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been subjected to a severe strain, which will not be relieved until the Corporation's new centre, now rapidly approaching completion, is ready for use.

Further venereal diseases treatment centres are projected at Cambuslang, Falkirk and Dundee. (See last year's Report.) Alterations are also to be made in the treatment arrangements hitherto available at Aberdeen Royal Infirmary and City Hospital and at Stirling Royal Infirmary. These are referred to in

chapter VIII.

17. Work of Centres.-In Appendix IV will be found a summary shewing in detail the work done by approved venereal diseases treatment centres in Scotland during the year ended May, 1926.

Detailed returns have now been received from centres for five successive years, and the opportunity is taken to indicate briefly the work done under each of the principal heads over the period from June, 1921, to May, 1926, inclusive.

The number of new patients, the total number of patients and the total number of attendances made by all patients, in each of the five years, are shewn in the following table :

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* Each year runs from June to the following May inclusive.

18. New Patients: General.-It will be noted that, while the number of attendances has risen each year since 1921-22 and the total number of patients has risen each year since 1922-23, the number of new patients fell until 1923-24 and has since risen. In order that the apparent increase in the number of new patients may not give rise to misapprehensions it is necessary to analyse these figures further, and this is done for each class of patient in the following tables.

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Persons suffering from two or more venereal diseases are included only under the head "Mixed Infections."

19. New Cases: Summary.--The indications of these tables may be briefly summarised as follows:-

(a) Males.-Syphilis, soft chancre and mixed infections all shew a steady decrease over the five-year period. New male cases of syphilis have decreased by nearly 33 per cent. from 2,956 in 1921-22 to 1,990 in 1925-26; while new cases of soft chancre in males have fallen by 59 per cent. and new mixed infections in males by 69 per cent. between the beginning and the end of the period. New male cases of gonorrhoea, on the other hand, after increasing steadily up to 1924-25, fell by 5 per cent. in the following year. In view of the steady increase year by year in the number of persons who present themselves at venereal diseases treatment centres and who are found not to be infected with a venereal disease, it may be assumed that the proportion of

persons actually infected who so present themselves has at least not decreased. There is therefore some ground for believing that there has been a real decrease in the incidence of syphilis among males in Scotland; but it is too soon to draw any inference that gonorrhoea too is shewing signs of abatement. One thing, at least, is certain: the widespread publicity given in recent years to the serious effects of the venereal diseases on the individual and on the race has led and is leading an ever-increasing proportion of persons who have run the risk of infection to seek examination at public clinics.

(b) Females.-There was a striking increase (30 per cent.) in the number of new female cases of gonorrhoea in the year 1925-26. This is no doubt partly due to the fact that four new centres for women were opened between June, 1925, and May, 1926, and that there were, accordingly, considerably increased facilities for the diagnosis of the disease in that year. New cases of syphilis in women shew, on the whole, a tendency to decline, and new cases of soft chancre, never numerous, as well as mixed infections, have also decreased. The increase of 189 per cent. in the number of new non-venereal cases among women from

1921-22 to 1925-26 is remarkable.

20. Defaulters.-It has long been a source of discouragement to clinicians and others associated with the work of treatment centres that so large a proportion of patients cease to attend either before completing a course of treatment or, having completed a course, before final tests for cure have been made. The number of such patients in each of the last five years is shewn in the following table under heads (a) and (b).

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(a) Left before com. pleting a course of treatment

(b) Left after one course, but before final tests for cure

(c) Transferred

other centres..

(d) Cured

Total

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22885

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28 2,165

23

to

2,285 21 2,378
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7 820 8 1,091 12 1,532 14 2,015 19 6,249
4,759 45 4,054 40 3,602 39 4,067 37 4,017 37 20,499 39
10,676 100 10,294 100 9,316 100 10,991 100 10,886 100 52,163 100

2,526 23 2,008 18 11,862

Defaulters (a+b) 5,126 48 5,420 52 4.623 49 5,392 49 4,854 44 25,415 49

It will be seen that while the percentage of patients who discontinued treatment before discharge (grouped above as "Defaulters "') tends to fall slowly, the percentage of cases who failed to complete even one course of treatment has remained steady for three years. It must be admitted that an unknown proportion of "defaulters" may have been only technically in default; a few, no doubt, have died; some may have been kept away by crippling illness; some may have removed without

notice to another area, and perhaps resumed treatment at another centre; yet others may have decided to continue treatment with a private practitioner. There remain, however, those, doubtless the majority, who either because they "thought they were cured" or merely because they found treatment irksome, disregarded the clinician's warning to wait until cure was assured. Not all of these would still be infectious when they ceased treatment, but many would be, and many more would again become so when the effects of the uncompleted treatment began to wane. Moreover, leaving infectivity out of account, a large number would by their heedlessness of medical advice seriously jeopardise or even forfeit their own prospect of ultimate cure. It is not surprising, therefore, that alike among local authorities, who see so imperfectly utilised the treatment facilities for which they, in the first instance, are financially responsible, among clinicians who feel that their time and skill are largely wasted, and among social workers and others whose duties bring them into daily contact with children maimed through the uncured disease of their parents, there is a growing demand for compulsory measures to secure submission to treatment by all persons infected with a venereal disease and continuance under treatment until discharged.

21. Visiting Nurses.-In an effort to reduce the amount of defaulting among patients, the Corporations of Glasgow and Edinburgh have each appointed a nurse almoner whose duty it is to visit patients who have desisted from treatment and to endeavour to induce them to resume. The Edinburgh almoner has only recently been appointed, but the Glasgow nurse has already been successful to the extent of securing the return of one-half of the patients whom she traced. It should be said that of the remaining half almost all promised to return to treatment but failed to do so.

22. Patients Cured.-The following table supplements that given on page 83 of the last Report and shews the number of patients suffering from each disease discharged as cured in the year 1925-26, together with the total number so discharged in the five years 1921-26.

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23. Attendances per Patient.-The average number of attendances per patient in each category for the last two years is given in the following table.

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1924-25

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It is noteworthy that all classes of patients, with the exception of women suffering from gonorrhoea and from soft chancre-the latter a negligible number-attended on the average more persistently in 1925-26. In the case of mixed infections only did women average more attendances per head than men, and that in both years.

24. Congenital Syphilis. Extra-Genital Syphilis. - The number of patients suffering from congenital syphilis dealt with each year and the number of patients who shewed evidence of extra-genital infection were as follows, viz. —

Congenital Syphilis. Extra-Genital Syphilis.

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