residences, includes 27 buildings, seven of them dormitories, and
a farm of 675 ac., with vegetable gardens and a model dairy.
Student self-government is in effective operation, the students
themselves assuming responsibility for most of the regulations
governing attendance and conduct, and for the management of the
Students' Building and the Good Fellowship Club House, and for all
extra curriculum activities, including the providing of various
money-making occupations for self-supporting students. The facts
that the price for rooms and board is the same for every student, the
rooms being selected by lot, that there are no sororities or other
clubs to which membership is not absolutely open, and that no
admission fee may be charged to any campus meeting, all help to
maintain a democratic spirit.
Among the notable war-time services of Vassar were the farm unit,
the reconstruction units, and the training camp for nurses. In the
summer of 1917 Vassar undertook the experiment of student labour
on the college farm. Its success led to many similar enterprises
throughout the country. Volunteers were accepted for the summer
of 1918 to work in two shifts of six weeks each. They were housed
in one of the campus buildings, paying their board out of their
wages, working eight hours a day, and undertaking every form of
farm work, as well as work in the model dairy, and drying, canning
and preserving in the college kitchens. The Vassar units for service
abroad, one under the American Red Cross, and a canteen unit
under the Y.M.C.A., were financed by alumnae and under-
graduates, with assistance from the Red Cross, and served in
France. The Red Cross reconstruction unit included trained nurses,
a dietitian, a doctor and social workers. Much of the rehabilitation
work at Verdun was in their charge. The summer training camp for
nurses was organized under the direction of the Red Cross and the
National Council of Defense. Five hundred graduates of colleges for
women entered upon a course of training for three months at Vassar
and two years in a hospital, leading to the degree of registered nurse.
One hundred and ten colleges were represented in this training camp,
the probationary nurses coming from 46 different states of the
Union and three British colonies. (B. J.*)
VAUGHAN WILLIAMS, RALPH (1872- ), English musical
composer, was born at Down Ampney, Oct. 12 1872. He was
educated at Charterhouse and Trinity College, Cambridge,
where he took the degree of Mus. Bac. in 1894. He studied fur-
ther at the Royal College of Music, and also at Paris and Berlin.
He took the degree of Mus. Doc. at Cambridge in 1901, and in
1919 received an hon. musical degree from the university of
Oxford. His works include Toward the Unknown Region (1907);
Willow-wood (1909); Sea Symphony (1910); On Wenlock Edge
(1911); London Symphony (1914; Carnegie award 1917) and
many fine songs, including arrangements of traditional melodies.
VAUGHAN WILLIAMS, SIR ROLAND LOMAX BOWDLER
(1838-1916), English judge, was born in London Dec. 31 1838,
the fifth son of the Rt. Hon. Sir Edward Vaughan Williams. He
was educated at Westminster and Christ Church, Oxford, where
he took his degree in 1860. He was called to the bar in 1861, and
was made a Q.C. in 1889. In 1890 he was raised to the bench of
the Queen's Bench division, in 1891 was transferred to the
Bankruptcy division, and in 1897 became a lord justice of appeal.
In 1906 Vaughan Williams was appointed chairman of the royal
commission on the disestablishment of the Church in Wales.
He retired from the bench in 1914, and died at Abingcr, Dorking,
Dec. 8 1916. His book TheLawand Practice of Bankruptcy (1870;
latest ed. 1915) is a leading authority.
VAZOV, IVAN (1850-1921), Bulgarian poet and writer, was
born at Sopot in Bulgaria in 1850, and received his first educa-
tion in the Sopot village school. Later on, he went to Russia to
continue his studies. His first literary efforts took the form of
essays and songs describing the sorrows of the Bulgars under
Turkish rule, their hopes for a free united Bulgaria, their dis-
appointment when the Treaty of Berlin divided the Bulgarian
people once again. His most important work is the novel Pod
I goto (Under the Yoke), which has been translated into many
European languages. Pod Igoto gives a simple and convincing
picture of village life in Turkish times and of the heroes of the
struggle for freedom. Among Vazov's other works are The New
Craves of Slivnitza (Scrbo-Bulgarian War of 1885-6); The Kaza-
larska Czaritza; Borislav and Towards the Abyss, two of his best
plays. Vazov, who identified himself with the sufferings and
joys of the people, is honoured throughout the country as the
national poet and as a true patriot. His jubilee was officially
celebrated ip 1920 and he was awarded a pension from the State.
