LOCK HOSPITAL ADMINISTRATION IN 1870.
diseases which
prevention of venereal diseases ought to simplest problems of sanitary science. The it is sought to prevent and their causation are
thoroughly so capable
well known, and the circumstances of infection of being brought under control, that it would
Theoretically the be one of the
so are
a matter of easy accomplishment to practice preventive medicine here; and in this country, where the social difficulties in realizing the control of prostitution are not so great as in
appear
England, we have a right to anticipate material and progressive results from a well-devised and carefully-administered plan of prevention. Yet a recent report by the Imperial Sanitary Commissioner reveals the disheartening fact that the admission rate from venereal diseases among European troops was 202 per 1,000 in 1870, or slightly in excess of It must the rate for any one of the previous four years." be admitted therefore," the reporter concludes, " that whether "
"
we
examine
for the
from individual cantonments or whole, the results have been very far
the returns
from the army from what were
as
a
desired, and the measures which were enacted prevention of venereal disease have failed to produce
the beneficial results which
were
anticipated."
It is curious
glance back at the prevalence of this class of diseases among European troops in past years. The rates per 1,000, as shown by Dr. Bryden's tables, are as follows :?
and
interesting
to
1852-53 1853-54 1854-55 1855-56
...
1856-57 1858 1859 1860 1861 These
figures 1858,
anterior to
seem
203 133 177 179 149 261 359 338 369
1862 1863 1864 1865 1869 1867 1868 ] 869 1870
to fall into three
...
...
...
...
...
...
...
...
...
318 281 254 227 217 166 199 200 202
periods, namely,??
when the average is 168 ; from 1858 to 1866
November 1,
THE LATE SURGEON JAMES EAWCTTS.
1871.]
inclusive,
average 291; and from 18G7 to 1870, average 191. period corresponds with the operation of the rules the prevention of venereal diseases introduced under Clause
lhe last for
7, Section XIX of Act XXII of 1864, which came into general use during the years 1866-67. The results?and we may accept tliem as thoroughly reliable?show a marked contrast with the high rates of 1858-66?a decrease of sick to the amount of 100 per 1,000?but are less favourable than the rates of year6 anterior to 1858. The high rates of this intermediate period have never been satisfactorily explained, and the later
improvement,
which however is still in excess of
high ratio of venereal disease, the given by Dr. Balfour for 1868 being figure 293, and for 6 stations, in which the Contagious Diseases' Act" had been in operation for some time, 271- Bengal is thus about 70 per 1,000 better than England, but the 202 former years, represents
a
for 24 home stations
"
per thousand is a result with which it is impossible to rest contented, and the report does not exhibit the precise amount of temporary
or
permanent loss of service which this causes.
least, an analysis of these diseases into primary and secondary syphilis and gonorrhoea in comparison with former years should have been attempted, and this might have placed the working of the rules in a truer light. The figures of 1870 are still more disappointing when it is considered that strong efforts were made both in 1869 and 1870 to render the operation of the rules more searching and effective by extending the area of their incidence, widening the class of persons subject to registration and examination, and rendering their administration more strict and closely supervised. Hopes were expressed in 1870, on reviewing the results of 1869, "that with the more strict supervision now introduced, the returns of 1870 may At the very
show
decided
seems
to attribute the failure of 1870 to
progress."
The
Commissioner
Sanitary
these stricter rules which had been
a
laxity
in
framed and
now
applying approved,
and
points out the great delay and carelessness which occurred in submitting the returns and reports. Now this may indicate a lax administration of the rules and imperfect performance of duty by all concerned, but it may not. Forms, returns and reports are an evidence of work, and a means of representing results: but it is clear that the work and results may exist being thus represented; and on the other hand,
without their
we see in India specious and flattering forms, reports which we know are not true represenanything. The only change suggested by the
how often do returns and tatives
of
Sanitary Commissioner to amend the unfavourable results of 1870 is a change in the forms in use, which have been altered and amplified. The rules remain the same, only a stricter enforcement of them is recommended.
