% l:txCDamoTnI 1 584', MEDICAL JOURNA~L j ANTI-VENEREAL MEASURES IN THE AMERICAN ARMY. [rNov. 23, .9*0 7 7 -- beyond losing his pay-wlile the disease disables him fep TIE_WAR. duty, provided he lhad prophylaxis. after exposure. But if lie contracts a venereal disease and has not, according to regulations, had proplhylactic treatment, lhe is court- A' lT-VENEREAL MEASURES IN THE martialled for disobedience of orders, and, if convicted, is AMERICAN ARMY. punished. Since 1912 there lhave also been fortnig-ltly Di). W. A. PUSEY, Chairman of the Committee on Venereal physical inspections. 1)isease appointed by the Surgeon-General of the United In the planning of the base hospital of each cantonment S;tates Army, has recently published a detailed account full provision lias been made for venereal diseases. ft'is a of the manner in which the venereal disease problem' is part of the scheme that men suffering from acute venereal lhandled in that army.1 disease shall 'be confined to the 1hotpital until the acute T'hi venereal disease rate of the avmy previous to 1898 infectious stages are past.; this applies to all cases of acute averaged per I,000; had thle present gonorrhloea and, all cases of syphilis, w,hi,ch lhave early moore rigorous conditions of recording syplhilis tlen been active lesions. It has sometimes bee'n`round,'difficult to get in force, it is estimated that the rate for venereal diseases this policy'cartied' out. 'One of' th'e arguments for it is the it (luring that period 'would have been 110 per 1,000 or mnore. great advantage affords 'in il'o orrlhoea' for curing With the mobilization of new troops in the Spanish- quickly and preventing its spread to t posterior urethra; American war in 1898 the rate suddenly dloubled, aoing another is the assurance it givesof theoroughearly to 160 per 1,000. The high rate then produced persisted treatment of syphilis, and the rapidi-y withi wlhicli the ,after the war for thirteen years, varying between 180 and infectious stage is. passed; a third, andi a very great ad- 160 per 1,000 until 1911. Between 1909 and 1911 tlhe vantage, is the reduction in thie dainger of non-venereal miiedical department developed its wrecseut policy. Its spread of tlhese diseases. mnost important features were regulations which pro- Each base hop,ital is provided with a general laboratory vided for loss of pay for disability fromnvenereal dis- inl whlichl W0rasserman tests are rnmde,'.'and, it is intended eases, periodical pljysical inspections, and venereal pro- I th:tt eaclh veniereal service in the 'base lisopital slhall lh'aye plhylaxis. The result ot this policy was slhown by the its own small la'boratory, equipped for ex'amination for rapid and continuious decline in venereal diseases. Fromn spirocliaetes and bacteria and for' -thie examination of alate of 164 per 1,000 in 1911 it dropped to 116 in 1912 to 86 in 1913. The measures taken are first, social 'Tihe conduct of nmedical affairs in the caiitonments and educational, and secondly, proplhylactic and muedical. depends to a very large extent on the attitude of those in Social measures include the repression of prostitution and supreme autlhority-tlhat is, (1) the commanding general of the liquor traffic, which it is lheld go together, and the in a cantonment; (2) tlle division surgeon; and (3) the provision of proper social surroundings anid of opportunities commanding officer of the base hospital. for recreation and diversion. Aleoliolic liquor is a factor The place where patients with chronic gonorrlloea and in the diffusion of venereal diseases, owing to its weakening syphilis are likely to fail to get expert care is in the effects upon those inhibitoi y influences that under ordinary division as distinguished from the base hospital. The conditions prevent man's givingvway to Ihis impulses. regimental surgeon must be a general practitioner wliile The control of the liquor traffic and of prostitutioni lie is in that position. Adequate care of syphlilis and of lhas called for co-operation betweeni federal anid local tlhe chronic complications of gonorrlhoea eminienltly demand uLtlhorities. Inside cantoniments atnd other (lovernnicent expert training, and this is no more to be expected of the ieservations the federal autlhorities are supreme, buit in regimental surgeon than is special training ini all the other a(ldition a district las been provided by law, consisting specialities. Mdeover he is not provided witlh the special of R. zone, at present designa,tied by the Secretary of -War equiipment nciesary for it. It ollows, tllerefore, that to be five miles, around eachl of the cantonments. In gonorrhoea and-syphilis should, as fai as possible, be taken tllose3 zones