He was the first Bulgarian writer whose works had been read
outside Bulgaria. He died at Sofia Sept. 22 1921.
VENEREAL DISEASES (see 27.983). There are three distinct
diseases included under the term " venereal " gonorrhoea,
syphilis, and soft chancre, of which the first two are of primary
importance in relation to public health. The advance in our
knowledge of venereal disease, its prevention and curative treat-
ment, during 1910-21, may be regarded as the outcome of
experience upon a large scale based upon the following dis-
coveries: (i) the specific organism of syphilis by Schaudinn; (2)
the inoculation of monkeys by Metchnikoff and protection there-
from by the application of a 33% calomel cream ointment; (3)
the application by Wassermann of the Bordet haemolytic test to
syphilis; and (4) the discovery by Ehrlich of " 606 " (salvarsan)
as a rapid curative agent of syphilis. All four discoveries may be
said to have laid the foundation of all modern methods of medi-
cally dealing with this disease.
The discussion of the whole subject at the International
Medical Congress held in London in 1912, and the change in the
attitude of a large section of the public and the press, eventually
led up to the appointment of a British Royal Commission in 1913.
The report of the Commission, published in 1916, was strongly
supported by a National Council for Combating Venereal
Disease, and ultimately an Act of Parliament was passed which
made provision for the carrying out of its recommendations.
Scientific Advances. During 1910-20 the so-called para-
syphilitic diseases, general paralysis of the insane, and tabes
dorsalis (locomotor ataxia), were proved to be the direct result of
VENEREAL DISEASES
909
active proliferation of the spirochaeta pallida, in the brain and
spinal cord respectively, of these two diseases. This knowledge was
due to the discovery by Noguchi and Moore of spirochaetes in
the brains of 12 out of 70 brains of persons dying of general paral-
ysis. Confirmation of this was soon at hand in all civilized
countries where these diseases occur. Mott was able to find the
spirochaete pallida in the brains of 66 out of too successive fatal
cases. Inasmuch as the cerebro-spinal fluid invariably gives a
positive Wassermann reaction in general paralysis, it may be in-
ferred that the spirochaete is always present. A large experience
in the services during the World War has shown that in spite of
modern energetic treatment a certain proportion of cases give a
positive reaction of the cerebro-spinal fluid, and there is evidence
to show that when generalization of the organism takes place in
the secondary stage, its implantation in the substance of the
central nervous system may occur; and it is these cases which
subsequently develop this fatal and incurable disease, general
paralysis; incurable because neither the mercury nor the arseno-
benzol compounds are able to enter the substance of the nervous
system and destroy the specific organism. This is a practical
point of the greatest significance, for it shows that the only way
to avoid this and other fatal incurable diseases is the adoption of
curative treatment in the primary stage, as emphasized in the
report of the Royal Commission. But even better is the adoption
of prophylactic measures, by which the organism is killed while it
is still on the surface of the body; for many persons may not
know that they have been infected owing to the fact that the
sore is not of a typical nature and in a number of cases is there-
fore regarded by the doctor or patient as a soft sore or chancroid;
consequently only local treatment is adopted; or it may be that
the sore causing little pain or discomfort leads to the patient
neglecting treatment until it is too late.
A. Marie and Levaditi have recently put forward the view
that there are two forms of specific organism a neurotropic
spirochaete, which seeks the nervous system, and a dermatotropic
one which seeks the skin. Although there are no morphological
differences discoverable in the organisms, yet certain clinical
epidemiological and experimental facts support this argument.
Prevalence. The returns of the Registrar General in England,
as was shown in the report of the Royal Commission, are liable
to many fallacies, which invalidate the accuracy of any deduc-
tions that could be made from them. The returns of deaths,
which may unquestionably be assumed to be due to syphilis with
the exception of general paralysis and aneurism, are very limited;
yet we know that a large proportion of the deaths from organic
brain and spinal cord diseases is due to this cause, likewise a
large proportion of valvular and other diseases of the heart.
