CHILDREN AND V.D.
a conspiracy of silence
Eve’s Weekly, Bombay
Vol. XXXIV, No. 21 of May 24-30, 1980
Pages: 40,41 & 47
the high incidence of v.d. among children has been ignored by the public and by health authorities. the reason for this is our prudery and a tendency to pretend that something of which we are ashamed does not exist.
The United Nations has declared 1979 as the International Year for the Child (IYC) to focus public attention on the plight of children and to improve the quality of childhood. The IYC has come and gone, but the welfare of children is a continuing process. India has adopted a national policy for children and declared her children as “supremely important assets whose nurture and welfare are her responsibility.” There are the National Children’s Board and the National Commission for the IYC. However, these statements and the course of action are like two parallel lines which will never meet - pious platitude on one side and the callous inaction on the other. How can we overcome this? And what action needs to be taken urgently to make our children healthy and happy?
The writer has heard many talks and read a number of articles in newspapers covering, many aspects of childhood disabilities, such as mental and physical handicaps, blindness, deafness, nutritional deficiency, etc. and the number of children in each category and the measures taken or suggested for their correction. However, it is remarkable that no reference is made in these to the havoc played by venereal disease which is one of the most serious hazards for children.
The high incidence of V.D. among children, the disabilities, diseases and deaths that follow, have been totally ignored both by the public and by health authorities. The reason for this is of course our prudery and our national tendency to pretend that something of which we are ashamed does not exist.
This conspiracy of silence regarding V.D. is not new and is quite familiar to most venereologists. The age-old assumption that venereal diseases are the result of promiscuous sex relations and therefore the wages of sin continues to weigh heavily on the public mind implying thereby that those who suffer from it deserve it and sympathy need not be wasted on them.
This moralistic attitude ignores that children suffering from V.D. are being punished for the sins of their parents or are the innocent victims of infection or forced sex. Congenital syphilis acquired in the uterus or at the time of delivery, person to person transmission of V.D. by direct or indirect contact is common.
It is necessary to emphasize that these diseases attain significant proportions and contribute greatly to childhood illness, disabilities and death. If our proclaimed concern for children is to have the meaning, we should first recognise that V.D. affects children in many tragic ways. Bit we lack any reliable statistics which is the first need in the battle to save children from its insidious and cruel grip.
By adopting an ostrich like attitude to V.D., we are victimizing innocent children, and by our hypocrisy in this matter, we are weakening the nation itself. These diseases have a serious impact not only on the individual who got the disease originally, but also on the other members of the family, even the whole community. Of all the diseases inflicting man, these are the least confined, the least manifest, the most insidious.
However, because we smugly regards V.D. as deserved punishment, the facilities for its treatment and cure are minimal, and neglected, ignored or often even unknown to the victim, it can affect a foetus in the uterus as well as when it is born and outside the womb. And it often spreads from these children to their brothers and sisters, the neighbouring children by fondling, kissing and other personal contacts.
The child population of the country is said to constitute nearly 40 per cent of the total population. If we assume the population of India now to be nearing 700 million, the child population comes to 280 million. How many of this large number of children suffer from venereal diseases? Annually about 125 to 130 of 1000 new born infants die soon after their birth. How many of thses deaths are due to syphilis? How many deaths are due to virus infection acquired venereally? What is the role of syphilis and gonorrhoea in disabilities like blindness, deafness, paralysis and mental retardation among children?
Treponema pallida of syphilis are capable of invading the developing uterus or soon after its birth and causing abortion, miscarriage, stillbirth or post-natal death. All these questions demand answers from health authorities, yet they seem to consider them outside their province - as if children suffering from V.D. caused diseases are less worthy of attention than those suffering from diseases of other types. As if these children are not the nation’s responsibility, they have not even bothered so far to get countrywide statistics on this.
Above: An 11 year old boy, the victim of syphilis.
While searching for information, the writer came across a report on the city of Bombay for the year 1920. This can at least give an idea of the havoc V.D. can play today with the city more congested, with sex more promiscuous. “ The J.J. Hospital, Bombay,” the report read, “recorded that 18.7 per cent of its indoor patients and 23.3 per cent of its outdoor patients had evidence of V.D. At the Motibai and Cama hospitals for women, 10 to 15per cent of the patients were seropositive for syphilis. Among the 2000 annual still births in the city, 18.5 per cent were due to syphilis. Out of 9000 children that died annually, 3000 died of congenital syphilis. Of the blind children 30 per cent, of the deaf children 25 per cent, of the mentally deficient children 50 per cent were due to V.D.” But this report had no effect on the health authorities.
Above: Faces of congenital syphilis showing deformity of nose and flattening of malar bones.
Venereal diseases are not static and their incidence multiplies like compound interest. Dr. T. Guthe, C.M.O. for communicable diseases to the W.H.O. stated in 1965, “The incidence of V.D. is very high in India, and Bombay ranks among the ten most highly infected cities in the world.” Today, the actual situation regarding V.D. is likely to be worse. It is estimated that there are more than 70 million new cases of V.D. a year and a yearly rise of ten to 12 per cent in their incidence in the country. This is an alarming situation indeed, but no one seems to be least upset or concerned. The figure for childhood V.D. may easily surpass the 10 million a year mark. And still we refuse to wake up.
