235

THE LANCET.

LONDON: SATURDAY, MARCH 4, 1865.

THE PREVENTION OF SYPHILIS AMONG THE CIVIL POPULATION.

AT a recent meeting of the Epidemiological Society an im-portant discussion took place upon the prevention of syphilisamongst the civil population. The discussion was well-timed.

Efforts are being successfully made, under the provisions ofthe Contagious Diseases Prevention Act, to limit the prevalenceof venereal maladies in the army and navy. A Government

Committee is now also sitting to investigate the nature andtreatment of syphilis, with special reference to the public ser-vices. It is fitting, therefore, at a time when the Legislaturehas become awakened to the great moment of this question,that the interests of the civil population should not be over-looked. Amongst them syphilis, although less patent, is notless injurious than amongst our soldiers and sailors. Few

maladies excite more the apprehension of medical philan-thropists ; still fewer conduce so greatly to the physical dete-rioration of a people.The subject was brought before the Epidemiological Society

by Dr. BABIN&TOX. He first touched briefly upon the objec-tions commonly urged against legislative interference with

prostitution--to wit, the arbitrary meddling with the libertyof the subject, and the moral sanctioning by implication ofincontinence. To both objections Dr. BABINGTON demurred.He held that by "freedom" is meant the power or right to doeverything we choose which is not morally wrong, or incon-sistent with an equal right in others to do the same. But

freedom to do what is right within these limits is incon-

sistent with freedom to go beyond them. Thus, to do whatwe like with our own property is inconsistent with doing whatwe like with the property of others. If a thief were as free

to steal another’s property without punishment as an honestman is free to do what he likes with his own property, therewould be an end to all law and order in society. It seems,

therefore, Dr. BABINGTON cogently argued, that the freer thecountry, or, in other words, the freer every individual is to doas he likes within the bounds of rectitude, the more stringentshould be the laws of restraint upon those who desire to do

wrong; and hence that we, who are a free people, have moreright than our neighbours across the Channel to make lawsrestrictive of vice. iTo control prostitution is not thereby to sanction it. There

is a wide distinction between approval or sanction and tolera-tion. We tolerate gambling to the extent of allowing men tobet upon horseracing and other events ; yet we cannot be saidto approve of it, for we place it under restraint by prohibitinglotteries, betting-houses, and gambling-booths at racecourses.We do not approve of drunkenness ; yet we neither interdict Ithe use of spirits, nor interfere with the drunkard himself unlesshe publicly exposes his vice. In that case, however, we fine

him; and, moreover, we put a high duty on spirits, registerand visit distilleries, and punish illicit distillation. The evils ofdrunkenness are very great; yet not so great as those which. I

arise from the infection of syphilis. Were the latter eonfined

to the individual, they might be regarded as a just punish-ment for the commission of sin, and be of consequence only toits perpetrators. But it is never to be forgotten that syphilisis hereditary; that the offspring of those parents, whether

father or mother, who are tainted with it, may suffer for gene--

rations to come. The innocent expiate the sins of the guilty;the nation itself is deteriorated ; and hence it becomes a legi-

timate question whose province it is to provide for the publicgood. Dr. BABIGTON could not see why the Legislatureshould not, for the sake of establishing greater freedom

’ amongst the virtuous, interfere with the freedom of the vicious.As Staff-Surgeon Dr. CRAWFORD aptly and ingeniously putthe question during the discussion, prostitution is alreadylegalized ; we in reality protect the woman in propagating aloathsome disease.

Dr. BABINGTON thought that the obstacles to carrying outa system of registration and examination of prostitutes werenot insurmountable. As Mr. RADCLIFFE subsequently showed,the practical difficulties in the way of such a system were muchexaggerated. Public sentiment, as regards interference withthe "liberty of the subject," was, so far as prostituteswere concerned, very much astray. The Legislature looksupon prostitutes as members of the criminal classes, and

amongst these classes all prostitutes who are known to thepolice as living in brothels, walking the streets, or otherwiseopenly following their avocation, are enumerated in the

