WARNING OF A VETERAN - “BEWARE OF DANGERS OF SOCIAL DISEASES”
By Dr. M. P. Vora
The Bombay Civic Journal, December 1964; Pages: 28-32
Question: - What is meant by social diseases and why are they so called?
Answer: - They are the Venereal Diseases (V.D.) which are usually contracted through close body contact and sex relation with an infected person in the society. In order to avoid stigma attached to V.D., they are so called.
They constitute a great hazard of the public and their impact on the national economy is not sufficiently appreciated. They are the most social ills of man, the least confined, the least manifest and the least likely to be static. They are shrouded in the fog of ignorance, superstition, prejudice and secrecy. It is not generally appreciated that V.D. is not necessarily the result of an immoral life or the inevitable result of promiscuous behaviour and that it affects both the guilty and the innocent alike.
Q: - Are they known by any other names?
A: - There are many kinds of venereal diseases but most common and dangerous are Syphilis and Gonorrhoea. Syphilis is called the great-pox in contradiction to smallpox or “Vish Fotah” meaning poisonous eruption all over the body seen in the second stage. It is also called ‘Firangi Rog’ supposed to have been brought our country by foreigners (Firangi), visiting or settling down for some five decades ago. Gonorrhoea is called ‘Clap’ morning drop of ‘PARAMA’.
Q: - -In what way do these diseases differ from other diseases which medical practitioners have to treat?
A: - These diseases being social diseases there is lot of hush hush about them and even talking about them is tabooed. Those who contract them do not come to the doctors for treatment for the false sense of shame or fear of exposure and they are neglected.
The management of these diseases is not as simple as is often taken for granted. It demands observance of certain principles: -
The correct diagnosis of venereal diseases, especially in early stages on clinical examination alone (i.e. spot diagnosis) is often impracticable and involves serious dangers.
If the medical practitioner, treating these diseases, desires that his management of cases be scientific, responsible and efficient, he must have recourse to, before the institution of specific treatment, laboratory tests, which play such an important part in the early and accurate diagnosis of all venereal diseases. There are no short-cuts to early diagnosis of venereal case. He must also observe faithfully fundamental principles involved in the management of a venereal case. The professional conscience and sense of vocation are implicit in “good practice” which every medical man naturally desires to have.
Q.: - Will you please give more particulars about venereal diseases?
A.: - The term V.D. stands for venereal diseases. They are very dangerous and crippling. There are several venereal diseases, but the most common of them are syphilis and gonorrhoea. They usually spread by intimate contact, almost always sexual. Both are killers or destroyers of humanity. There are certain reasons for their increased incidence among teen-agers. Persons with little knowledge of the problem can have V.D. without knowing or suspecting it. The first signs of syphilis are often so light as to go unnoticed or, as it often the case, to be mistaken for some other ailment. So also, gonorrhoea may be difficult to recognise, as there are a number of maladies resembling it.
V.D. usually results from conduct outside the accepted moral code. People who suspect they may be infected fear of discovery and so delay seeing a qualified doctor. When the early signs disappear - as they always do in both syphilis and gonorrhoea - there is, naturally, a sense of relief that it was not anything serious after all. But the germs will continue to multiply and do their deadly work, quietly, in the body.
Many individuals who suspect they are infected do not seek treatment simply because they “feel all right”. Hence infected person can pass on the disease to others without knowing that they are doing so. When they begin to “feel bad”, it is often too late to repair the damage done.
Finally, there are those who are completely ignorant of venereal diseases and how they spread. Unfortunately, a high percentage of this uninformed group is composed of teen-agers and other young people. They are lacking in even an elementary knowledge of sex and the nature of V.D. As a result venereal diseases are spreading fast among them. It is, therefore, imperative that they be educated with regard to these diseases. It is important to know and remember the plain facts about the two common of venereal diseases - syphilis and gonorrhoea.
Q.: - What is syphilis?
A.: - Syphilis is an infectious disease, generalised at first, subsequently localised and dispersed. It is unique in the benign character of the early illness, remarkably slow but steady in progression, extending over years and punctuated by alternate periods of activity and quiescence. Its causative organism is a cork-screw shape germ called Treponema, or spirochaete pallidum. The germ cannot withstand drying. It requires a liquid vehicle for its transmission from host to host. Syphilis can cause skin rash, heart disease, nervous disease, paralysis, insanity, deafness, bone and joint pains, and even premature death.
Q.: - How is syphilis contracted? What are the modes of its spread?
A.: - Syphilis is contagious or catching. It spreads from person to person by sexual relations or by other close physical contacts - such as kissing - which provide the necessary conditions for its transmission. Indirect transmission of the infection is possible but not very common. It is not spread from toilet seats, towels or door knobs.
Q.: - What are the early symptoms of syphilis? Does the disease run into well marked stages or it has continuous unbroken course?
