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was removed to hospital, and all except 1 recovered after treatment. Two further notifications of
anthrax were received, but were subsequently, as the result of further diagnosis, withdrawn.
As an interesting sequel to the discovery in London of anthrax infection as a result of the use
of cheap shaving brushes, an account of which appeared in the Annual Report for 1915, it was reported
during 1916 that other consignments of shaving brushes in various parts of the country had been found
to be infected with anthrax, and had been destroyed. It appears very desirable that more stringent
regulations governing the importation of hair should be made.
Venereal Diseases.
The final report of the Royal Commission on Venereal Diseases was issued in March, 1916.
Reference to the scheme for giving effect to the recommendations of the Commissioners will be found
on p. 16. There are certain questions concerning prevalence of syphilis in recent years, upon which
a report to the Public Health Committee of the Council (6th April, 1916) was submitted, and some of
the notes made on this subject are here reproduced.
(1) The general impression conveyed by reading Section II. of the Report is, that the
prevalence of the disease is being maintained. Mr. J. E. Lane, one of the Commissioners,
however, stated four years ago that it might be taken for granted "that the extent of syphilis
is considerably less than formerly and that it is of a less virulent type"; an opinion of this kind
will no doubt carry more weight than any inference drawn from the statistics, though it might well
be argued that the figures and charts referred to in Section II. of the Report, may be interpreted
as confirming Mr. Lane's view. Again, the Commissioners think the great reduction (between
the years 1870 and 1911) from 160 to 20 "candidates refused on account of syphilis per 10,000
offering for enlistment" cannot be regarded as a "conclusive indication of decreasing prevalence
among the civil population." It may be noted that this large fall is cited by Dr. Stevenson
as one of five considerations, which seem to him "to point, though indecisively, in the direction
of a genuine fall"; and he adds that he knows of no considerations "arising from the figures
which have an opposite effect."
(2) Secondly, in their statistical inquiry the Commissioners, in the absence of reliable
death or morbidity statistics, appeal to the Wassermann test; and they draw conclusions as to
the extent of prevalence of syphilis at the present time, from experience gained by the use of this
test. They conclude that at least 10 per cent. of the whole population in the large cities has been
infected (p. 23); this estimate being, apparently to some extent, based on a generalisation from
the results obtained in 1,000 London hospital patients not presenting obvious evidence of syphilis.
Such a population is, however, a special population, which has been selected in two ways; it
includes persons of a particular social class, and it also consists of people who are ill. It is stated
that "it would have been very valuable to endeavour to extract admissions of syphilis" from
the cases giving positive results, and inquiries were actually made as to a history of syphilis in
four of the persons in question, three of whom admitted the possibility of having been infected.
The inquiries were resented and the investigation was no further proceeded with. It is interesting
to compare the results obtained with those revealed in two other estimates of a somewhat
similar character, which were not, however, made with quite the same object in view. Alexander
Fleming tested over 500 persons who were "supposed not to have syphilis," patients attending
hospital for various diseases, and others, and he obtained only 12 positive results (2.2 per cent.).
Again, Hecht obtained 1 positive result in 142 normal persons (.7 per cent.) There are wide
divergencies between 10 per cent., 2.2 per cent. and .7 per cent. The three populations
examined were probably not strictly comparable, but the great discrepancies in the results seem
to indicate that caution is needed in applying any of these percentages to so large and diverse
a population as that of London. Thus the difference between 10 per cent. and .7 per cent. would
mean a difference between 450,000 and 31,500 persons; and on the .7 per cent. basis upwards
of 400,000 persons would be passed as unaffected who would stand condemned on the 10 per
cent. basis.
Despite the extended experience gained in recent years there still seems need for a word
of caution concerning the interpretation of the Wassermann test. It is perhaps worth bearing
in mind that the test is not a specific one, and it is definitely known to be complied with, in the
case more particularly of diseases which are rare in this country, and in patients in whom
syphilis can be almost certainly excluded. Sir Henry Morris in summing up the results of a
"Discussion on Syphilis" four years ago said, "with such uncertain, variable and paradoxical
results as I have quoted, are we really in a position at present to say what the precise meaning
and value of the Wassermann reaction is ?" He then refers to the complicated nature of the
test, and he concludes "it seems to me—whose line of life is not bacteriological research—as
I have said, all very intricate and wonderful" . . . . "but of this I feel sure that
only very competent and well practised workers are fit to be entrusted with these investigations."
Doubtless the question as to the extent of prevalence of this disease will be further
elucidated as time goes on, but meanwhile caution seems to be necessary in the interpretation
of results, and especially with regard to estimates of widespread taint in the population which
are based upon observations of this character.