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486 Radium had proved very useful in the painful warty con- ditions of the sole. Mr. A. E. HAYWARD PINCH showed a series of most striking photographs illustrating the curative effect of radium. He employed a pure radium salt and in three strengths. One of the most difficult conditions to treat was the "port-wine" " mark ; the best results were obtained with weak applications. In the case of rodent ulcer one massive dose should be given, and this alone often effected a cure. Lichenification of the skin in neurotic subjects was also amenable to treatment. The pruritus and discomfort rapidly disappeared. Radium was of great value in cases of keloid, an excellent cosmetic result being obtained. Dr. DuBREUILH had employed X rays with marked success in the painful warty conditions of the sole. In an extremely careful paper Dr. OPPENHEIM and Dr. WECHSLER (Vienna) described the results of tuberculin inoculation (von Pirquet’s reaction) in the skin of patients suffering from various skin diseases. The percentage of positive reactions remained about normal in local derma- toses ; it was greatly increased in lupus vulgaris, while in florid secondary syphilis the number of positive reactions fell well below the normal. They thought that this change was the result of an altered sensibility of the skin in these various conditions to tuberculin. Many other interesting communications were made. Dr. GEORGE PERNET (London) recorded a case of Mycosis d’Emblée treated unsuccessfully with X Rays and Salvarsan. - Dr. BULKLEY considered important indications could be obtained from the urine in skin cases.-Subcutaneous Cal- cinosis was described by Dr. F. PARKES WEBER (London), ’ and Dr. NICHOLAS and Dr. MoNTOT (Lyons) discussed a Congenital and Familial Chronic Bullous and Vegetating Dermatosis. Before each meeting a large number of rare cases were exhibited. ____ SECTIONS XIII. AND XIX.-JOINT SESSION OF THE SECTION OF DERMATOLOGY AND SYPHILI- GRAPHY WITH THE SECTION OF FORENSIC MEDICINE. SATURDAY, AUGUST 9TH. Professor BLASCHKO (Berlin) opened a discussion on Syphilis: Its Dangers to the Community and the Question of State Control. He referred to the German Society for the Prevention of Venereal Diseases, founded in 1902. This society was now known all over Germany, and was consulted by the Govern- ment. Many laws had been passed at its instigation, and he thought some such system would be of great use in England. Referring to the regulation of prostitutes, this in his opinion had never been of the slightest use in diminish- ing disease, for the excellent reason that it missed the most important class of case, the young clandestines. Indeed, any attempt to exercise control by police supervision was unsatisfactory. A board of health should be constituted for this purpose, while a system of registration applicable to both sexes ought to be in force. Facilities for treatment should be brought within the reach of all, and this should only be made compulsory for youthful or weak-minded individuals, in whose case isolation might be practised if necessary. Professor FINGER (Vienna) urged the importance of education in sexual matters, especially for youths. It was also most necessary to instruct patients suffering from venereal diseases as to the nature of their condition and its dangers to others. Midwives were not sufficiently conversant with the aspects of venereal disease, and they also should receive instruction. He recommended improvement in the dwellings of the poor, especially with regard to bedroom accommodation. No difficulties ought to be put in the way of patients receiving treatment, which should be made as easy as possible, and for this reason hospital hours for consultation might be arranged at the most suitable times. In the paper communicated for him Major H. C. FRENCH, R.A.M.C., who was absent through illness, dealt mainly with the subject of State Control. He thought venereal disease must in time become notifiable on account of the heavy cost to the State, apart from all other considerations. The Cantonment Act in India had effected a yearly saving of £55,515 when reckoned at Is. per diem for hospital diet, quite apart from other considerations. The annual number of invalids from India to England with syphilis had been reduced from 611 in 1897 to 18 in 1910. It was a common error to suppose that a man suffering from venereal disease was as dangerous as a woman. Indeed, the amount of disease conveyed by a woman was probably a hundred times as much as that conveyed by a man. Although a syphilitic woman was a more real source of danger, any method of dealing with the question could only be successful by the early isolation of men and women and the efficient inspection of both. In Malta an enormous reduction in the incidence of syphilis had been effected by a system of confidential medical notification and more effective segregation of diseased persons. Both this and the reduction in India had taken place before the introduction of salvarsan. The administrative system of control existing in the army could easily be adopted or improved to meet the special requirements of civil com- munities in England. In summarising the means at disposal, he advocated medical notification of disease, suppression of souteneurs and solicitation, protection of orphans and destitute children, and police measures. There should be more available beds in hospitals, where systematic instruction of students ought to be carried out. In their report Professor GAUCHER and Professor GOUGEROT (Paris) urged that it was as necessary to combat syphilis as tuberculosis or alcohol. Syphilis attacked the community in many ways, and the innocent suffered fre- quently. They called especial attention to the dangers from forks, tumblers, &c., in restaurants, and recommended boiling of these articles as a precaution. The risk of disease from domestic servants was possible, but this could be avoided by obtaining a health certificate, especially in the case of wet- nurses. In the case of the discovery of syphilis in a domestic the medical attendant should maintain professional secrecy, but should warn the patient of the danger of harming others, recommending entrance into hospital. The regulation of prostitution in France and other countries could not be efficiently carried out. Most syphilologists were unfavour- able to it, for the majority of prostitutes escaped regis- tration, and it was only applicable to one sex. Where the prostitutes were free from all administrative and medical supervision-the system of "abolitionism "-the results were much better. They recommended education of young men and young women, organised treatment of syphilitic prosti- tutes, the suppression and prevention of prostitution by the recognition of paternity, the conferring on seduced virgins of the rights of married wives, and by pecuniary or penal punishment of the lover who abandons his mistress. Dr. L. E. LEREDDE (Paris) drew attention to the fact that syphilis in its various manifestations was second as a cause of death in Paris. This estimate included syphilis of the nervous system, viscera, and vascular system. Dr. PONTOPPIDAN (Copenhagen) said all police supervision should be given up. Every patient with syphilis must notify the medical man, who would keep him under control and inform the authorities only for statistical purposes. Gratuitous treatment should be available for all. This had proved very expensive in Denmark. He urged that the doctor should not be turned into a policeman, but should maintain the ordinary relationship to his patient. Although their results were too small for statistics, he thought under the new régime they were much the same as before. There were, he pointed out, twice as many beds available for venereal diseases in Copen- hagen as in London. Dr. CARLE (Lyons) agreed that police supervision should go. When compulsion was given up he found a greater number of patients came to his policlinic. A third meeting of the International Commission in Brussels was required. Dr. DOUGLAS WHITE (London) also disapproved of the registration system ; it failed to account for the young I clandestine. " He advocated the protection of minors. Any scheme should take into account gonorrhoea, which was three or four times as prevalent as syphilis. Mr. J. E. LANE (London) thought syphilis a much milder disease now than formerly, due to the advance in general hygiene. All patients ought to be able to obtain salvarsan. Dr. HELEN WILSON (Sheffield) did not believe in com- pulsion, nor was confidential notification, in her opinion, of much real value. Dr. DUBOIS HAVENITH (Brussels) reminded the hearers that the words syphilis and venereal diseases frightened