A.: - The first sign is usually an ulcer, which appears after about 10 to 90 days following the entry of the germs into the body (inoculated). It appears at the point the germs enter the body, usually on the skin or mucous membrane near about the sex organ and lasts for about a month, if untreated. Normally, it does not pain or itch. It is called a chancre. At the beginning, it may look like a pimple, blister or crack. There is nothing fundamentally characteristic about the appearance of a chancre. The diagnosis can only be established by the demonstration of actual living germs in the lesion. At times, the ulcer is very small or hidden, so that it is not noticed. This is often true in girls.
In an appreciable number of infected persons, the initial lesion, or the chancre, may not progress sufficiently to enable its recognition. The first sore of syphilis will disappear even without treatment, or with some applications, but the germs do not go away. A unique feature of early syphilitic infection is that it usually produces virtually no symptoms of systematic disease despite the presence of spirochetemia (presence of generalised infection). This is called the primary stage of syphilis.
The secondary stage of syphilis follows in four to six weeks after the first sore. There might be skin rash, sore throat, pains in bones and joints, enlargement of lymph nodes, and sores in the mouth. At times, these signs and symptoms may be as slight and trivial as to go unnoticed. They may even go without treatment, but the germs of syphilis still remain to multiply in the body. The disease is highly infectious at this stage. At this time, serologic test for syphilis is invariably positive.
Latent stage: - When the signs and symptoms of secondary stage pass away, “a latent or quiet stage” follows. It may last 2 to 20 years. During this phase, a person feels fine and healthy; for there is no outward evidence of infection. But in some time later, the infection becomes active again in the body and manifests in blindness, insanity, heart-disease, nervous disease or paralysis. This is called the third stage of syphilis.
Q.: - Are there any fallacies entertained by the young about syphilis?
A.: - Yes, there are many:-
These are all the misconceptions and must be removed from our minds.
It is supposed to be hereditary. Syphilis is not hereditary, but it is often passed from an infected mother to the baby before it is born. This is called congenital syphilis. If the mother is given proper and adequate treatment during early pregnancy, the baby can be born without syphilis. But, if the mother is not so treated, the baby may be born prematurely (miscarriage), dead (still birth), or with syphilis, and may be blind, deaf, mentally retarded and have skin eruptions. At times, it may appear sound and healthy at birth, but may later develop the crippling signs of syphilis.
Q.: - What would happen if syphilis is not properly treated?
A.: - When the warning signs go away - as they always do even without treatment, or after some inadequate or irregular treatment - the germs in the body are still active and continue to multiply and can do great damage. It may take 2 to 20 years for the damage to show up. When it does, it may be in the form of insanity, heart disease, or nervous disease, paralysis or even premature death.
Q.: - Can syphilis be cured?
A.: - Yes, if it is treated early enough, syphilis can be cured completely by modern treatment before any permanent damage is done to the body. It is imperative that syphilis is diagnosed and treated in its very early stage. This also helps to prevent its spreading. But most of the patients try to heal the ulcer and neglect the disease in the blood. People who have had syphilis cured can catch it again if they expose themselves to the risk of infection.
Q. .: - Is self-doctoring in case of venereal diseases advisable?
A.: - No, it simply will not work. Only a qualified venereologist can make the necessary examination to find out if you have venereal infection, and only he can give you proper and adequate treatment. Importance of skilled advice and treatment cannot be over-rated. Syphilis does not go away by itself, although the early signs always do.
Q.: - What is gonorrhoea? How is it spread?
A.: - It is a dangerous disease of the urogenital tract caused by the germ, gonococcus. It may cause chronic illness, arthritis, body aches, inflammation of the sex glands and sterility.
It is spread from person to person by sexual relations, as syphilis is. (It is caught from someone who has the disease). It is certainly not a strain. Nor is it hereditary. The germs of gonorrhoea die quickly outside the human body, and, in practice, chances of getting the infection from toilet articles are very slight.
Q.: - What are the symptoms of gonorrhoea?
A.: - A few days after the infection, there is usually burning and smarting in the urinary pipe while passing urine. At about the same time, a purulent discharge develops and begins to dribble out from the external urinary meatus. Often, boys will notice these signs and symptoms in three to seven days from the day of exposure, but girls may not. Very often, gonorrhoea begins without these symptoms in women. Diagnosis is made by demonstration of gonococci in stained smears and by culture.
Q.: - What happens if gonorrhoea is neglected?
A.: - It may damage the important sex glands and make it impossible for a person to father or mother, as the case may be. It can cause constriction of the urinary passage (stricture of the urethra), difficulties in urinating, attacks of retention of urine, painful arthritis, backache, inflammation of the eyes, and chronic ill health. It is frequently the cause of blindness in the new-born baby. It may cause such serious complications in women requiring operation. Blindness results if the germs get into the eyes.
Q.: - Is it possible to cure gonorrhoea?
A.: - Yes, the modern treatment is quite effective in procuring a complete and speedy cure. But the treatment must be given quite early if the disease is to be stopped from doing damage to the body. Once the disease becomes chronic, drugs alone cannot repair the damage done to the vital organs of the body.
Q.: - Can you yourself cure gonorrhoea? Is self-doctoring desirable?
