Sex and science
MEDICINE JOHN ROWAN WILSON
Until relatively recently, the principal threat to health came from outside; the
story of medicine was the story of man's battle against infective micro-organisms— viruses, bacteria, protozoa. But in the last fifty years he has scored a series of brilliant victories against these tiny adversaries. Vaccination and the development of antibacterial drugs have protected him against most of the traditional plagues of mankind. The main dangers now are those which arise from his own pleasures—eat- ing, smoking, drinking, and sexual intercourse.
Venereal disease is, of course, an infection, just like pneumonia. Why, then, have we not been able to control it as we have controlled other infective conditions? One reason is that the most common organism, the gonococcus, is extraordinarily adaptable. When penicillin was first introduced, the gonococcus seemed to go under almost without a fight. It was pathetic to see the venerealogists, sitting around in their empty out-patient departments. drinking in- numerable cups of coffee as they gloomily dis- cussed what they would turn their hands to when they were declared redundant. Then, gradually at first but with increasing speed, business began to pick up. Alter a while it be- came apparent what had happened. The sus- ceptible bacteria had been killed off. But there were a few left over which were, due to some accidental mutation, resistant to the antibiotic. These, in the absence of competition, had in- creased and multiplied, quickly repopulating their restricted little world. And all their off- spring were resistant to penicillin too.
Since then, a running battle has been in pro- gress, in which science has laboured to produce new antibiotics while the bacteria have hit back by producing even more strains of resistant in- fection. They have been aided by changes in our social habits Spread is encouraged by the present fashion for sexual promiscuity. There is a great increase in the number ot girls who may have very little in the way of symptoms
but act as carriers of the infection. At one time the carrier state was found mainly in prosti- tutes, but unhappily this is so no longer. A young man interviewed on the television was asked if he got his gonorrhoea from consorting
with prostitutes. 'I certainly did not.' he replied indignantly. 'I got it from a debutante.' As a friend of mine who runs a large venereal disease clinic at a London hospital said recently, 'Yu
has really gone up in the world. We get a much better class of patient now than we used to.'
The massive increase in the incidence of venereal disease in recent years is very largely in young people, for obvious reasons. What is to be done about this? Well, doctors as a class do not have any special qualification to lay the Jaw down on moral questions. Their responsi- bility is to disclose the facts about the risks which people run in pursuit of their pleasures —whether these are smoking or eating or driv- ing fast cars or indulging in promiscuous sex. After that, it is up to society to decide whether it wants to take the risk or not.
However, in areas where conventional morality is involved, a particular difficulty , arises in relation to prevention. To recommend preventive measures may appear to condone the activity itself. This was one of the tradi- tional arguments against licensed prostitution, and it has also been raised against the giving of routine contraceptives to teenage girls.
Such a dilemma may soon present itelf in another form. There has recently been increased interest in the possibility of controlling venereal diseases by vaccination. This is theoretically possible. It depends largely on our ability to isolate and cultivate the responsible organisms. There are difficulties in doing so at the moment, but there is no basic reason why they should not be overcome. If so, we might be presented with the possibility of giving every child an in- jection of a combined vaccine against gonor- rhoea, syphilis, and non-specific urethritis, in the same way as we vaccinate against smallpox.
This might well happen at about the same time as the development of a really satisfactory contraceptive; that is, one that would make all women infertile except on such occasions as they wished to reverse the process temporarily in order to conceive. Between them, these two advances would turn sexual intercourse into a purely social activity, with no more conse- quences than a kiss on the cheek or a game of gin rummy. Sexual morality would be funda- mentally changed, since there would be no danger of doing harm to another person. And chastity, inside or outside marriage, might well end up as no more than a symbolic observance, like the avoidance of bacon by Orthodox Jews. After all, the public health measure of today is often the religious ritual of tomorrow.
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