sanitary arrangementson either side of the main entrande also seems

unfortunate. No systematic description of the hut isgiven in the report, a fact which makes commentdifficult and possibly unfair.. No mention is madeeither in terms of "working hours" or "strength ofstaff " as to the number of patients who can beaccommodated or treated in such a building. Armyhuts may or may not be suitable for adaptation as

treatment centres, and the Ministry of Health might beencouraged to give all the information at their disposalfor the guidance of municipal authorities and medicalmen inexperienced in V.D. administrative work.

A Statement by the S.P.V.D.The Society for the Prevention of Venereal Disease

has circulated widely in the press a statement in regardto immediate self-disinfection in the hope that thepublic will demand an inquiry by an impartial andcompetent body. The statement is signed by LordWilloughby de Broke and several eminent medical men,who definitely affirm and are prepared to bring con-clusive evidence as to :-

(1) The efficacy of immediate self-disinfection in the male as aprevention against venereal infection and the possibility of almosteradicating these diseases by this means. ’

(2) The biased nature of the composition and report of LordAstor’s Interdepartmental Committee, the high authority of whichthe Minister of Health strongly emphasised in his speech at thedeputation.

(3) The gross inaccuracy of the statistics supplied by the WarOffice.

(4) The failure of the Government, the War Office, theAdmiralty, and the Ministry of Health, to organise public educa-tion on this subject or carry out any thorough scheme fortesting the efficiency of immediate self-disinfection as a pre-ventive of venereal disease either during the war, or since theArmistice.

(5) The increase in venereal disease since the Armistice, andits necessary effect on innocent women and children, by increasingsterility, miscarriages, and the production of diseased children.

(6) The very large amount of popular support for a campaignof education in the principles and practice of the prevention ofinfection by venereal disease by means of immediate self-disinfec-tion that is given by organised labour, the medical profession, andpractically all those who have had personal experience in the pre-vention of venereal disease by such methods.

(7) The great financial burden that venereal disease i-. to thenation.

The signatories also call attention to the very largenumber of young persons of both sexes (but especiallyyoung men) who persist in voluntary exposure to risk,and to the fact emphasised by the late Sir WilliamOsler and many others that infection may be conveyedto the innocent by a cup, glass, bath, towel, razor, andmany things in common use.

The All-America Conference.An "Institute on Venereal Diseases," arranged by

the U.S. Public Health Service at Washington andattended by health officers, private practitioners, andothers, preceded the six-day session of the All-AmericaConference on Venereal Diseases held this week andattended by hundreds of experts from all parts of theWestern hemisphere. The object of the Institute wasto afford to medical men, " educators, psychologists,sociologists, and others," the opportunity of pursuinga ten-day course in relation to both the medical andsociological aspects of venereal disease. The followingsubjects, amongst others, were on the programme:Diagnosis and Treatment of Venereal Disease, Dia-gnosis of the Mental Condition of Delinquent Women,Protective Work for Girls, Heredity and Eugenics,Public Education in Venereal Disease, Sex Psychology.We believe that the value of such intensive courses liesnot so much in the actual information acquired bythose attending as in the formation of an atmospherein which latent interests are discovered and the flaggingenergy of the solitary worker stimulated and developed.The interest of American municipal authorities in the444 largest cities was further enlisted by a surveyin which the cities were marked according to the vigourof their fight against venereal disease, being awardedso many points for various medical measures, so manyfor preventive educational work, so many for restric-tive laws and their enforcement, and so on, with atotal possible maximum of 1000. The cities were thendivided into four classes according to their popula-tion, and each class was graded according to its

aggregate mark. While the results of this survey werenot made public, it aroused the competitive spirit of theauthorities, inciting those of cities that stand low in thelist to improve their standing and of those that standhigh to fresh efforts to maintain their rank, in prepara-tion for a second survey, the results of which are tobe published.I Eitphemisms in the American Press.’ An enormous amount of propaganda work has beendone in relation to the Conference on Venereal Diseasessitting this week in Washington, and the press has beenapproached with the object of arousing interest in thewhole subject. Editors have received statements ofthe aims of the Conference and a short precis dealingwith the campaign against venereal disease. The unfor-tunate suggestion has, however, been made that, insteadof clearly stating that the diseases to be considered andattacked are syphilis and gonorrhoea, reference shouldbe made to them as the " great red plague " and the" lesser red plague " respectively. We regard the useof such nomenclature as a fundamental mistake. It is,in our opinion, a survival of the false modesty whichobsessed the civilised world in the past, and from whichwe are only now but slowly being delivered. The

