SECRECY AND DISEASE.
THE important meeting at the Mansion House on Tuesday of the National Council for Combating Venereal Diseases, and the communications from well-known men and women in the Press during the week on the subject with which the National Council deals, are notable signs of a growing public determination to act firmly and instantly against a terrible national danger. If the con- solations of the war are few, some of them are very great, and among them we mention the change of spirit which is now nerving people to deal quietly and confidently with matters which seemed to them prohibitively difficult before the war. The war might have damned us, as Germany planned, but it will end in saving us. Afterwards we shall be a more highly organized nation than we once thought necessary or desirable, and we shall see all things rather differently, but we shall be much stronger. A very noticeable example of the change of heart and outlook is the attitude of people towards this question of venereal diseases. The war has brought us much too closely into contact with real and hard things for us to shrink blushing, as people too often used to do, from a question which concerns the health and safety of the whole nation. The matter, of course, was always too important for the kind of silence that mistook itself for modesty or decency. But false modesty was preferred to honesty. And it is not merely as important now as ever it was to face the facts ; it is more important, for the disease has spread and is spreading. Fortunately with the need for plain speaking and strong action comes the will for both. The nation is in the temper to grapple at once with the problem, and to set it among those which have been solved and finally placed beyond the reach of destructive controversy. The Appeal from the Women Social Workers which appeared in the papers of Monday cannot be praised too highly for its splendid courage. Not many years ago women holding the position and enjoying the repute of the signatories of this Appeal would probably have persuaded themselves that more harm than good was to be done by demanding a law for the compulsory notification and compulsory treatment of venereal disease. They would have followed the easy course of pretended ignorance of the whole subject. They might have stilled their consciences by telling themselves, according to a familiar argument, that the ravages of disease were God's scourge for vice. Many of them would have hastened to believe—what was never true except under a false presentation of the case—that to prevent the spread of venereal disease was to give an official sanction to vice. But those days have passed
without a sign that they will return. As women earnestly and nobly present the case now there is not a shadow of suggestion that vice is a thing to be tolerated. They are far better informed than their predecessors. They know that the disease strikes down the innocent as much as the guilty. They are not therefore in favour of scourging those who have done no harm, and scourging them at the expense of the health and strength of generations to come. They call that policy cruelty and wickedness, as indeed it is. Every infectious disease, except venereal disease, is compulsorily notifiable. They see no reason why there should be this one excep- tion—an exception in the case of a disease which is demonstrably poisoning the blood of our race just when we have such a part to play for good in a transformed world as we have never had before. All honour to the women who attached their names to the Appeal in Monday's papers!
They state in that Appeal that, while fully recognizing the excellent work of the Royal Commission on Venereal Diseases in educating the public and urging free treatment for sufferers, they feel it their duty to ask for more effectual action to be taken at once. Venereal diseases produce blindness, deafness, insanity, sterility, nervous diseases, and skin and bone diseases. Sir William Osier has said that they rank third or fourth among killing diseases. The notion that the innocent rarely suffer from these diseases, except by heredity, is absolutely exploded. The Commissioners have reported that the diseases may be conveyed by surgical and dental instru- ments, razors, combs, brushes, spoons, forks, cups, towels, clothing, industrial implements, and so on. Innocent people are infected in the ordinary routine of life, and the disease often makes deep inroads into their health before they know what they are suffering from. The signatories of the Appeal go on :-
" The disease is certainly spreading, and that is why we suggest that something should be done immediately. Soldiers' mothers write that they have given their sons willingly to die for the Empire, but not like this. It seems almost incredible that men and women, known to be infectious, should bo at liberty to spread the contagion when and where they will. Yet so it is. In many cases, even warnings are libellous before the law. It cannot be generally known that the disease is now very largely spread by girls of between fifteen and eighteen years of ago. Can we wait while these mere children, caught perhaps innocently, or in a moment of madness, become the mothers of the future generation, and give birth to children more miserable than themselves ? The pro- posed remedy for this state of things is the education of the public by lectures and by private admonition, but will you by these means get hold of one per thousand of the public you desire to educate ? Will they come to the lectures ? Who will be able to admonish the larger part of them ? How can we wait to educate the young men and girls who are already infected ? Who will educate the prostitutes, especially the foreign ones, who do not understand our language ? Only through legislation can the whole community be really educated and imbued with a full sense of responsibility towards the race. The obvious remedies for every contagious disease are notification and compulsory treatment."