A.: - No, certainly not. Only a qualified venereologist can decide whether or not you have gonorrhoea, and only he can know what treatment is needed, and when you are completely cured of the disease. Relief of symptoms does not mean cure.
Q.: - Are tests of cure essential in V.D. when it is treated?
A.: - Yes, when the treatment is over, subsequent check-ups and proper tests of cure, extending over a certain period, are absolutely essential in venereal diseases before a clean bill of health is given.
Q.: - What is the result of inadequate or irregular treatment of V.D.?
A.: - Proper, regular and adequate treatment of V.D. on the early stages is essential for a cure. Inadequate or irregular treatment often makes the vital organs of the body more susceptible to attacks of the disease. Once the infection becomes old, it is difficult to cure completely.
Q.: - Are venereal diseases preventable? What are the points to be remembered?
A.: - Yes, to a great extent. They are almost, if not quite completely preventable. To be effective, precautions must be taken immediately before and after contact. This is called prophylaxis. At times, the prophylaxis may prevent the early appearance of the signs and symptoms of a disease, but not the infection. So those who use it should resort afterwards to periodic check-ups and blood tests. Presence of venereal infection without one’s knowledge or awareness is not uncommon.
Remember: Venereal diseases must be diagnosed and treated in the very early stages. Their treatment without scientific diagnosis is unpardonable in the modern age. Attempts to get them treated by unqualified persons or on the advice of friends are very dangerous. They only help to add difficulties in the work of venereologists. If you find anything wrong with your system often an exposure to the risk of infection, contact the nearest venereologist immediately and you will have complete cure assured in the earliest possible time. Special clinics at Bellasis Toad, St. George’s Hospital, Cama and Albless Hospital and J.J. Hospital, all in Bombay will give you advice, diagnostic aid and treatment without any obligation on your part. All the information is kept in the strictest confidence.
Q.: - What are the remedies of V.D.?
A.: - The remedies of the V.D. are left to the specialist’s in Venereology. They depend on the condition, stage of disease, sex, age, etc., of the patient and duration of infection. Of course, for your knowledge it may be said that anti-biotics like penicillin Sulpha drugs, their derivatives and combinations are now extensively used. However, their indiscriminate use must be avoided at all costs in infections.
Q.: - Has the treatment of V.D. improved recently?
A.: - Yes, two decades ago it was considered fantastic to assure the patient with either syphilis or gonorrhoea of a cure in a few days or weeks. The treatment was prolonged, cumbersome and costly. Now, with the introduction of new drugs, it is simple, speedy, painless and quite effective, if the patient could apply foe early for advice and treatment and continue his attendance until he has been told “cured”. This is a great achievement. But along with the optimism came grave warning, “Don’t be fooled. Again and again, venereal diseases have shown themselves the most deceptive of all diseases. In their long history, they fooled again and again those who thought that they had found an answer.” And this warning has once again found to be real and true as can be seen from the recent rising trends of venereal diseases all over the world. An eternal vigilance is the best remedy to keep their incidence at the lowest level.
Q.: - How far education of the people will help in the prevention of these diseases?
A.: - Value of education of the people with regard to these diseases cannot be minimised. Public Health authorities and press generally maintain the total blackout. The word V.D. is invariably avoided as if it carried contagion or implied sin. This policy of silence, born of shame about sex, hampers our struggle against V.D. It is ignorance which leads V.D. patients, to conceal their first signs and symptoms, to try self-medication on the advice of their friends or to go to quacks for treatment and finally to accept the disappearance of early signs and symptoms as “Cure”. Frank discussion on the subject and education of the people with regard to these diseases, are the best weapons against the spread of V.D. Young people especially must be told about the dangers of promiscuous behaviour, infectious nature of the diseases, early signs and symptoms, effects on his marital partner and progeny and finally how to prevent infection by appropriate precautions. Without proper education of the public, awakening of public consciousness and development of intolerance to venereal diseases, to the same extent and degree we have developed towards smallpox or cholera, can never be possible. If our attitude towards V.D. was free from shame as that toward smallpox, V.D. could be a rarity indeed. The propaganda drive about preventive measures can help a good deal.
Q.: - Is mass treatment of V.D. by medical practitioners possible?
A.: - Yes, if they accept the recommendations of W.H.O in their practice. The recommendations are good from point of Public Health only and not from the point of an individual who demands security of life. The general medical practitioner is the key-figure in detecting V.D. in early stages. Although he has always figured prominently in the V.D. Control thinking, he has still to come up to the desired mark to become a part of the V.D. control team in the country-wide effort. It is sincerely hoped that he will take his due share of responsibility in the control of V.D. in the country.
Q.: - How should medical profession those young persons who have faultered?
A.: - It is the duty of the medical profession to treat them with sympathy, kindness and understanding. They must relieve human suffering whenever it exists leaving moral and spiritual conditions of preachers, reformers, and philosophers. With powerful means that science has put at the disposal of the medical men they have succeeded where prophets’, preachers and kings have failed through ages and brought sun shine and happiness to suffering humanity in western countries.