the federal authiprities are in a position to out of the care of tle general medical' officers. The policy control completely the liquor traffic and the various Con- is to send them to hospital as freely as practicable, and dlitions which encourage, prostitution. Outside the zones everything is done to encourage the. return of ambulatory tlhe Federal Government can still exert great influience. cases to the hospital for such treatment as they need. It BJut for the mnost part reliance has been placed in great is also the policy to have a qualifiedofficer detailed for the measure on the local eivil authorities, and, owing to tlhe special duty of.supervising all venereal mnatters, including awakened public conscience, they lhave, almost witlhout the treatment of venereal cases througlhout the can'ton exception, realized their responsibility in tllese mnatters, ment. But in spite of tliis the fact remains that the weak a.nd responded as well as the most sang,uinie couldlhave point in the.are of the soldier's venereal diseases is 'the asked in their efforts to improve them. The schlelmle does carehe receiveswhenhe is on duty. He is allowed to stay iot include the segregation of prostitutes, nor their ex- on duty often when it would ultimately be better for hi'm ;1 11fination or certification, but every endeavour is illade to and for the servipe ifhe were nominally as well as actually sick, and unider expert care. This is often due to stiuulateactivity in earing for venereal eluop the civil. population, with the ain, among otlhers, of eedulcing attituide of the'commanding line officer'. He wants his tlnt?uinber of "car-ie-s." mneni or he doesnot want them, and he has no use for'tb is For the army itself the first part of prop-hylaxis is the sol(lierwvho taing lhalf-days off to go to the hospital for prevention of infection after exposure. The regulationis treatmnent. There is room for much education bere, and wvith regard to this are of universal application, and for the development of considerably more co-operation. care is talken to see that it is tlho-oughly carried out. The results of the policy have been satisfactory. Between Venereal proplhylaxis is; part of the dtuty of every 1897 and 1900, a period that covered the Spanish-American '-egimental infirinary andil of every othter infirmiary tlhat war, the venereal rate went up from an average of 80 per lhas in its care the healtlh of a unit of soldiers. The 1,000 to 160. Since 1913 the ratehas remained under 90, regimental infirmaries (lo inost of thtis work and every- excepting during 1916. In 1916, when there was a rapid tliing for giving prophylactic treatmient, is always acces- increase of the army and mobilization on the Mexican sible in every one of these. Them:edical officers are borde-, the rate went to 91.4. Dr. Pusey takes the rate of 'esponsible for it, but it is etarined ouit by specially trained 90 as the mean average to be striven for in the present ieon-commissioned officers, one of whiom-1 is constantly crisis, although the rate of 91 in 1916 would certainly be on duty, so that the returning soldier can get prophy- fairly justifiable as'the standard. The rate for the regular .lactic treatment at any timiiein the twenty-fourlhours that army fromSeptember, 1917, to May, 1918, averageda little lie applies for it. As far as possible prophylactic treatment betten than 90. 'With the secon week of mobilization is carried out seriously, without allowing an atmos'phere of th)e venereal rttb for the National'Army shot up to 367 per levity or obscenity to creep in. The necessity formedical 1,000. The National Guard atthis time showed a rat of prophylaxis is instilled into the soldiers' minds. They are 150. The rate of the Regular Army at this date was S. told that it is not a sure preVentive of infection; that the Thie very high rate in the National Army is to be -sooner it is applied the' nmore likeyiti6t and accounted for by the fact that when venereal disease is discovered for the first time in a soldier it is counted as that after eight hours it is likely to be ineffective. The new taking of it, if exposed, is a of army If a ease, although it may be an old infection;i,four miatter regulation. to a ran coutracts venereal disease, he is not punished wooks liad 'elapse before. the' icidence of veneW disease ina b&ly of troops eotid 'boe determined4 4he Jo01r7r. Ainer,Mee. Assoc., September 28bb, 1918. rate for the National Army for the-first four week. ader 'Nv.: 23, tCASUALTIES IN THE MEDICAL T m, BarTu * 85 i9g8j SERVICES. i bIEDGICAL JOURNAL 585 mobilization was twice that of the National Guard. This Died on Service. would appear to suggest that the prevalence of venereal LIEUT.-COLONEL J.