Judicial Statistics prepared annually for the Home Office, andlaid before Parliament. The prostitutes known to the policeare those who require to be dealt with by the Legislature.Now the number of these returned for England and Wales in1863 was 28,800 ; the number of brothels 7204. It is to be

remembered that there is no question here of the entire numberof prostitutes in the kingdom. It is simply the numberknown to the police which concerns us. The statistics re-

ferred to are the only trustworthy figures we possess on thesubject; they have been collected on a definite plan for several

years ; and it must be obvious that any suggestions for a policeregulation of prostitution must be based upon them. It is

gratifying to find that the number of prostitutes who wouldat first need to be placed under sanitary supervision is so small;and that as a consequence neither the difficulty of supervisionnor its expense would be so great as is commonly believed.Indeed, the Judicial Statistics bring the question within verynarrow and practicable limits.Of the excellent results to be derived from systematic sani-

tary regulation of prostitutes, Dr. STUART, Dr. SMART, R.N.,and Dr. DICKSON, R.N., in the course of the discussion, citedseveral striking illustrations from the experience of certainregiments and ships in India and China. Dr. SMART, more-

over, mentioned that both at Portsmouth and Chatham much

good had already arisen from the Contagious Diseases Act.The results of the Act, according to Drs. HARDIE (73rd Regt.)and CUNNINGHAM (60th Rules), had been less fortunate at t

Shorncliffe and Aldershott, owing to the neighbouring civilhospitals refusing to co-operate in carrying out its provisions.Dr. RoBixsox (Scots Fusilier Guards) remarked that a planof a similar character to one which he had long ago submittedto the authorities in reference to the Guards would probablyhave to be carried out before the full benefit of the ContagiousDiseases Act could be reaped—namely, the establishment of

236 THE NEGLECT OF MENTAL DISEASES.

Lock hospitals in garrison towns, the expense to be borne

partly by the Government and partly by the local authorities.Dr. DICKSON also commented on the imperfections of the Act,in making no provision for the registration of prostitutes, andthe issue of health passports in their migrations from town totown. Another defect of the Act mentioned by Dr. SEPTIMUS&IBBOX was the absence of any provision for payment of themedical officers who carried out its requirements.A Bill providing for the registration and inspection of pros-

titutes, Dr. BABINGTON thinks, would probably cause as littlesensation, and meet with as little opposition, as was encoun-tered by the Compulsory Vaccination Act. It is tolerablycertain that few, if any, impediments would be offered by theprostitutes themselves. They would be gainers in so far asregistration and inspection would necessarily involve supportand treatment during sickness if syphilis were present. To

meet the latter needs, Lock hospitals would be requisite in allthe great centres of prostitution.

But, assuming that we are not prepared to introduce a sani-tary supervision of prostitutes, are there no means of improv-ing the present state of affairs ? Dr. BABINGTON answers in

the affirmative. He suggests that, in this event, some specialpublic provision should be made for the medical treatment of

syphilis, such as would induce diseased prostitutes to place them-selves early under treatment. The system pursued at generalhospitals and public dispensaries, he believes, repels them.At least, it is too commonly the case, as Mr. DE MÉRIC forciblyshowed, that the woman only presents herself for treatment,under existing circumstances, when she is unable from suffer-ing any longer to ply her revolting trade, and when she has

spread the disease in many directions. Dr. ROBINSON also

spoke of the horrible condition of some of the women hauntingthe vicinity of the barracks in Hyde Park, causing infinite

mischief amongst the soldiers, and for whom some specialprovision would be a boon, while to the public it would be a

great economy and benefit.

Dr. BABINGTON suggests the establishment of houses of re-covery destined for infected prostitutes ; and the appointmentof district medical officers—who would be paid out of the rates,somewhat in the same fashion as the public vaccinators-towhom the infected could resort. He further suggests thatthese special officers should be placed under the control orguidance of the Medical Department of the Privy Council, orof a medical board, on the principle of the late Vaccine Board,expressly formed for the purpose.

In addition, he suggests the formation of a great philan-thropic society for the express purpose of combating the mon-strous and crying evil of syphilis, and framed after the mannerof the Society for the Suppression of Vice, the Royal Humane

Society, or the Royal Fire-Escape Society. This society hewould designate-so as not to shock the delicacy of the mostrefined—the "Health Union.

"

"We are raising millions,"he observed," to provide for the spiritual wants of a people.Is it not next in importance to this to get rid of a diseasewhich counts its victims by myriads, and descends from gene- iration to generation ?"

