THE WAR DISEASE
By COL. L. W. HARRISON * " What various chances in Life, what seeds conveyed this strange disease, unknown of any through long centuries, which, in our own day, has raged throughout Europe, through portions of Asia, and through the cities of Afr:ca ; but which broke into Italy through the grievous wars of the French, and took its name from that race."
FIUS runs the translation, by Wynne-French, of the, opening lines of Syphilis, sive Morbus Gallicus, the poem in which Girolamo racastoro, in the year 153o, gave syphilis its name and at the outset ssociated its spread with war. The pandemic to which Fracastoro eferred began in 1495, with the occupation of Naples by Charles of France and the subsequent return of his mercenaries to eir own countries ; it is perhaps the outstanding example of the ct that war always promotes the spread of venereal disease.
Such an increase during the war of 1914-18 hastened the birth the Public Health (Venereal Diseases) Regulations, 1916, which airily govern the anti-venereal measures in this country today ; y apply to syphilis, gonorrhoea, and soft chancre. Good general scriptions of these diseases are available in booklets published y the Central Council for Health Education, and here it must uffice to say that, amongst a multitude of evils for which they are esponsible, syphilis and gonorrhoea do an incredible amount of arm in the production of domestic misery, individual inefficiency, of families by death of their bread-winners in the prime of life, terility, mortality of infants, and grave physical disability of children, dolescents and young adults at the outset of their careers.
During the last war the number of British and Dominion soldiers eated for venereal disease was 416,498, of whom about toz,000 ad syphilis and 271,000 gonorrhoea. The increase of these diseases 'the civilian population at that time is unknown, but some idea of t may be gathered from the number of service men who were nfected and from the facts that in 1917 the mortality of infants ertified as due to syphilis was nearly twice that in 1913 (ten times at in 1939), and that in 1938 the crude mortality of women from eurysm of large blood-vessels, a disease most commonly due to hills contracted many years previously, was two and a half times e mortality from the same cause in 1921. The contrast between is large increase in women and the relatively small increase in men s attributable to the fact that during the last war, whereas a high
roportion of the- men who contracted syphilis were treated for it service hospitals, only a very small proportion of the women
ected then can have received this protection. Syphilis kills by any other means than aneurysm ; but, for a number of reasons hich cannot be given here, aneurysm is the only one which reflects t all clearly (albeit on a very reduced scale) changes in the incidence f the syphilis which remained untreated in its early stages several ears previously.
Under the 1916 Regulations already mentioned (similar measures . pply in Scotland and Northern Ireland) the County Councils and ounty Borough Councils had by 1939 set up in England and Wales 87 free-treatment centres (rig in voluntary hospitals), and there ere 13 hostels for the care and rehabilitation of girls rendered omeless through their infection becoming known to their parents r their employers ; there was also provision, in 99 approved' aboratories, for the free examination of specimens from persons uspected of suffering from these diseases. These measures had hieved a notable degree of success. Thus there was good evidence at in 1939 the incidence of early syphilis in England and Wales s less than one-third of that in 192o, the number of early cases ealt with in the centres (which treated the very great majority of e infected) being 4,986 ; the rates in the fighting services stationed home supported the civilian figures. Less was known about the idence of gonorrhoea because a much greatr proportion of those ected with this disease were being treated privately, but, as in ther countries, the success was probably not substantial. The dis- very of new remedies within recent years had, however, raised reasonable hope that gonorrhoea had become as controllable as Colonel Harrison is Adviser on Venereal Diseases at the Ministry of ealth. syphilis, and it can fairly be stated that under modern methods of treatment, the three official venereal diseases (soft chancre is unim- portant in this country, besides being easily curable) were rapidly becoming only a minor public health problem.
War conditions have caused a sharp reversal of the downward trend of incidence, as was not unexpected. In the first half of 1939, in conferences with medical officers of health and venereal disease medical officers which I arranged in different parts of England to discuss measures for coping with the inevitable accentua- tion of the venereal problem in the event of war, it was emphasised that, through the shift of large sections of the population into areas hitherto unprovided with treatment-centres because of the absence there of any venereal disease, through disruption of families, and through the usual lowering of moral sexual standards which affects a country at war, social conditions would favour the spread of these diseases. Plans for the creation of more centres as required were discussed at each of these conferences, but the prospects of pre- venting a large increase in venereal diseases did not seem bright, having regard to the slowness of the statutory machinery for creation of treatment-centres and to the fact that the number of specialists in this branch of medicine was not much greater than was required to staff the existing centres, without allowing for reduction by the demands of the services. The prospect would have been more depressing if it had been known that social conditions here would become -more favourable to the spread of venereal diseases than probably in any war that has ever afflicted any country.
Venereal diseases are, of course, spread by promiscuity, and this is promoted principally by absence from home with only remote prospects of returning there ; reaction from mental strain ; boredom ; the possession of money to burn ; gold-digging " ; indulgence in alcohol in dosage a little higher than is customary for the individual ; and, in some societies, custom and example. We have here multi- tudes of temporary exiles from their own homes, many of them receiving very high wages, and atnongst them, as also amongst our own nationals, are very large numbers who periodically undergo intense mental strain and excitement. We have also multitudes of reckless, unstable girls who drink far too much and are determined to have a good time come what may. When to these factors, and to others which will doubtless occur to many readers, is added the fact that the density of population (always favourable to the spread of venereal disease) is greater here than in most countries, it is not surprising that in 194o early syphilis cases (including infections of British. service men in this country) were 31 per cent., in 1941 70 per cent., and in 1942 120 per cent. more than in 1939. The figures for gonorrhoea are not known so accurately, but there is no reason to suppose that they were significantly more favourable.
The measures adopted to cope with the situation include: expan- sion of treatment facilities ; revision of hours of sessions to ensure— as far as is practicable in difficult circumstances—that they are sufficiently convenient for the patients ; Regulation 33B, about which so much-has recently been published ; and intensification of efforts to enlighten the public on the nature of the venereal diseases and the importance of infected persons seeking treatment. In the expan- sion of treatment facilities, to the cost of which the Ministry of Health contributes 75 per cent., the general aim is to have these within ten miles of any infected person, and the number of centres has been increased to 209; also, under a new arrangement, Ito practitioners with certain qualifications have been enrolled in 79 areas in 13 counties to treat venereal cases in their own surgeries, the fees being paid by the local authorities. A useful gauge of the needs of any area ;n respect of treatment facilities is provided by the numbers of service infections stated to have occurred there and by the number of contacts reported under Regulation 33B. One great defect in the existing arrangements is that the proportion of infected women brought under treatment is too low. This is due partly to their carelessness, partly to ignorance of their condition (the symptoms of gonorrhoea and of syphilis in women are often so mild as almost to pass unnoticed by the affected person), and partly to inconvenience of treatment arrangements. Serious handicaps to the working of the scheme are the difficulty of obtaining premises for treatment-centres and the relative scarcity of medical prac- titioners for the staffing of new centres, or qualified and willing to undertake treatment in their own surgeries.
On the other hand we must be thankful that we are aided by powerful remedies in making the infected non-infectious quickly ; but for these, the position would indeed be serious. But more than remedies for the disease are needed. Behind the disease lie the conditions that promote it. The essential is to find remedies for the conditions that favour sexual promiscuity. That is a problem for tlac ordinary citizen to reflect on.
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