Ante-natal Treatment of Syphilis: Demonstration of Results at the London Hospital
BMJ (Clinical Research Edition)
A DEMONSTRATION of tlle results of pre-natal treatmrent of syp)jilis was givell at the London Hospital on Decemiber 18tl, whlieti a numiber of nmedical Im1enl and wotm-en and otlhers interested in lhealtlh and social work attenided at the inivitation of the cllairmilan of the lhospital, Viscount Knutsford, and Dr. J. H. Sequeira, tlle director of the venereal clinic anid of the skin departtmnent. More tllan forty infants were presenit witlh their m:otlhers at a Chr-istmas gatl-hering, and the
... l-hering, and the visitors were able to see for tlheniselves the lhealthy appearance of the children. All the cliildren were borni of motlhers wlho lhad been treated gor syphilis in the department durinig pregniancy, and in eaclh instance the cilild was free from clinical evidence of conigenital disease. Lold KNIT -FORD, in presiding over a brief prelininiarv discussioni i1 time adjoininlg roomI, expilained thjat mauy woimien in tIme area served by time lhospital hlad been fountid tolave stcceisiive m-liscarriages owing to syphilis. As a result of Dr. Sequeira's work, not onily were the imiiscurriages and stillbirtlhs prevented, but thie chiildreui wer e borti free ft-otuu (lisease. SuchI a work wouild imot lhave beei pos.-ible at tIme Lonidon Hospital witliouit the gene-ous lieljm of time (3rocem-s' Couimpany of the Citv of Lond(lon, wvho nale it one of their special objects to iielp philanthropic wolli whlicil lhad a scientific basis. This company gave ,10,000 to build wards for acconummlodatingsyplilitic cases. Thle cases were collected thllouglh variotsl organizations. It was tlhought wlheni tIme departmnent was started tlat it would be diffictult to get the expectant icothmer to cotnie and declare herself syplhilitic, but in practice thiis difficuLlty dlid ilot seein to arise. Soime of tlIe tmotlhers cailne to the obstetric or niatertnity dlepartmiient witlh a hiistory of miscarrl'iages; otlher suls-pected cases wvere senit on by miiaterniity almioners wvlo worklied the district Withmiil the -adins of a immile of the hiospital; tIe City Of Lomi(doni Lying in los- pital also senit a numiber of cases. Time de)mar-tmnent was vow cotnecting up) withi va-to1is miiatet-nity centre-S, and it was (lesired to conmplete this last piece of o-aninz,ttion anld to suL,ggest time sanle plant to llospitals in otliem dlistricts. 1)1. SiQumt,:IA relerred to tlho tiew sp)irlt wvith wVhichI this Wh11ol (questiOnI Avas n0ow aipproachled. A clause in the cliArteof tIme Louidoni Hospital wlliclh at onie timne lield goo(d deniie(d admrsissionl to p-egtnatnt Nvomoienl an(d also to petsoims stuffe-ing( fr-ont v-leneeal diseases. Tlheme were sone institutions where tlle spirit of tlhat old by-law still survived, and hiis desire was to prove tlhat this bit of progressivisin was iot otnly witlhout danger to tIme receiving iWsLttituionm, l)Lt tilat it lbad great advanitage for time coimnumim'ity. Siice March l1st, 1916, wlieni, tihaiilks to the renenrosity anid enligilteniument of tile Grocers' (oti paniy, tihe wvards wvere openetd, fifty-six pregnant wonmien sufferiuig frouim syphillis lhad been treated in time private rooims of those wvards, auid tlese wonmlell in due timile liad borne children, forty-five of wvhmonm, absolutelv free f-ouim itufectioum, wvere presenit that afteinoon. Seveii patients could not be tr-ced owitlg to retuiovals. In four other cases replies had been received fromii thle mothiers that the chiildreni lad d iem], in one case fromi inifluenza, in. anothier from nmarasim mus prol)ably due to bad feeding, atid ini two othier cases frotii causes whlichi lie lhad not beeil able to aseertaill, but eveen if these chiildreni died from congenital syplhilis, time restilt renimined rem-larkably good. Somiie of the woniuen canile to time venereal departmiient and xve-e found to be preguant, others were sent fromti tIme obstetric departtujent and from qlmtslide organizations, were tirst exariiiec by time Wasseril.maun test, amid, if this was positive, canine to hiis departimmenit for treatment. After treatuimenit tliev went to tile lying-in ward or came under the out-patient clharity, and were attended by time mnidw'ives anid setmio students under tIme suipervision of the obstetric pljysicians of tIme liospital. He was ofteu asked wlhether it was not a serious tliing to send tlese women inito tIme ly, ing-in ward, buit lhaving received injections, they wvere niot sources of infection to operator or niurse, provided due care w%,em e talien. It was also asked wvletlier time injection mliglht miot cause a pregnant woman to miscarry, but this occurrence was so rare as not to invalidate Ihis general statenjment that every patient found to be sufferinuy frouml syphilis simould: be treated and t"eated proummptly. H-e gave -particulars of sonie cases in detail. One wonmaln (wlvo was presenit that afternooni witlh lher infant) lhad a child( born dead in 1907, a second born dead in 1909, a thlird born alive in 1913, but the subject of congenital syplilis, and in her fouirtll pregnancy, after being treated in tle departmienit, lhad( a baby born at full term and witlh a negative Wassernamnn r-eaction. Anlotlher wolan witl a syplhilitichistorv came to the department in 1916, and hiad lhad two clhildren sinice tlie treatmnent, bothi of wlhomn were alive and well. Another witli tllree miscarriages before treatmiient now lhad a hlealtlhy clhild. Yet anotlher, who lhad lhad five miscarriagces, was treated in February, 1917, wlhen slhe was two miiouithls in pregnianey; lher elild was born in September, anid was now, at 14 montohs, a perfectly hlealtlhy child, witlh a niegative Wassermauin reactioi. In conclUsion, Dr. Sequeira pointe(l out thje niecessity for co-operation between the miiatetriity centres, thje inifaInt welfare centre, tIme laboratory wlhere the Vassermann test was doone, and tlhe venereal clinic. Lately the officem s in charge of nmaterniity and clhild welfare centtes h:a(l been sending cases, and it wvas thisii side of thie worli wlicll needed enlarg,emlenit and official encouragemient. A mnedical officer of the veniereal clinic in a towvi of 40,000 inhabitants was vi.siting the departm-ent recenitly, and the speaker asked himii iflie worked in association with the maternity centre. His reply wvas tihat lie did Inot klnow whetlher hiis town liad one. Evidenitly theme was wanit of co-orclination somewlhere. Dr. Sequeira conClUded by acknowledgingI his indebtedness to I s obstetric and(1 otlher colleagues, hiis clinical assistanits, alld the nursing staff. Sir' THOIHAS BARLOW congratulated Dr. Sequeira on his results, anid tlho tenli workli wlicil lhad inade thiemu possible. 'The conduct of hiis clinic was ani object lesson to tlienm all. In tackling sociological problemus like veniereal diseases and iniebriety, tlhere ouiglit to be a frienidly contspiracy between all people of knowvledge and good-wvill. Dr. MARY SCHARLIEB endorsed Sir Thlomiias Barlow's remiialks, especially front tlle poinit of view of womtjeni doctors, niurses, and all womiien coneerned foL the fuiture, of tIme race. It was verv iuportanit tlait tlie mtiotiemn shiould be mtade to feel tlhemitselves sisters and fellow citizenis, and thiat anl atumiosplhere3 of sympathy anid niolt of reproof should be created. Sir AU I'ltl Lt NE,'SHIOL-ME sai(d that lie \vouil(l (m11ole tlio London Hospital as an examnple of co-operation between the (liffel-ent departniienits, to jLsttify tile settilnfg u^p of thlese; cliniics in a general lhospital. He and ihis departmient at thle Local Governmnent Boar(d attaclhed gLeat im-iportanice to the securing of co-operationi between clild velfate anid venereal disease centres, and also between such centres and tlie g,enieral practitioner. Efforts lhad al-eady been iiade in that direction -witlh sonic0 miieasure of success, wvieli would hlave becum greater but for the large diver-sion of practitionie s to armlly service. Midwvives anid general practitioners lhad beeni advised to send their patients, especially thjose whlo had lhad repeated miscarriages, to the veniereal clinic; tIme iImiportanice of this co-operationl wvas fully ealize(l officially, anid lie believed that withlinl thje next year or two it woiil(l be mtiuclh further (leveloped. THF Journal Ogciel lhas prontul(latedl a (lecree or-(fallizing the control of the imiaking, aid dlistril)ution of raditum atid in general of all radio-active bodies and Iuitnilsous; pro(lets (lderive(d fromn that subl)stance. A bureaui ot radioactive l)odies in. conniiexioni wvith tle Millistiv o Ariillllnent is clharg,e(d with the fabrication, inmportatJion, and e.xp)orta-1, tion of these, agents, b)ut the contr(ol for medical pitirpos-is will be exercised by the Ullder Secretury of State tor tIme Healthi Service of the FreniCIh Ar-imiy. THE ninth annual report of the Council of the Inidiani Institute of Science, Bengalore, showvs that the buiildlillgs are now nearly complete, and it is expecte(d that the library bloeck will be taken over duLring the currenit ses;sion. Tlhe income paid to the council by the board of mlanagement of the properties in Botnbay was £8,794, and(l exceeded the sutni guat-anteed by £461. The Goveranmjenit of India has increasedl its contribution by half thiat amnount, anid tlle Goveunniient of the Nizain of HIyderabad has prom-ised £666 ayear forthree years. The instittute las co-operated with the Indian Muuitions Board in the utilization of local resources for war purposes. The eyperimental work in connexion with the production of acetone, formerly carried on in the institute, has been tratisferre(d to the Government acetone factory at Nasik. Sir Alfred Bourne, whose term of office as director of the institute expired in 1917, is continuing in office for the p)resent.