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a cirrhosis of the liver associated with jaundice and in some cases with rigidity of the limbs. The micro-scopical appearances in the liver were similar tothose produced by the subcutaneous administrationof manganese. It was of some interest to note thatmany medicinal waters contained small though quiteappreciable quantities of manganese salts in solution.The selective action of manganese on the liver wouldappear to be due to the fact that it was largelyexcreted from the body by the bile. It was only whenlarge doses were administered parenterally that smallamounts might appear in the urine. The similarityof chronic manganese poisoning to the syndrome ofprogessive hepatico-lenticular degeneration describedby Kinnier Wilson (1912) was extremely striking.The nervous lesions occurring in the animals used inthese experiments were at present the subject ofinvestigation.A communication on Growth-promoting Substances

and Embryonic and Tumour Extracts, by Mr. A. H.DREW, was also read.

MEDICAL SOCIETY FOR THE STUDY OFVENEREAL DISEASES.

A MEETING of this Society was held at the rooms ofthe Medical Society of London on Feb. 29th, ColonelL. W. HARRISON, the President, being in the chair.

A Suggested Investigation.The PRESIDENT intimated that the Council had

given consideration to a statement 1 made at a recentdiscussion to the effect that the modern intensivetreatment of syphilis was responsible for an increasein neuro-recurrences in syphilitics. There were

divergent views on the matter, not only here, but onthe Continent, and it was very desirable to settle it.Therefore the Council desired that members shouldinvestigate the point, each in his own clinic. Duringthe war about 100,000 soldiers had had a necessarilyshort course of salvarsan and mercury treatment,and as the war started nine years ago, the time wasapproaching when the aftermath of syphilis of theparenchyma of the central nervous system amongthose cases could be expected. On the basis of a4 per cent. incidence of general paralysis of the insaneand 2 per cent. of tabes, then some 6000 of those warcases could be expected to present themselves withsyphilis of the parenchyma of the central nervoussystem. He believed there was nothing like thatnumber in the whole country, and in the treatmentcentres none, or very few, had been seen. He hopedthis combined inquiry would settle this importantquestion once and for all.

Dr. F. N. KAY MENZIES supported the Presidentand advocated the issuing of a questionnaire to all incharge of venereal clinics.

Dr. WILFRID Fox said a similar statement wasmade after each advance in the treatment of syphilishad been introduced. Some thought neuro-recurrencewould ensue if anything more than Hutchinson’spills were given.A discussion was then held on

The Instruction of the Medical Profession and of the LayPublic with Respect to the Facilities Provided for the

Diagnosis and Treatment of Venereal Disease.Dr. MENZIES, in opening, pointed out that by

Article IV. of the Public Health V.D. Regulations,1916, county councils and county borough councilsmust arrange lectures and addresses of an instructionalcharacter, as well as for the publication of anyinformation which was likely to be of value, eitherto the medical profession or to the lay public withregard to venereal diseases. Those in the LondonCounty Council took the view that it was best thatsome things should be done by the public authorityitself, while others could well be delegated tovoluntary bodies, which should be paid for the dutiesthev carried out in furtherance of the scheme. The

1 See THE LANCET, Jan. 19th, 1924, p. 131.

whole profession in London was circularised, givingparticulars of the schemes for treatment and thefacilities which had been set up, where material couldbe reliably examined, and a report furnished ; alsohow the members of the profession could be mergedinto and be helpful to the whole crusade. Certifiedpractising midwives were also supplied with thenecessary information on the subject; these could bevery useful in bringing cases suffering from syphilisto the clinics. Other circulars were sent to maternityand child welfare centres, Poor-law authorities, andprison authorities, the last-named because of thenumber of prisoners who might still be in an infectivecondition when their sentences had expired. Magis-trates, police, and bodies of social workers were alsocircularised. Next, a scheme was started for informingthe public where treatment could be obtained, and Dr.Menzies showed specimens of posters which hadbeen exhibited in public lavatories and other suitableplaces. He described the evolution which the Councilpassed through due to changing views as to whatwere the most efficacious means of reaching the public.In 1919 special series of addresses to employees ofcontrolled firms were organised, and film representa-tions setting out the dangers of the disease werefrequently shown. Special committees were alsostarted in the various metropolitan boroughs to assistthe propaganda work. ilne L.C.C. nan now uroppeathe press portion of the campaign. In London thepathological examinations made for practitioners inconnexion with the disease numbered 3000 in 1917 : -.in 1923 it had risen to 24,000. The teaching facilitiesto the profession had given, so far, a rather dis-appointing result. The all-day clinic had been foundto be of enormous advantage. Four hundred Londonpractitioners had now taken up the offer of salvarsanand substitute drugs free of charge, having producedthe necessary certificate of competence to use them.Hints as to better or more likely lines of attack hadbeen invited, but to this the critics had made a verypoor response.