We
are
inclined to
think that too much stress is laid in this and other matters
forms. If more attention were paid to things, and less forms, the issue would undoubtedly be a better one. But things cannot travel by post, and forms can : that constitutes a most significant difference. A more searching investigation of the conditions and circumstances of infection, and a more close application of measures suitably devised to meet these, is obviously necessary, and this can only be attained by the practical work of competent executive agents, which work, if its value is to be properly tested, must be scrutinized on the spot by competent supervising agents. Thus, and thus only, can improyeon to
241
menfc be obtained, and if the work is thoroughly done, its representative, the forms, &c., will follow as a matter of course. It appears to us, moreover, that the machinery of adminisIt is so jointed and complex, that it tration is a loose one. would seem to be the duty of" no one in particular to supervise the local administration and working of the rules; the appointment of a sub-committee is a step in the right direction, as tending to specialise interest and effort, but in matters of this sort the action of committees must be weak; what is wanted is the responsible individual whose special duty it is to control the executive by personal inspection, and whose position gives him a right to demand thorough work, and suggest and supervise practical measures to render that work more
effective.
As matters now
tration,
stand,
there is
if the results
or
a
confessed
the best
are
laxity
of adminis-
attainable under the
system, the question arises,?it is worth the expense and sacrifice of social involves?
The
"
rights
and
detention of
who would otherwise
feelings so
many
spread disease,"
which its
application during 1870, doubt, as far as excellent, but as
women
is
no
the cure of these diseases goes, humane and regards prevention, it must be shown that the amount of prostitution practiced is diminished, and the liability to contract disease therefrom
detention of
a
lessened,
ere
the
"
beneficial effect" of the
certain number of women in lock
hospitals can. proved. It is just possible that the number of professional prostitutes beyond the pale of registration increases in a direct ratio to the increase of the number withdrawn from the practice of prostitution by lock hospitals, and Dr. Payne's figures go to show that disease is more common among the unregistered or newly registered. The venereal appetite is a pretty constant quantity, and demand creates supply. Unless the measures to suppress venereal disease are widely and thoroughly applied, we cannot assert that restrictions and precautions partially adopted may not be neutralised by developments elsewhere. There still remains the question,?are these preventive measures the best possible, or should we not rather endeavour a kind of prevention still more radical by amending those social arrangements which engender and foster these diseases ? Future years will decide whether on the present system further improvement is possible, but while every effort should be made to render it as thorough aud effective as practicable?and it is on executive medical officers that the main responsibility and burden rests?the deeper aspects of the subject which lio beyond should not be forgotten. be
diseases which
prevention of venereal diseases ought to simplest problems of sanitary science. The it is sought to prevent and their causation are
thoroughly so capable
well known, and the circumstances of infection of being brought under control, that it would
Theoretically the be one of the
so are
a matter of easy accomplishment to practice preventive medicine here; and in this country, where the social difficulties in realizing the control of prostitution are not so great as in
appear
England, we have a right to anticipate material and progressive results from a well-devised and carefully-administered plan of prevention. Yet a recent report by the Imperial Sanitary Commissioner reveals the disheartening fact that the admission rate from venereal diseases among European troops was 202 per 1,000 in 1870, or slightly in excess of It must the rate for any one of the previous four years." be admitted therefore," the reporter concludes, " that whether "
"
we
examine
for the
from individual cantonments or whole, the results have been very far
the returns
from the army from what were
as
a
desired, and the measures which were enacted prevention of venereal disease have failed to produce
the beneficial results which
were
anticipated."
It is curious
glance back at the prevalence of this class of diseases among European troops in past years. The rates per 1,000, as shown by Dr. Bryden's tables, are as follows :?
and
interesting
to
1852-53 1853-54 1854-55 1855-56
...
1856-57 1858 1859 1860 1861 These
figures 1858,
anterior to
seem
203 133 177 179 149 261 359 338 369
1862 1863 1864 1865 1869 1867 1868 ] 869 1870
to fall into three
...
...
...
...
...
...
...
...
...
318 281 254 227 217 166 199 200 202
periods, namely,??
when the average is 168 ; from 1858 to 1866
November 1,
THE LATE SURGEON JAMES EAWCTTS.