Evidence was given at the Royal Commission showing that 5 %
of syphilitics subsequently developed general paralysis, also that
10 years is the average time for the brain symptoms to develop
and several years then elapse before a fatal termination. It
follows that the prevalence of syphilis in a community 12 to 13
years previously may be gauged by the percentage of deaths
from general paralysis in any given year. Possibly this would be
a more accurate method of estimating, to some extent, the prev-
alence of syphilis in a community than even the statistics
afforded by the early treatment centres, for a large number of
people suffering with the disease, even now, do not come under
observation on account of avoiding the social stigma.
Death from general paralysis is about four times as great in
men as in women; it may be assumed therefore that syphilitic
infection is four times as frequent in men as in women. The
incidence of general paralysis is about the same in all classes but
it diminishes as we rise in the social scale in women. The in-
ference is obvious as regards venereal disease and the social
status of women. In the juvenile form due to congenital syphilis
it occurs equally in the two sexes. Gonorrhoea, not being a
direct cause of death, although of many chronic and even fatal
diseases especially in women, rarely enters into the returns.
An attempt was made by the Royal Commission to estimate
! by the application of the blood test the prevalence of syphilis.
i Thus the present writer tested the specimens of blood withdrawn
from a vein by Sir John Collie from 500 apparently healthy men
applying for service in the L.C.C., and found that 9-2% gave a
positive reaction. These, and many other statistics from various
sources, notably hospitals, poor-law infirmaries, asylums for
lunatics, idiots and imbeciles, and institutions for the blind and
the deaf, published in the report, showed that a large percentage
of the population had been infected with syphilis, and that a
very large proportion of these people were suffering from a
disease or disability directly or indirectly due to infection.
From the mass of evidence collected it was roughly calculated
by the Royal Commission that probably 10% of the population
had been infected with syphilis. This corresponds with the
statistics of the United States:
" The results of a survey by the Wassermann test of adults
admitted to hospitals (apart from venereal clinics) in five large
cities of the United States showed 9-5 % positives out of a total of
15,264. Vedder obtained 13% positive reactions in 11,933 recruits
for the U.S. army in 1916, 15 % of 856 candidates for the police force,
and 5% of 3,203 candidates for commissions in the army. It is
worthy of note that in the same locality that gave 5-8 % positive
Wassermanns, Warthin found evidence of syphilis in 30% of post-
mortem examinations. Hence Jeans concludes that the minimum of
syphilitics in the United States is 10%, and the probable percentage
twenty." 1
It was assumed from the evidence before the Royal Commis-
sion that a much larger percentage of the people had suffered
with gonorrhoea; inasmuch as one attack of this disease does
not give immunity and relapses of an apparently cured infection
frequently occur, it follows that reliable statistics of admissions
for gonorrhoea are difficult to ascertain by the rate of admissions.
Altogether it would not be an unfair estimate to assume that
20% to 30% of the population prior to the World War had
suffered with venereal diseases.
The Annual Report of the Chief Medical Officer of the Minis-
try of Health for 1920 stated that the Ministry had based its
policy upon the recommendations of the Royal Commission on
Venereal Disease, 1916. The principal recommendations were
thus summarized: (a) Confidential registration of cause of
death. (6) Extension of facilities for diagnosis, (c) Organization
by the local authority of means of free treatment for all
classes at convenient hours and under suitable conditions, (d)
Improved professional and public education, (e) A grant-in-
aid of 75% of total cost incurred in approved schemes. (/) Treat-
ment in army and navy, poor-law institutions, prisons, etc. (g)
Prohibition of all advertisements of remedies and unqualified
practice, (h) Recognition by the Government of the National
Council for Combating Venereal Diseases.
The Commission recommended that " no system of notification
of venereal diseases should be put in force at the present time,"
and they condemned " unqualified practice " by chemists,
herbalists and others as " disastrous " and " one of the principal
hindrances to the eradication of those diseases," and they stated
that " the most urgent requirement is to secure to every patient
the freest and earliest possible access to medical assistance when
there is suspicion of venereal disease. This implies, inter alia,
that all temptation for the patient to have resort to an unquali-
fied person shall be removed."