AV, e reiterate the question, and trust (as we intimated a se’n- Inight ago) that some portion of the energy of the Government li,Committee now sitting, and of which Dr. BABINGTON is amember, may be devoted to a consideration of the questions I

which he has so appropriately raised.

THERE are periods in the life of every man at which he findsit necessary to rise out of the absorption of his individual pur-suits, and to take a general survey of his position, aims, andrelations ; and there are occasions in the course of progress ofa profession when, rising above its more special and immediatework, it may advantageously take a similar wide view of itsrelations and responsibilities in the social fabric. At the pre-sent time it is a question whether, in the eager, absorbing,and fruitful pursuit of medical science, sufficient thought istaken of, and sufficient attention given to, the important rela-tions in which, as regards certain matters, Medicine stands tothe State-relations which its progress as a science inevitablyrenders more complex, special, and weighty. As we pointedout on a recent occasion, the whole subject of what may not

inappropriately be called State Medicine can scarcely be deemedin a satisfactory condition. The great extension which everybranch of medical science is continually receiving, and thecomplex and difficult questions on which its assistance is reoquired by the State, cannot fail to render more and more

evident the need of some system of organization by whichthese increasing functions may be effectually performed. So

desirable a reform, however, plainly cannot be brought aboutby the unaided exertions of the profession : herein the Statemust take the lead; and it is to be feared that it will not bemoved to take the proper steps to this end until, as is so greatlyneeded, Medicine is duly represented in the House of Commons.

There is one subject, however, of no mean importance, inwhich, it must be admitted, much remains to be done by themedical profession itself,-and that is the subject of insanity.Here the medical practitioner has functions of a serious andspecial kind-functions that are sometimes little less than

judicial ; and it is of grave concern both to the general publicand to the profession that every precaution should be taken,and every means used, to secure adequate qualifications inthose who have to undertake duties of so great importance.By virtue of his special knowledge, a court of justice maydemand of any member of the profession a scientific opinionof the state of a person’s mind when the question at issue is

one of the disposal of vast property, or even, perhaps, one oflife or death ; and by virtue of his special qualification theState places in his hands a power over the liberty of a personof unsound mind which, were it not for the familiarity of its

exercise, would seem truly formidable. In such case the

patient cannot, as in other disease, dispose of himself as hemay think fit : deprived of his reason by a terrible affiiction,he is no longer a free agent, and no longer in a condition toprotect himself either from his own folly or from the negli-gence and misconduct of others. The most serious responsi-bility necessarily devolves on his medical attendant underthese difficult and delicate circumstances; and it may seem a

very obvious assertion to make, that a knowledge of insanity

; should form a necessary part of professional education. Never.: theless, instruction in mental diseases does not at the presenttime form any part of professional education : it is the onlypart of pathological instruction that is entirely neglected atour medical schools, and ignored by examining boards. Instead

. of being thus grievously neglected, ought not rather a subject, to be specially cultivated which, like this, imposes upon the: members of the profession such weighty duties in regard to-,

the property, liberty, and life of the individual ?

237THE INDIAN MEDICAL SERVICE.

It is not less desirable for the welfare of the profession itselfthat systematic instruction in mental diseases should be given,and an adequate knowledge of them required. Surely it is a greathardship that an action should be brought against a medicalman for signing a certificate of insanity, and that a jury shouldgive heavy damages against him, when he has acted in thematter with entire conscientiousness and according to the bestof his judgment. But it certainly would be a much moreserious hardship if the public had no right of action againstanyone who, with evil design or without due knowledge,might exercise this great power unjustly or unwisely. Here,as elsewhere, power and responsibility must be correlative :on those to whom much power is given must great responsi-bility be enforced. It is assuredly, then, the bounden dutyof those who provide for the education of the medical student,and those who professedly require a due knowledge of his pro*fession as the condition of his qualification, to take care thathe enter into practice fully prepared_ for the serious dutieswhich fall upon him in questions of soundness or unsoundnessof mind. If, from an error of judgment, a mistake is made,the whole profession suffers from a scandal which, though itmake the malicious sneer, cannot but make the judiciousgrieve.

