1396

he wish to receive treatment from a spiritual healer itshould be made plain beyond all doubt that he was thepatient of a doctor of the hospital while he was in hospital,and no treatment of any sort could be allowed which wasnot directed and authorised by the doctor under whosecare the patient was.The inquiries of the Public Health Laboratory Ser-

vice’s committee 8 on the sewage contamination of

bathing beaches in England and Wales had suggestedthat " with the possible exception of a few aestheticallyrevolting beaches ... the risk to health of bathing insewage-contaminated sea-water can, for all practicalpurposes, be ignored ". Representatives pronouncedthemselves flabbergasted at the committee’s complacency,and they sympathised with Dr. W. H. N. Angus whenhe said that the public was not going to be hoodwinkedby medical statistics and pathological techniques whenthey waded into this fxcal flotsam. The pollution of theSolent " sewer " was said to be equivalent to three gallonsof sewage in a small swimming-pool, and the meeting wasobviously more impressed by this comparison than byassurances that the committee’s findings were reasonable.On Monday a helicopter brought the Duke of Edin-

burgh, the retiring president of the B.M.A., to join themeeting, and he inducted Sir Arthur Porritt as presidentfor 1960-61.

SYPHILIS AND THE PUBLIC HEALTH

THE decline of infectious syphilis in Western countriessince the 1939-45 war is rightly claimed as highly satis-factory. There can be little doubt that much of thissuccess has been due to penicillin, which has proved athoroughly effective and comparatively safe remedy.Effective treatment, however, does not completely solvethe problem of venereal infections-a fact of which theincrease in gonorrhoea in the past few years has forciblyreminded us. In this country the number of patientswith infectious syphilis has continued to decline, and hasnow reached a lower level than any previously recorded.The total number of patients with acquired syphilis of

, less than a year’s duration attending the clinics in 1946 9-the year of highest incidence after the late war-was17,675, but by 1958 the total had fallen to 704.10 Probablyfew cases are treated elsewhere than at the clinics andtherefore this low figure does not greatly underestimatethe prevalence.The chief medical officer of the Ministry of Health, in

his report for 1957,11 remarked that it was hard to under-stand why the number of new cases of early infectioussyphilis continued to fall despite the continuing rise inincidence of gonorrhoea. He suggested that higherdosage of penicillin, now often given in a slow-releasemedium for the treatment of gonorrhoea, might in somecases be responsible for aborting incubating early syphilis.Yet early syphilis is beginning to increase in some countrieswhere the same factors may be presumed to operate.The Expert Committee on Venereal Infections and

Treponematoses of the World Health Organisation 12stated that in the U.S.A. infectious cases of syphilisincreased by 15% in 1959 over the preceding year; the8. See ibid. Jan. 9, 1960, p. 100.9. Report of the Ministry of Health for the Year 1957: part II; appendix C,

table B; p. 281. H.M. Stationery Office, 1958.10. Report ofthe Ministry of Health for the Year 1958: part II; appendix C,

table B, p. 253. H.M. Stationery Office, 1959.11. Report of the Ministry of Health for the Year 1957: part II, p. 70.

H.M. Stationery Office, 1958.12. W.H.O. document WHO/VDT/257, Oct. 30, 1959; p. 27.

disease has, in fact, been on the increase since 1954, andsyphilis in all its stages ranks fourth among notifiablediseases in the U.S.A. In recent years increases have been

reported also from Finland, France, Italy, and variousareas in Africa.

The remarkable outbreak of infectious syphilis in Mary-land, described in last week’s issue, in which recogni-tion of a single case of syphilis led to the detection of 44other previously untreated cases, shows that this conditioncan spread among the promiscuous with epidemic force.One striking feature of this group of cases was the youthof the patients. All but 4 were under 25 years of age and25 were under 20, a girl of 13 being the youngest. A jointstatement from the U.S.A. by the Association of Stateand Territorial Health Officers, the American VenerealDisease Association, and the American Social HealthAssociation, 13 declares that venereal disease is increasingamong teenagers and children. From 1957 to 1958 thenumber of reported cases of infected children aged 10-14increased from 2443 to 2793 (14-3%) and of those aged15-19 from 44,864 to 49,909 (11.4%). Full details for1959 are not yet known; but 29 States and 21 cities havealready reported increases in early syphilis in youngpeople aged 15-19, and 25 States and 43 cities have

reported increases in gonorrhcea in the same age-group.There have also been reports of an increase of bothdiseases among children aged 10-14.

In a symposium at this year’s Health Congress of theRoyal Society of Health 14 it was stated that evidencecollected from 147 clinics for venereal disease in England,Scotland, and Wales showed that new cases of gonor-rhcea had increased by 13-8% in 1958 over the total for1957. By far the biggest increase was in young peopleaged 18-19. We must be vigilant and continue to

strengthen our measures for prevention and control ofvenereal infections. There is, perhaps, one particularlesson to be learnt from the Maryland experience andfrom methods in the U.S.A. generally: the more assiduousthe efforts to trace contacts, the larger the number ofinfected persons brought under treatment. Neverthelessthe techniques of contact tracing must conform to theoutlook of the society in which they are applied; and it isdoubtful whether the method of " cluster-testing ", inwhich not only sex contacts of patients but many otherfriends and acquaintances who might conceivably havebeen exposed are investigated, would be acceptable here.

ANGOR ANIMI AFTER AQUEOUS PROCAINEPENICILLIN

IN 1951 Batchelor et a1.15 described 8 cases in whichintramuscular injection of aqueous procaine penicillinwas followed by an immediate reaction of which themost striking symptom was anxiety with a conviction ofimpending death. Bjornberg and Selstram 16 have nowrecorded similar reactions in 33 patients. A constantfeature was a conviction of impending death or severeanxiety; and sensory disturbances, such as par2esthesiTand tactile, visual, and auditory hallucinations, were

common, with various degrees of mental confusion. Theacute episode lasted for from minutes to an hour, withexhaustion and anxiety persisting for a few days or

13. Today’s V.D. Control Problem: joint statement by Association of Stateand Territorial Health Officers. American Venereal Disease Associa-tion, and American Social Health Association, February, 1960, p. 16.

14 Med. Offr, 1960, 103, 251.15. Batchelor, R. C. L., Horne, G. O., Rogerson, H. L. Lancet, 1951, ii, 195.16. Björnberg, A., Selstram, J. Acta psychiat. Kbh. 1960, 35, 129.