At the institute of Venereology Madras, 894 children out of 41,020 patients were treated for V.D. in 1978. At the V.D. Centre, Safdarjung Hospital, New Delhi, 2067 children out of 202,803 patients and 1131 children out of 75,483 patients were treated for V.D. in 1974 and 1975. Three autopsy studies on still born infants in Tamil Nadu State revealed Treponema pallida in tissues of (1) 3 per cent out of 164, (2) 9 per cent out of 35 and (3) 5 per cent out of 22 still born infants, confirming syphilis as the cause of death. This gives an overall average rate of 5.6 per cent still births due to syphilis. The studies of seropositivity rates in pregnant women revealed 8 per cent in Madras and 12 per cent in Madurai during 1953-1958; 23.3 per cent in Nagpur in 1966 and 7 per cent in Bombay in 1964. These observations confirm that a significant proportion of foetal deaths and disabilities are traceable to syphilis in pregnant women.
If these figures ad findings have any meaning, it becomes crystal clear that serologic tests for syphilis must form a part of the routine check up of pregnant women and that prompt and adequate therapy must be provided for the positive women to save children from syphilitic hazards. The tests must also include gonococcal infection by smear examination and culture.
To achieve these objectives the most essential prerequisite is the establishment of free, reliable and quick laboratory services all over the country including rural areas. In actual fact this essential facility has been overlooked in many medical institutions. Primary health centres established all over the country are conspicuously devoid of this facility. Does not this show ineptitude, callous indifference and utter lack of foresight in our health planners and administrators?
During early maternal syphilis, the risk of infection of the foetus is 95 per cent and the foetal loss could not be less than 50 per cent. Treponema pallida is transmitted trans-placentally to the developing foetus as early as 10 to 12 weeks after conception. An untreated congenital syphilitic infant may die, or develop a variety of diseases, or the infection may remain latent up to the age of 15. Serologic surveys have confirmed that such unrecognised infection is common and that it is the most important source for spreading the infection.
Again, many innocent children, irrespective of age and sex, get infected with syphilis or gonorrhoea or both by sexual contacts with highly infectious persons, or as the result of sexual assaults on them by infected persons. It is believed by some that sexual intercourse with children cures syphilis. And many an innocent child is a victim of this vicious superstition. But such instances do not come to notice for fear of punishment, shame, ignorance. Such children become carriers of infection themselves.
Gonococcal infection in pregnant women can cause blindness or systemic infection in the infants. WE have today adequate knowledge and techniques like dark-field microscopy, highly specific tests, biopsy of the liver or tissues, Immunofluorescent studies and staining, electric microscopy, automated tests, improved culture media, etc., by which the diseases can be identified. And once identified, we have the drugs to prevent or cure the infection.
V.D. in children has become a pressing problem. This must be wodely recognised and every attempt must be made to contain it. It must be stressed that V.D. can be both prevented and cured. Therefore there is no excuse for allowing this dreaded disease to spread and destroy its victims, especially young, innocent children.
Routine testing for syphilis and gonorrhoea must be made compulsory at all health centres and widespread, reliable and quick laboratory facilities for the same must be made freshly available all over the country. This is the basic need which has been totally neglected all these years. The incidence of congenital syphilis, childhood deaths and disabilities can be markedly reduced, nay, completely eradicated, if proper steps are taken in time.
How deep-rooted and widespread our prejudice against V.D. is can be seen from the fact that neither Indian Universities not the Medical Council of India, whose elementary duty id to maintain proper standards of medical education and medical services, is the least inclined to adopt progressive measures with regard to venereology. The National Health Service in the United Kingdom has venereologists in addition to dermatologists on the panel of specialists, but the official agencies that manage the E.S.I.S., the C.H.S. and the public and private hospitals in this country will still display Victorian prudery and refuse to appoint qualified venereologists on their staff to provide proper medical services to V.D. patients in their establishments.
No wonder one W.H.O expert said, “More than 90 per cent of venereal patients have to go without proper medical care even in the city of Bombay,” which can boast of many fine hospitals. It is not difficult to imagine the needless diseases and deaths and the economic loss that result because of this incompetent, inefficient and inadequate medicare.
Unfortunately, this age-old attitude to V.D. is found not only among the lay public but also in the medical profession. Some doctors occupying very high posts in medicine (outside venereology) look down upon venereologists as third grade professionals. So they have no place in medical education or planning medical services. Though so many seminars are held or special issues of medical journals brought out on children’s diseases, even a reference to venereal diseases is a rarity. Such a strong allergy to the subject is hard to find anywhere else in the world. No one comes forward to launch a project to educate the public on V.D. and ignorance, compounded by prejudice, condemns innocent children, born and unborn, to a life of disease and disability or early death.