The National Council for Combating Venereal Diseases was
established to promote and assist by propaganda and lectures
the programme of the Royal Commission ; it had the approval and
support of the Local Government Board and of the Ministry of
Health. Still, in spite of moral teaching, lectures, propaganda
and early treatment centres, an alarming incidence of venereal
disease occurred in the British armies and in those of the Do-
minions during the World War. Some idea of the prevalence of
these diseases may be gained by reference to a statement by the
late Sir William Osier (Lancet, May 26 1917) :
"The last quoted figures for the British army at home are (Han-
sard, April 23): 71,000 cases of gonorrhoea, 21,000 cases of syphilis,
and 6,000 cases of soft chancre. In the Canadian army to March 31
1917, there have been 18,335 cases of venereal disease figures which
have stirred public opinion in the Dominions to boiling point."
1 Medical Science Abstracts and Reviews. Published for the
Medical Research Committee, vol. i., 1919-20, p. 397.
910
VENEREAL DISEASES
There are many facts which show that there has been, in
consequence of the war, and in spite of the application of the
measures recommended by the Royal Commission, a very
considerable increase in the prevalence of venereal diseases in
the United Kingdom (see evidence by Dr. Sequeira, Miss Ettie
Rout and others in the report of the Committee of the Birth-
Rate Commission).
Table i, taken from the Annual Report of the Chief Medical
Officer of the Ministry of Health for 1920, indicates the extent to
which the clinics were utilized in 1920. From this table it
TABLE I. Experience of British Clinics, 1920.
Number of persons dealt with for the
b
"o
a
first time.
^8
'o'
CO
0.2
c a
9
O
J-> U
a
8
Q
c
5X
b
c
gi
3"O
2 O
< <o
c
u o u
1*3
J3
y
"Q
E ui >*
c
Q.
<8j|
o
c
"3
l>
rt rt
2<
30
Z'c
W
U
o
O
H
O
H
H-o
8
1917
29,036
204,692
113
1918
26,912
806
17,635
45,353
6,622
51.975
488,137
134
1919
42,134
2,164
38,499
82,797
15,447
98,244
1,002,791
160
1920
42,805
2,442
40,284
85.53 1
19,654
I".S,I,S
1,488,514
190
appears: (a) that in the fourth year of the scheme there were
approximately 85,00x3 cases of venereal disease and 19,000 cases
which proved not to be venereal disease, the total number of new
cases being 105,000 and the attendances 1,488,000; (6) that there
was a rapid increase of " new " cases of venereal disease in 1918
and 1919 and a stationary position in 1920. The term " new
cases " can only be relative, and does not afford a basis for
calculations of incidence; (c) that if the army estimate of the
relative frequency of gonorrhoea and other venereal diseases
(2$ to i) be correct for the civil community, only a small propor-
tion of the cases of gonorrhoea in the country came under treat-
ment at the clinics; (d) that the total attendances (and the ratio
of attendances to patients) had increased greatly, and that the
number of persons who were apprehensive of their condition and
who came to the clinics for diagnosis had increased two facts
which suggest that the clinics were better appreciated.
The total expenditure of British local authorities was 116,000
in 1917-8, 214,000 in 1918-0, 287,000 in 1910-20; towards
which the Ministry of Health provided grants of 84,000,
145,232, and 224,716.
Owing probably to financial reasons and inefficiency of some of
the clinics there were indications of a change of policy by the
Ministry of Health, for in the above-mentioned report it was
stated:
" It cannot be too clearly understood that the best way of dealing
with most cases of these diseases is through the skilful private prac-
titioner. For a substantial portion of this problem the public clinic
should be looked upon as a temporary organization pending the time
when the practitioner is ready, available, competent, and properly
equipped to undertake effective treatment. Certain patients re-
quire hospital treatment, but the authority should not needlessly
establish institutions if and when the ordinary channels of medical
practice are available and reliable, or can be made so." . . . .
" I am bound to advise that if the work of these clinics is not
properly done if it is casual, superficial or perfunctory they should
be disapproved by the Ministry. It is better to have only a few clinics
well-organized and scientifically controlled than a large number
which are not thus administered. These statements indicative of a
change of policy in the future may find an explanation in a study of
the statistics (see Table 2) relating to the number of patients dis-
charged from venereal disease centres as having completed treat-
ment. This table shows that 29 % of syphilitics and 33 % of persons
suffering from gonorrhoea ceased to attend before completing a
course of treatment. Nearly three times as many as those who were
discharged after completion of treatment and observation and
accordingly can be definitely tabulated as cured and non-infective.