It will be seen, from a report and resolution published inanother column, that efforts are now being made to procure adue recognition of mental diseases in the examinations of the

University of London, and that a resolution on the subject,proposed by Dr. MAUDSLEY, and seconded by Dr. SiBSOx, hasbeen unanimously adopted by the Medical Sub-Committee, andwill be presented to the Annual Committee of Convocation.As it is doubtful whether the efforts of the medical schools

can be of much avail unless they are seconded by the actiorof the examining bodies, it may be hoped that this desirablereform will be carried to a successful issue.

WE continue to receive a great many communications fromIndian medical officers on the subject of the late Warrant.Upon the whole, we perceive that it has been received with

less satisfaction than we expected. Acting on the recognisedprinciple that " those who wear the shoe know best where itpinches," we proceed to lay before our readers what appear tobe considered in India the merits and defects of the measure

so long anxiously expected. Many of the clauses of the

Warrant are thought to be obscurely worded, and thus toleave the door open to various readings and interpretations bythe financial authorities unfavourable to the interests of the

service. Medical officers have suffered so much in this waythat they are naturally suspicious. On this point it is uselessto enlarge. If the Secretary for India’s last Warrant is unfairlyinterpreted, medical officers should at once memorialize the

Secretary of State, and if no redress can be obtained in thatquarter, get their friends in Parliament to take up the ques-tion. Meanwhile, it will be time enough to cry out when theyare hurt.

On the whole the Warrant is considered a boon, althoughan unequal boon, to the service. To present inspectors anddeputy inspectors-general, and to the grade of assistant-

surgeons, it brings substantial benefits of a high order. Tc

surgeons-major, and those who get their promotion to therank of surgeon after sixteen, seventeen, and eighteen years

service as assistant-surgeons, it brings undoubted benefits,although in a less degree. Then the concession of promotionat the end of twelve years is universally acknowledged as agreat gain, particularly in Madras, where the rate of pro-motion had become of late years so slow as to fill the juniorgrades of the service with despair at the sight of assistant-

surgeons arrived at the mature age of forty-three and forty.five years. A great deal is said in the Warrant about inspec-tors and deputy inspectors-general, but, consequent on thetransfer of a considerable proportion of these appointmentsto the British service, the number available for the Indianservice will be small.

Again, under the new arrangements pay and emolumentswill be pretty well reduced to a dead level; the indolent manwho does his duty and no more, will fare as well as the dili-gent and painstaking who do their duty and something more.This is a great defect. No public service can ever be kept in awholesome condition unless some prizes are retained where-with to reward men of merit. Where all fare alike, torpidityand stagnation must ensue, and the public interests must

suffer.

A very general impression prevails among the gentlemen whohave gone up for the Indian examination that they will be

entitled to draw the sum of 450 rupees from the date of their

L landing in India, and this is certainly the interpretation put) upon the Warrant by most people in this country; but there, seems much reason to believe that the financial authorities in

3 India have put quite a different interpretation pn this clause.1 It appears that, so far from this being the case, it has been

.ruled that assistant-surgeons appointed to do general dutys may be made to roam over the country for three or four yearsz on 286 rupees per mensem.

e Several of our correspondents assure us that this is posi-tively the case, and give examples of many officers being atthe present time so employed, and so paid.

Those coming into the Indian Service on the faith of the

natural reading of the clause in question, should ascertain bya personal interview, if necessary, with the highest authorityat the India Office, whether the Indian " non-natural read-

ing is sanctioned or not in this country.Upon the whole, the scale of retiring pensions seems to

have given satisfaction.

Medical Annotations.

LAW AND LICENCE.

11 Ne quid nimis."

THE letter of the registrar of the Faculty of Physicians andSurgeons of Glasgow which we publish to-day virtually admitsthe whole gravamen of the charge which we alleged against itlately. Seeming to deny some things, it in effect acknowledgeseverything which is urged against it. The registrar sets forththat the licence is officially considered by those who grant itas one for general practice in medicine and surgery. He ac-

knowledges also that for the sum of ten guineas they are readyto sell this licence, and have sold it, and are selling it, to gen-tlemen, members of the College of Surgeons of England only,who have not been examined in medicine, or materia medica,or clinical medicine, or chemistry, or botany-subjects whichthe Faculty well know, and otherwise admit, to be essential tothe information and to the right-doing of persons assuming to