originators of these euphemisms are moved by a senseof policy " to save the blushes of the thin-skinned."We regard as desirable less hushing and more blushing.The ignorant, whose age justifies a knowledge of thesociological and medical facts about syphilis andgonorrhoea, should be informed concerning them withoutany verbal disguise. If those of tender years are likelyto become inquisitive concerning the use of the terms"syphilis" and "gonorrhoea," the inconvenient curiosityof the young will certainly be aroused by the sensa-tionalism which attaches to red plagues, whether largeor small.

SccLvctstcn 5’acbstitictes in Ame1’íca.

At the suggestion of Surgeon-General H. Si Cumming,the All-America Conference is giving some time to- adiscussion on the use of various arsenic " substitutes "

for salvarsan. To standardise the drug and to preventthe sale.of worthless substitutes the name "arsphena-min " was adopted by the Treasury Department, and

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licences for its manufacture granted only to persons 1who complied with certain conditions consideredessential for safety and health. Service medical officershave been repeatedly cautioned against the use of pre-parations not belonging to the arsphenamin group, andwere directed to use only the arsphenamin produced bylicensed firms. Some of the unlicensed preparations onthe market were found to contain no arsenic or othercurative agent at all; and those that are still beingmade result from efforts to circumvent the rigid testsrequired by the Public Health Service. No one whodoes not comply with these regulations may call hisproduct " arsphenamin " ; but there seems to be nolaw to prevent the manufacture of substitutes bearingother names and claiming to obtain the same results." We do not consider that any other products havebeen shown to be sufficiently reliable," says Dr.

Cumming. " But the value of arsphenamin is wellestablished."

______________

A SCHEME OF MEDICAL SERVICE FORSCOTLAND.1

THE Scottish Consultative Council on Medical andAllied Services have presented an Interim Report withthe above title to the Scottish Board of Health. The

Report has been adopted by the Council unanimously,and is signed with their authority by the chairman,Sir DONALD MACALISTER, and the vice-chairman,Dr. NORMAN WALKER.The following summary of recommendations indicates

the scope and tenour of the.Report:-1. Unification of all local health authorities. .

2. A complete medical service to be within the reach of everymember of the community, organised by the State, but not ofnecessity provided at public expense or carried out by State officialsor practitioners.

3. Organisation to be based on the family as the normal unit andthe family doctor as the normal medical attendant. All healthagencies to be mediated to the individual by the family doctor.

4. The expansion of the present insurance system to provide forthe whole population of "National Insurance grade (including alldependants), those entitled to medical service under the Poor-law,and for the treatment of discharged soldiers.

5. Special services to be available to others above " Insurance "

grade for which that section of the community is unable to makeadequate provision.

6. The provision of small " recovery homes " or "hospiees " forcases of ordinary illness where the patient cannot be properlytreated at home and where no

"

cottage hospital " or nursing homeis available.

7. The provision of " invalid homes" for chronic invalids. Poor-law hospitals might be used for the purpose.

8. The family doctor to be provided with all necessary supple-mentary advice and assistance. All serious surgical cases to be sentto hospital for operation. For acute medical and other cases,‘ district consultants," selected by local members of the profession,

to be appointed. Ambulant cases to receive advice at hospitals orconsultation clinics. Cooperation among general practitioners forconsultation and treatment to be encouraged.

9. Facilities to be provided to all practitioners and to all classesfor reference to clinical laboratories, and to experts in specialbranches of medical science.

10. The recommendations regarding hospitals are reserved pendingthe report of a joint committee considering the question.

11. Convalescent homes should be increased in number, andinclude " preventive " or

"

rest " homes.12. The Queen Victoria Jubilee Nurses’ Organisation to be utilised

as a suitable basis for a national system of skilled district nursing.13. The provision of fully trained health visitors in populous

areas.14. The provision of an adequate maternity service as soon as a

sufficient number of trained midwives is available. A necessaryadjunct would be the provision of sufficient beds in each districtfor difficult cases or where the home conditions are unsuitable.