These facts seem to show the necessity of adopting some disciplinary
measures to combat the evil, such as exist in the United States."
Prevention. Sir Archdall Reid, in his work on the prevention
of venereal disease, complains that no reference was made in the
report of the Royal Commission of the value of Metchnikoff' s
discovery. The National Council strenuously opposed what they
termed " the packet system " but the facts had to be faced.
TABLE 2. Patients at British Treatment-Centres.
Syph-
ilis
Gonor-
rhoea
Total
(l) Number of persons dealt with dur-
ing 1919 and 1920
(2) Number of persons who ceased to
105,619
87,792
193,4"
attend :
(a) before completing a course of
treatment ....
(6) after completion of a course of
30,459
28,869
59,328
treatment, but before final
tests as to cure
(3) Number of persons discharged after
9-35
6,481
15,831
completion of treatment and
observation
(4) Number of persons who on the ist
8,240
13,300
21,540
of Jan. 1921 were under treat-
ment or observation
47,894
28,822
76,716
Early curative treatment and moral suasion by propaganda and
lectures had not effected the purpose which most of the members
of the Royal Commission believed and desired they would. Sir
Bryan Donkin, in a letter to The Times in Jan. 1917, first called
attention to the necessity of the adoption of immediate self-
disinfection in accordance with the discovery of Metchnikoff.
He cited the remarkable success attending the simple measures
of immediate self-disinfection adopted at Portsmouth by Sir
Archdall Reid. Reid states in his book that one in 1,000 solu-
tion of permanganate of potash, carried in a flat screw-stoppered
bottle with a swab of cotton wool, proved a simple and cheap
means by which he obtained successful results. The directions
were that the soldier should immediately after exposure to
infection thoroughly swab the exposed surfaces with the fluid;
and he states on p. 130: " Immediately venereal disease
vanished from my units. For six months not a single case
occurred. In two years and four months, during which quite
20,000 men must have passed through my hands, only seven
men were infected. Of the seven cases, six of gonorrhoea and one
of syphilis, all could be accounted for by drink or negligence."
A controversy as to the right or wrong of such treatment thus
arose which eventuated in a number of eminent medical men
leaving the National Council for Combating Venereal Diseases
to form the Society for the Prevention of Venereal Disease by
immediate self-disinfection. While not discouraging continuance
of efforts by moral persuasion, athletics, education and early
curative treatment, this Society realized that immediate self-
disinfection either by calomel cream or permanganate solution,
was essential supplement to the before-mentioned measures;
recognizing as the members of this Society do, that a large
proportion of the adult population are not, and in our present
social conditions, cannot or will not remain continent. It may
be assumed that both the societies are animated with the same
desire, and it was hoped that by the establishment of a special
committee of the Birth-Rate Commission in June 1920, in order
to take expert evidence on the value of the various measures for
the prevention of venereal diseases, unanimity on the part of the
two societies might arise. A report on " The prevention of
venereal disease " by this Committee was issued in Feb. 1921.
The report states (p. 21): " The Committee is of opinion that
any administrative or legal difficulties that may at present
prevent individuals, who desire to do so, from purchasing such
disinfectants from chemists, on their own initiative as a pro-
tection against venereal disease should be removed; and that the
section of the Act dealing with this matter should be rendered
more explicit and amended if necessary; " but up to June 1921
no result had been achieved as regards action by the Government
or by way of settling the essential point of difference between the
two societies.
The supporters of the S.P.V.D. maintain that if 183 curative
treatment centres (which cost the State 300,000 in 1920) are
necessary, a similar number of prophylactic centres are more
necessary. Now the National Council advised the Government
to establish what they call Early Ablution Centres where skilled
but delayed disinfection would be carried out. There are so
many obvious defects in this system when applied to the civil
VENEREAL DISEASES
911
population, together with the enormous cost which would be
thrown upon the present overburdened ratepayers, that even in
June 1921 there was only one in operation (in Manchester), and