1871.]
inclusive,
average 291; and from 18G7 to 1870, average 191. period corresponds with the operation of the rules the prevention of venereal diseases introduced under Clause
lhe last for
7, Section XIX of Act XXII of 1864, which came into general use during the years 1866-67. The results?and we may accept tliem as thoroughly reliable?show a marked contrast with the high rates of 1858-66?a decrease of sick to the amount of 100 per 1,000?but are less favourable than the rates of year6 anterior to 1858. The high rates of this intermediate period have never been satisfactorily explained, and the later
improvement,
which however is still in excess of
high ratio of venereal disease, the given by Dr. Balfour for 1868 being figure 293, and for 6 stations, in which the Contagious Diseases' Act" had been in operation for some time, 271- Bengal is thus about 70 per 1,000 better than England, but the 202 former years, represents
a
for 24 home stations
"
per thousand is a result with which it is impossible to rest contented, and the report does not exhibit the precise amount of temporary
or
permanent loss of service which this causes.
least, an analysis of these diseases into primary and secondary syphilis and gonorrhoea in comparison with former years should have been attempted, and this might have placed the working of the rules in a truer light. The figures of 1870 are still more disappointing when it is considered that strong efforts were made both in 1869 and 1870 to render the operation of the rules more searching and effective by extending the area of their incidence, widening the class of persons subject to registration and examination, and rendering their administration more strict and closely supervised. Hopes were expressed in 1870, on reviewing the results of 1869, "that with the more strict supervision now introduced, the returns of 1870 may At the very
show
decided
seems
to attribute the failure of 1870 to
progress."
The
Commissioner
Sanitary
these stricter rules which had been
a
laxity
in
framed and
now
applying approved,
and
points out the great delay and carelessness which occurred in submitting the returns and reports. Now this may indicate a lax administration of the rules and imperfect performance of duty by all concerned, but it may not. Forms, returns and reports are an evidence of work, and a means of representing results: but it is clear that the work and results may exist being thus represented; and on the other hand,
without their
we see in India specious and flattering forms, reports which we know are not true represenanything. The only change suggested by the
how often do returns and tatives
of
Sanitary Commissioner to amend the unfavourable results of 1870 is a change in the forms in use, which have been altered and amplified. The rules remain the same, only a stricter enforcement of them is recommended.
We
are
inclined to
think that too much stress is laid in this and other matters
forms. If more attention were paid to things, and less forms, the issue would undoubtedly be a better one. But things cannot travel by post, and forms can : that constitutes a most significant difference. A more searching investigation of the conditions and circumstances of infection, and a more close application of measures suitably devised to meet these, is obviously necessary, and this can only be attained by the practical work of competent executive agents, which work, if its value is to be properly tested, must be scrutinized on the spot by competent supervising agents. Thus, and thus only, can improyeon to
241
menfc be obtained, and if the work is thoroughly done, its representative, the forms, &c., will follow as a matter of course. It appears to us, moreover, that the machinery of adminisIt is so jointed and complex, that it tration is a loose one. would seem to be the duty of" no one in particular to supervise the local administration and working of the rules; the appointment of a sub-committee is a step in the right direction, as tending to specialise interest and effort, but in matters of this sort the action of committees must be weak; what is wanted is the responsible individual whose special duty it is to control the executive by personal inspection, and whose position gives him a right to demand thorough work, and suggest and supervise practical measures to render that work more
effective.
As matters now
tration,
stand,
there is
if the results
or
a
confessed
the best
are
laxity
of adminis-
attainable under the
system, the question arises,?it is worth the expense and sacrifice of social involves?
The
"
rights
and
detention of
who would otherwise
feelings so
many
spread disease,"
which its
application during 1870, doubt, as far as excellent, but as
women
is
no
the cure of these diseases goes, humane and regards prevention, it must be shown that the amount of prostitution practiced is diminished, and the liability to contract disease therefrom
detention of
a
lessened,
ere
the
"
beneficial effect" of the
certain number of women in lock
hospitals can. proved. It is just possible that the number of professional prostitutes beyond the pale of registration increases in a direct ratio to the increase of the number withdrawn from the practice of prostitution by lock hospitals, and Dr. Payne's figures go to show that disease is more common among the unregistered or newly registered. The venereal appetite is a pretty constant quantity, and demand creates supply. Unless the measures to suppress venereal disease are widely and thoroughly applied, we cannot assert that restrictions and precautions partially adopted may not be neutralised by developments elsewhere. There still remains the question,?are these preventive measures the best possible, or should we not rather endeavour a kind of prevention still more radical by amending those social arrangements which engender and foster these diseases ? Future years will decide whether on the present system further improvement is possible, but while every effort should be made to render it as thorough aud effective as practicable?and it is on executive medical officers that the main responsibility and burden rests?the deeper aspects of the subject which lio beyond should not be forgotten. be