15. Adequate facilities to be provided for dentistry. A con-

sulting dental surgeon to be attached to each laboratory clinic.16. The pharmaceutical arrangements of the scheme, it is recom-

mended, should follow the provisions of Section 15 (5) of theNational Insurance Act, 1911.

The Report should be studied as a whole. It is a briefand clearly written advocacy of a practical scheme,while the proposals, for example, for the provision oflaboratories and clinics, and for the institution ofdifferent types of convalescent homes, do not lendthemselves to summary. We shall have occasion todeal further with the document, which is noticed thisweek in a leading article.

1 Scottish Board of Health: Interim Report of the ConsultativeCouncil on Medical and Allied Services. London: Eyre andSpottiswoode. Edinburgh: His Majesty’s Stationery Office. 2d.

CANADA.

(FROM OUR OWN CORRESPONDENT.)

The Canadian Medical A88oc’iation.

THE fifty-second annual meeting of the CanadianMedical Association is to be held in Halifax, N.S., onJuly 5th, 6th, 7th, and 8th, 1921, under the presidencyof Dr. Murdoch Chisholm, of that city. Last year theAssociation, after a lapse of annual meetings for severalyears owing to the war, was convened in Vancouver; themeeting was last held in Halifax in 1905. At that timea movement was set on foot to organise and establisha journal. Last year, at Vancouver, a new constitutionand by-laws were adopted, and the next meeting willbe the first held under this new constitution. Thebranch associations now provided for consist of theprovincial medical societies, and there is also provisionfor affiliated societies-i.e., any Federal medical or

scientific body. The list of officers remains as before-namely, a president, a vice-president for each provincialsociety, a general secretary, a treasurer, and a council.McGill University: the Five Million Dollar Carnpaign.McGill University has announced a registration of

students for 1920-21 which is approximately equalto that of 1919-20. The total is more than 2485. TheFaculty of Medicine shows the largest registration-namely, 795. The Faculty of Science comes second,with 694. The eyes of all universities in Canada andthe United States are said to be watching with thekeenest interest the University’s public campaign toobtain$5,000,000. To promote this campaign a series ofpamphlets have been issued, and newspapers and

periodicals are giving the campaign unusual publicity.This is the third time in its history that the Universityhas appealed to the public for donations and subscrip-tions, for in the past McGill has always fared well atthe hands of numerous and influential friends. In1881$33,000 was raised by public subscription; again,in 1911, the second campaign netted$1,500,OGO.The third, or present campaign, aims at$5,000,000,and the outlook is most hopeful. During war timemany members of the various staffs and a large propor-tion of students were away, and the strictest economyhad to be practised. There was no money for newbuildings, staffs were depleted, scientific apparatus andequipment became totally inadequate. The close of thewar soon raised the registration in Arts from 389 in 1918to 932 in 1919 ; in medicine from 526 to 724 ; in appliedscience from 242 to 643. Additional professors andassistants had to be provided, and increased salaries wereurgently needed. There were about 500 on the staff ofMcGill, the average salary being around$3000 per annum.It is proposed now to spend$3,250,000 on salariesand increases in salaries;$1,250,000 on apparatus andequipment; and$500,000 on the maintenance of existingbuildings and laboratories. A new department of bio-chemistry has recently been created with ProfessorA. B. Macallum, formerly of the University of Toronto,and latterly chairman of the Federal Research Com-mittee, as its head. A new building is in contemplationto house pathology, medical jurisprudence, hygiene, andpsychiatry for the medical faculty at a cost of$460,000which will require an endowment of$150,000. Manyother buildings are required, including a ConvocationHall; and unless$5,000,000 can be obtained the

University will not be able to keep pace with othersimilar institutions on the Continent of America.

Canadian National Committee for ]}Iental Hygienae.When the second annual meeting of the above

organisation met in Vancouver a short time ago, Dr.Charles F. Martin (Montreal) was re-elected President,Dr. Charles K. Clarke (Toronto) Medical Director, andDr. C. M. Hincks (Toronto) Secretary. Dr. Clarke, inpresenting a report of the society for 1919, spoke of thepreliminary work which had to be done to educate thepublic as to the immense number of mental defectivesin Canadian schools. Surveys had been made in NewBrunswick and Nova Scotia. and the committee hadexercised considerable influence in Quebec and Ontario,