HOW WOULD IT WORK

A Note on thb Proposed Notification op Enthetic Diseasb.

By h. M. WILSON, M.D.

Ifc is frenuently suggested that in order to clieck the spread of diseasc due to sexual immorality, there should be some kind or compulsory notification of syphilis. The difflculties and dangers in the way of such a scheme are so many that it has been thought worth while to point ont several of them, and to ask those who care for justice and morality to pause before supporting it.

This disease diflers froin small-pox and scarlatina in certain important particulars, viz. : —

(a) The sufferer is usually most anxions to conceal the nature of his disease from his friends — even in tliose rare cases where it has been acqnired by innocent means.

{b) He is very often able to do so, because throughout the disease he may not be visibly ill, nor confined to the bouse ; while at the same time he is in a highly contagions condition.

(c) Eor a period of at least two years after he has contracted the disease he may still be capable of transmitting it, though apparently perfectly well. (Many authorities give the period as three or four years instead of two.)

(d) Owing to the manner in which this disease is usually communicated, the enormous majority of persons can avoid contagion in a way that is not possible with other diseases.

Bearing these points in mind, the difflculty of notification is at once apparent. Who is to notify — the doctor or the patient? It certainly cannot be — as in the case of other illnesses — the head of tbe house, since very often an iumate might be suffering for months and going to a doctor at the other side of the town, perhaps uuder an assumed name, without the head of the house being aware of it. If the patient is to do it, many cases will not be notifled, not only from wilful concealment, but because most people, if tbey suspected the nature of their disease, would be careful not to ask the doctor to give a name to it, lest they should be compelled to notify. The duty would, therefore, fall on the doctor, and he would be placed in an extraordinarily difflcult position.

He must, fir.stly, be omniscient, or, at any rate, possess many of the qualities of a flrst-class détective so that he may know at once if patients give wrong names or addresses, and may force them to reveal their true position ; and this omniscience must extend over severai years.

Secondly, obedience to the law would compel hira to betray the confidence of his patients. The doctor, often the most trusted family adviser and frieiuî, would become a dreaded inquisitor ; while quack doctors of the worst character would drive a thriving trade under promise of secrecy, and blackmail under threat of denunciation. Eurther, there is reason to fear that the efforts to conceal disease might cause it in some cases to assume a more virulent character, and to spread more rapidly than at présent.

Lastly, when cases are notifled, what next? Are tbey to be kept in hospital at tlie public expense for two or three years ? — or are they to be compelled to wear a badge to warn others of their condition? If not, it is not clear what would be the advautage of notification.

It is pretty évident that whatever the law micht aav thi>

Biseases Acts, which were abolished in 1886 when tiie recognised their iinmorality ’anâ'crnel

nr. these Acts, also, it might easily be the means of castingreproach

healtli offlceit as^serted

that they had reliable information that a womau was diseased, she could only disprove the statement by submitting to a surgical examination

Those who advocate this scheme— doubtless without realisinn it« probable elïects-base their agitation on an alie-ed increase fn® ^ prev^lence of disease. But as a matter of fact such statisS as ïe available ali tend to show that syphilis lias been gradually decreasine for

greatest expérience, such af Lr Jonathan Hutchmson, express the saine view. Venereal diseases are indeed, sadly too common, especially in great cities, but they form onlv proportion of the total amount of disease. According to the egistrar-General s Eeport, the death-rate from tliese diseases in 1887 was 85 per million ; in 18<J7 it was 72 ; and in 1907 it was 58 per million. Again’ ff inquiries made in Children’s Hospitals shows that,’ A ^ sulïering from syphilis ; in 1895, only 1 in 124.

A lurther diminution might be effected by adéquate provision for the treatment and cure of snfTcrers who voluntarily présent themselves But thereis no ground for panic, and, surely, nothing except blind panic, would induce Enghsh people to resort to measures which entail cruel injustice and a System of espionage, for the sake of very questionable

There is another proposai for compulsory powers in a different direction, yiz., that Guardian.s should bo ompowered to detaiu cases of venereal disease till cured. Without going into the économie and other arguments against this, it may sufflee here to point out that the réluctance of patients to enter hospital wiil be increased by the knowledge that they cannot leave when they choo.se, and thus the tendency will be to check recourse to treatment at the time when it is most important, i.e., in the early stages, when the disease is most curable as well as most coutagious.

It is important to remeinber the extraordinary decrease in venereal diseases in the British Army during the last 25 years. The admissions are now less than a third of what they were before the Eepeal of the C.p. Acts (in 1882, 246 per 1,000; in 1907, 71-9 per 1,000). The similar reducGon among British troops in India (from 265-2 per 1,000 in 1882, and 522-3 in 1895, to 89-9 in 1907) is attributed by the Army Medical Report mainly to the personal influence of commanding oflicers in inducing tlieir men to lead pure, healthy lives, to encouragement of games and regimeiital lustitutes, and to lectures by specially selected medical oflicers, together with more thorough and continuons treatment of disease. “The improved ecRication of the meu, and consequently a higher moral sense, together with less indulgence in alcohol, lias no doiibt had a considérable influence in reducing the incidence of these diseases.’’

The recommendations of the Army Medical Advisory Board (1903), as to the treatment of venereal diseases, include the followiiig passage : — “ TheCommittee lias corne to the conclusion that, in the United Kingdom at any rate, an attempt to grapple with the problem of venereal disea.se by methods of compuisory isoiation and treatment is neither practical nor expédient. Better resnlts are likely to be obtaincd by the diffusion of the knowledge of the serions conséquences of these diseases, and the provision of effective treatment for both sexes, nnder conditions to which 110 penal stigma is attached.’’

Ptibli.shed by (ho BiiiTisii Comiuttke op Tnn International Fédération for the Abolition op State Régulation op Vice. Offlee : -17, Tothill Street, Westminster. S.W.

Price l4il. pordoz. ; lOd. per 100, post froo. Jamuiru. 1910-