Mr. FRANK KIDD agreed that the propaganda whichhad been carried out by the L.C.C. was admirable,but as there had been some very unwise propagandaindulged in, he wished to utter a warning. It was,he thought, a mistake to use fear of disease as aweapon for inducing people to come for treatment,though probably it had been a factor in getting theV.D. clinics started, and without the clinics it wouldnot have been possible to train doctors to use thenew means of treatment. In the long run schemes ofpropaganda based upon fear were bound to fail:and a new malady seemed now to have arisen, whichhe might call propaganda disease. There were nowan increasing number of patients with syphilophobiaand gonorrhoeophobia, who consulted the doctor witha fixed terror of venereal disease. They believedthey would never be cured, that they would not beable to marry, and would die insane. They had reada number of alarmist statements in the papers, andbelieved them to be true. At a venereal section, of630 attendances, 34 were women who applied becausethey suspected their husbands after reading propa-ganda advertisements, but none of the husbandswere found to be diseased. Three others who werefree of disease came because what they had read intheir Sunday paper made them uneasy. Many-mostly men-applied for expert examination beforemarrying. In many with diseased minds on the subjectit was found to be difficult, if not impossible, to curethem. Some of the patients had been in the hands ofunwise and inefficiently trained men, and in them therewas no evidence that there had been disease for along time. Mr. Kidd quoted a number of cases

illustrating these points. He urged that in thiscampaign an appeal should be made to the highestinstincts, the building up of character and of goodclean social habits. He would rather see 10 per cent.of the population suffering from venereal diseasethan 50 per cent. suffering from, weighed down by.the fear of it, and he held a similar view on the subjectof the cancer campaign.

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Mr. E. B. TURNER dealt with the question fromthe standpoint of the general practitioner. He saidhe agreed largely with what Mr. Kidd said concerningpropaganda on the wrong lines, but, as one who wasresponsible for a great deal of propaganda on thissubject, he was convinced that propaganda on rightlines did an enormous amount of good. There mightbe cases of syphilophobia, but the campaign hadbrought to many the realisation that they had thedisease and how important it was that they should bepromptly treated for it. The free clinic was a wonder-ful way of treating the disease and diminishing itsincidence. But it became a different matter in ruraland other sparsely populated districts. There clinics were few and far between, and the servant or

farm-hand could not get leave from work to attenda distant clinic. When clinics were set up in thesuburbs ot large towns patients preferred to go intothe town because they felt more secure from sus-

picion among their fellows. The only remedy seemedto be the education in these matters of the medicalprofession as a whole, and it was this need whichmade him urge a general recognition of the subjectby the General Medical Council in the medical student’scurriculum. Even though some medical men preferrednot to treat venereal disease every practitionershould be able to take a smear and make a diagnosisand, if positive, direct the patient to the place wherehe could be efficiently treated. The aim should beto get cases at the beginning, and to that end the wholeprofession should be organised.

Prof. WINIFRED CULLIS said that, as a physiologist,she had always sought to emphasise the supreme import-ance of maintaining a high standard of health. Sheagreed with Mr. Kidd in deprecating the use of fear as amotive. Remedial measures were good, but how muchbetter to be able to abolish the need for those measures.Unless the general populace could be educated asto the need to go to the clinics, the latter would do nogood. With regard to syphilophobia, a certain pro-portion of people suffered from mental instability,but that was not a good reason for abolishing propa-ganda, which admittedly brought many people tothe treatment centres. If physiology were moregenerally taught she thought there would be a muchmore sane and helpful attitude in regard to sex

matters ; there was still appalling prejudice on thesubject, even among those who considered themselveseducated, including the clergy. Help was requiredfor the necessary teaching among the youngerpeople. Positive knowledge was one of the bestpreventives.

