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78
Increased tourism, immigration, drug addiction, social conditions
such as broken homes, maladjustment, overcrowding, low intellectual
standards have all tended to aggravate the situation.
In any campaign against V.D. the central problem is the early
recognition of cases and their contacts. Hitherto, prostitution was
considered to be the predominant method of spread but this is no
longer so.
Largely because legislative control, as contained in the war-time
measure Regulation 33B, was resented by the public and found no
favour with venereologists or social workers, it proved singularly
unsuccessful. Today, the control of V.D. is based upon contact
tracing and the voluntary submission to treatment of infected
persons.
As a method of reducing the spread of V.D. a system of sanitary
control of prostitutes in a large German city has met with a high
degree of success. "Eros Centres" which are privately owned are
managed with meticulous attention to hygiene. Clients are "vetted"
by the matron and the prostitutes undergo regular and strict
medical inspections in between the bi-weekly check-ups. Vaginal
and cervical smears are taken and serological examinations are
carried out. Adverse findings are followed by the immediate withdrawal
of the girl to a special clinic at a hospital. Since the
operation of these "centres" the incidence of venereal disease in
the area has declined significantly.
However, even in the most permissive of societies, V.D. could
not be contracted if it were not for the undetected pools of infection.
Unfortunately, case finding is frustrating, expensive and timeconsuming
and, unless every instance of exposure is subjected to
medical prophylaxis, can lead only to reduction but not eradication.
In these circumstances recrudescence is something more than
a mere threat. There seems to be grounds, here, for the establishment
of an immunological procedure with a reliable vaccine,
especially as the treponema is becoming resistant to existing forms
of treatment.
Compared with a total of 1,321 for the previous year, new cases
of primary of secondary syphilis in England and Wales during
1968 were 1,320 (1,085 males and 235 females). While these figures
show an almost static situation, there may be some justification
for satisfaction if they indicate that syphilis has at least been contained.
Although the percentage of cases in males under the age
of 20 years fell during the current year, those of females rose
from 18%, the 1967 figure, to 23% of the recorded female total
for 1968.
Inner London, however, always a major source of infection,
returned a figure of 927 for the current year, an advance of some