On Tuesday the papers published a communication from Lord Sydenham (President of the National Council for Combating Venereal Diseases), Sir Thomas Barlow, and others, in which it was pointed out that the compulsory notification demanded in the women's Appeal must be preceded by certain measures if the law is to be effective. Logically, we agree. The women's Appeal skips a link in the argument, but it is none the less valuable as a proof of the public spirit and courage of those who signed it. Nor do we see why the proposals of both parties should not be combined in one Bill. Lord Sydenham and his companions say :—
" To be effective, the scheme must, in our judgment, include as the first and most necessary measures : (1) The provision in every area of adequate facilities for prompt diagnosis and efficient treatment, free of charge ; (2) the prohibition of quack treatment ; (3) the granting of privilege to any communication made in good faith by a medical man in order to prevent the spread of infection. Notification must be futile unless accompanied by police measures for enforcing treatment, which could not be given until full facilities have been made available to all classes. When these facilities have been provided, the question of compulsion can be considered. It is gratifying to find evidence on all hands that the attention of the nation is at length being directed to the dark problem presented by these diseases, and we hope that all who appreciate the special gravity of the present situation will concentrate their energies upon remedial measures of primary importance which command general consent."
The granting of privilege to doctors is a most important point. The manner in which privilege is conceded and used lies at the root of the matter. According to the spirit in which the sufferer from venereal disease is treated under the proposed Act will depend in part the success or failure of the measure ; and success or failure will similarly depend in part upon the degree of protection the doctor enjoys in doing his duty. At present there are two powerful in- fluences at work which allow venereal disease the maximum oppor- tunity of spreading. The first is that the doctor who, in order to save others from infection, passes on the information that a patient is suffering from venereal disease makes himself liable to an action for slander. The law in this respect must be completely changed. The other, and we think much the wider, influence for evil is the
secrecy with which people suffering from venereal diseases generally behave. They are so ashamed of acknowledging what is regarded as a proof of vice that they hesitate to place themselves in the hands
of competent doctors ; they keep the truth to themselves ; or they have recourse to quacks who exploit their shame and their fears. All this must be radically changed if we are going to behave wisely in an emergency. It should be made universally known that
venereal diseases are just as communicable to innocent persons as other infectious diseases, and that therefore the disease is not necessarily any proof whatever of vice. In any case, it should be the studious aim of the doctors to persuade sufferers not to regard themselves as lepers, and to discourage public opinion from fixing badges of odium on anybody. We do not, of course, mean that an easy view should be taken of vim. We mean that the danger to the nation in the growing poisoning of the blood is so terrible that it would be wrong and mad to give any man an excuse to veil his sufferings in secrecy. The only reparation he can make to the community is to cure himself lest he infect others. It should be made as simple and easy as possible for him to offer that repara- tion. The cure of individuals, and the absolute prevention of the spread of the disease—these are the proper aims of action. But if these ends are to be reached there must be no secrecy. Every sufferer must find it easy, not horribly difficult, to make a clean breast of it to his doctor ; and every doctor must know that in taking whatever steps may be necessary to prevent his patient from spreading the disease he will have the support and the gratitude of the whole community, instead of being haunted by a threat of an action for slander. No doubt the doctor will have to exercise great discretion ; he must act on his right to convey a professional secret to others just so far as it may be necessary to protect the community and no farther. If he be a patriotic man, anxious to serve his country well, he will be very careful to create en atmosphere of confidence among his patients. The last thing he will try to do is to terrorize. After all, the business of a doctor is to cure, not to judge. He must not let his patients feel that they are stepping on to • downward slope of humiliation, but must stir up in them the con- viction that they are rising through self-respect to safety and happiness.
But for the bane of secrecy the poison in the blood of the nation might have been almost removed long ago. The situation is a gigantic irony, because venereal diseases, at all events if not left too long untreated, are curable. Doctors still search for means to ours consumption and cancer, but for venereal disease the cures are known and are approximately certain. Some think it might be stamped out as completely as rabies was stamped out by Mr. Long's persistence in preventive measures. The present spirit of the people is apt to the occasion. If the opportunity for strong action is lost it may never recur. Let us seize it. The Commissioners have suggested that a law requiring notification of the disease must wait upon a public demand for such a measure. Let us show that the demand is being made all over the country now. There are no dissentient voices. At least we have hoard none. The only question raised is whether compulsory notification should be proposed now or later. Those who feared factitious objections, and indignation on the old mistaken grounds, must see that their fears were as unfounded as the fears about resistance to compulsory military service. All the signs are hopeful. They are hopeful for those who need to be cured, and hopeful for those who dream of an England cleaned and purged from this poisonous taint. The prospect will be hopeless only if in this emergency we decide to do nothing.
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