Mrs. NEVILLE ROLFE, representing the NationalCouncil for Combating Venereal Diseases, said thisbody wished to push this campaign further than thepublic purse would support at present. During thelast two years the National Council had been able tocarry through a large amount of propaganda workagainst these diseases. She did not think the success of the campaign should be judged by its effect upon people who were abnormal, though she agreed withMr. Kidd and others that the ground-work of the ’efforts should not be the instilling of the fear of the 1consequences of disease. Knowledge of the conse- quences, however, should not be withheld, nor should the bad results of neglecting to continue treatment. After a propaganda film was shown in a district the immediate attendances at the local clinic were often 1doubled. The Council had first to bring venereal disease up to the level of other public health subjects in the national consciousness, and she believed 1the right line now was to take all health subjects itogether and no longer concentrate on these particular diseases. Efforts should be made to reduce the agencies <

which promoted promiscuity. In four years the various (

notices had resulted in 87,600 letters being addressed i

to the National Council, a large number of the writers iof which believed themselves to be infected and asked E

where they could obtain treatment. Mrs. Rolfe vproceeded to speak in detail of the activities ot the 1Council and the steps taken in the interests of men in s

the Mercantile Marine, i

Colonel E. T. BURKE thought that such cases asMr. Kidd spoke of were exceptional. Certainly theteaching of the general practitioner in these matterswas essential, and it should be made a compulsorysubject in the medical student’s curriculum.Students should be required to have three or six months’in the work of a V.D. clinic, so that a regiment ofmen would be built up who would be familiar withthe matter on entering general practice. ColonelBurke spoke of the harmful effect of the statement 01some doctors to their patients that three or fourinjections of " 606 " would put them right.The PRESIDENT said he was sure Mr. Kidd would

agree that propaganda was good so long as it waswise. He had long telt that all that was required wasa plain statement of the case, without exaggeration,with emphasis on the value of thorough treatment,and its effect in preventing horrible late sequelae.He thought the posters in the public lavatories werein the wrong place. In 1919 an offer was made bythe Insurance Committee of London to give post-graduate instruction at Rochester Row, and in twoyears 400 practitioners attended that course. AtSt. Thomas’s Hospital it was made compulsory forall dressers to attend the instruction on venerealdisease in the centre. If that were followed at allhospitals it would do much to anticipate the benefitwhich would later accrue from the steps taken by theGeneral Medical Council.

Dr. MENZIES briefly replied.

SOCIETY OF MEDICAL OFFICERS OFHEALTH.

A MEETING of the Fever Hospitals Medical ServiceGroup of this Society was held on Feb. 22nd, Dr.E. W. GOODALL, the President, being in the chair.

Dr. E. H. R. HARRIES opened a discussion onBed-Isolation, with Special Reference to Measles and

Chicken-pox.His paper appears in the original columns of thepresent issue of THE LANCET.The PRESIDENT congratulated Dr. Harries on his

observations, but thought that little, if any, knowledgeon the subject had been added to what was broughtforward at the discussion held at a meeting of theGroup in May last. In addition to the factors men-tioned as being favourable to the spread of infection,such as the period of the disease, he would add theperiod of the epidemic. There was some evidence toshow that certain diseases were more infectious duringthe waxing than during the waning of an epidemic.From his experience at the Eastern and North-WesternHospitals he had come to the conclusion that neithermeasles nor chicken-pox in the acute stage could benursed, with safety to other patients, in a " bed-isolation " ward. In his experience cross-infection wasmore frequent in such a ward than in a ward or blockconsisting of completely separate rooms or chambers.That went to show that the conveyance of infectionby air could not be ruled out. " Bed-isolation " wardsshould not contain more than 16 patients at theoutside. The smaller the number of beds the betterthe result. It was desirable to provide the nursingstaff employed in the ward with a written set of rules,but those rules should be simple and comprehensive.Local sanitary authorities must not be led into thinkingthat all kinds of acute infectious diseases could betreated together in the same ward under " bed-isolation " regulations, because even if it were foundthat the infection was never air-borne, it was quitecertain that to prevent it being carried by any memberof the staff that staff must be highly trained in thesemethods, and it was unlikely that the staff employedin small isolation hospitals would possess the requisiteexperience and technical knowledge. He thought itwould be very difficult to defend an action-at-lawbrought in the case of a patient who had contracted aserious disease, such as measles, from another such caseintentionally admitted into a " bed-isolation " ward.