Sexually transmitted disease [STD] control.
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Biomedical subjects
Publications and source records attributed to R S Morton.
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Modern society bears a heavy burden of medico-social pathology particularly amongst its young. The size, nature and costs of the sexually transmitted disease element is now considerable and dwarfs such successes as have been achieved. In the belief that the structure of a society and the way that structure functions determines the size of its STD problem, a review of Ancient Greek society has been undertaken. Greek society, not least concerning all aspects of sex, was well ordered, frank and tolerant. Some of the areas of Greek society's structure and functioning which differ most markedly from ours, and seem to have determined a modest STD problem, are highlighted and discussed. Greek ideas that might be adapted to match today's needs are presented for consideration.
Catherine the Great (1729-96) ruled Russia for the last 34 years of her life. She pursued many reforms with energy, intelligence and political shrewdness. Not least amongst her activities was a serious interest in matters of public health which extended to personal involvement in the care of the venereally infected. This paper suggests that perhaps her zeal in this last was based on more than social awareness.
It is widely recognised that the history of art reveals the contemporary attitudes of societies and artists to changing patterns of social and sexual behaviour. This collection of artistic creations shows that representations of syphilis in art, over more than five centuries, are consistent with this view. The first quarter century of the morbus gallicus in Europe, starting in 1493, coincided with the spread of Renaissance influence, including printing. A host of pamphlets with woodcut illustrations reflected public alarm at the epidemic proportions and severity of the new disease, with its disabling and sometimes deadly consequences. Also revealed in these early works are the astrological and theological beliefs of disease causation as well as identifiable and serious attempts at public education. These twinned themes of understanding and educational endeavour recur together throughout the centuries and take many forms as man attempts to outline and influence attitudes and so improve his medico-social health. Attitudes to causation changed with experience so that by the beginning of the 17th century the morbus gallicus is no longer a mere contagion but recognised socially and represented artistically, as a morbus venereus. Its clinical presentation had changed remarkably from the alarming early days; and so too had its prevalence--from epidemic to endemic proportions. We find that the artists of both the 16th and 17th centuries, while somewhat reticent about syphilis, are nonetheless at pains to suggest that sex is not without its serious side effects. Their artistic exhortations suggest women as the source of the disease, so that we find Venus shown as both ideal love and the source of contamination. Such attitudes contrast strikingly with what follows. The 18th century is characterised by the sophisticated elements of European societies taking an irreverent or satirical view of sex and syphilis. In England this is reflected in the works of Hogarth and other notable caricaturists. The fierce castigation of men and their follies is matched by more understand and rational attitudes towards women. But it does not last. Indeed it seems almost to invite the studied censoriousness of the 19th centrury with women again stigmatised as a source of degradation and disease. In essence this collection of examples of syphilis in art illustrates wide variations in attitude and behaviour from alarm to tolerance and from intolerance through liberality to licence and much the same again, over nearly five centuries. Just occasionally an artist seems to be ahead of his times.
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The need to improve the function of public health services to control sexually transmitted disease (STD) is presented. Improved public health service function in the United Kingdom calls for an improved administrative structure; a 10 year programme of development is envisaged. The threat of a heterosexually based epidemic of infection with human immunodeficiency virus (HIV) offers an opportunity to improve the control of STD generally.
Reports published in the past twenty years include many purporting to show, without much reason, that classic presentations of neurosyphilis are the exception rather than the rule. We join the few who take another view, and discuss here the reasons underlying the conflict of opinions.
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Recent developments in syphilis serology are set down. The approach today is more rational as it has some basis in immunological understandings. In spite of improvements, syphilis serology continues to have limitations, and differentiating active from inactive cases remains taxing. In primary and secondary syphilis, dark-ground microscopy is still the quickest and surest way to make the diagnosis. In latent syphilis and in late and congenital cases, as well as in instances of other treponemal infections, serological evidence of disease needs to be considered along with each patient's medical, social and sexual history, when and why they may have been given antibiotic treatment, and the results of radiological studies and cerebrospinal fluid examination. For some syphilitics, the decision to treat or not to treat remains a matter of art rather than science.
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Prostitution in Sheffield, a city with over half a million population, has been reviewed in its legal, social work, and medical aspects. The years studied were 1960-73. The medical studies were confined to the years 1968-72. Prosecutions for soliciting increased steadily during the study period. The trend was more marked locally than nationally and was associated both with increased police activity and, more recently, with the pursuit of a socially-aware sentencing, probationary, and social work policy. During the 5-year medical study, sixty prostitutes were seen. Using gonorrhoea as an index they were found to hazard the health of both themselves and others. Recurrent infection was the rule amongst them and 40 per cent. suffered salpingitis. In epidemiological terms our findings show that the vector role of prostitutes continues undiminished. The alleged decline in their role is relative only and not real. They accounted for one in six of locally acquired gonococcal infections in heterosexual men. The study indicates the need for the regular monitoring of the social phenomenon or prostitution and for the detailed study of all its aspects on a national basis.
A study of the occurrence of Clostridium difficile in the urogenital tract of males and females revealed higher isolation-rates in patients attending the special (venereal-disease) clinic than in patients attending family-planning and urological clinics. The presence of Cl. difficile in patients with venereal diseases is being investigated to see if the organism is simply an opportunist infecting a urethra disturbed by some antecedent disease, or if it is perhaps a primary cuase of disease.
By means of a standard lymphocyte microcytoxic technique, the tissue types were fully determined in 41 patients with non-gonococcal urethritis and 25 patients with Reiter's syndrome. The antigen HL-A27 was identified in 14 of the patients with Reiter's syndrome and occurred in 3 of the patients with non-gonococcal urethritis. An excess of the genotype HL-A27/W10 was found in patients with Reiter's syndrome. There was no correlation between the duration or the severity of the clinical manifestations of the syndrome and the presence of the antigens. The possibility that the syndrome might result from various pathogenic mechanisms is discussed.