by Major M.P. Vora
The Bombay Civic Journal
Offical Organ Of The Municipal Corporation of Greater Bombay
Vol. XVIII, No. 5 of July 1971. Page No. 14 and 15.
According to Dr. T. Guthe, the Chief of World Health Organisation for the Communicable diseases, “ Bombay ranks among the ten most highly V.D. infected cities in the world and has few clinics worth the name for the diagnosis and the treatment. As a result, more than 90 percent of the venereal patients have to go without proper medical care”.
Though there are not accurate data on the morbidity and the mortality on venereal diseases, one can safely infer from available information from different sources, that they top the list of communicable diseases in the city. A very moderate estimate of total number of fresh V.D. cases every year could be less than five million. However, such a big problem has not been able to attract the attention either of the public or of the public health authorities. If it were small-pox or cholera, there would be swift and instant action. Though the W.H.O. has assigned V.D. a place of importance it does not mean anything to the health authorities.
NO SEPARATE ENTITY
Venereology as a separate and distinct medical speciality has not been recognised in both Municipal hospitals and medical Colleges. It does not find a place in the list of specialities in most of the medical colleges in India (except Madras). It is often combined with dermatology. This has resulted in good deal of confusion and deterioration of standards in medical education and services to venereal patients. Of all the subjects taught in medicine, venereology is perhaps the most neglected one academically.
All of us will agree that every doctor should know the basic facts in the diagnosis and treatment of V.D. during the under-graduate studies. But unfortunately, very few students are made to realize the importance of these diseases. This is due to the out-dated concept of dermato-venereology’ adopted by the Municipal health and medical educational authorities. Experience has amply proved that venereal patients, their work and training of medical students are generally neglected in a combined department of the skin and the V.D. The way the patients are dealt with herein is nothing short of quackery. Reliable diagnosis, its confirmation by laboratory tests, correct treatment, education of the patient with regard to his disease, contact-tracing, case-holding, record-keeping, follow-up tests etc., are rarely done even in the so-called teaching medical institutions. This is shocking but absolutely true.
LACK OF INTEREST
It has been found that dermato-venereologists, apart from personal likings, lack keenness and interest in venereology and venereological work becomes a very minor or neglected component of the department. Numerous examples can be cited to substantiate this observation. The professors of the dermato-venereology are frankly known as dermatologists and in hospital services, venereology occupies a very little interest to the extent that most facilities, amenities, funds and staff are utilized for dermatological work. An uncommon case of dermatology creates a great sensation and excitement, while many unusual cases of venereal conditions fail to evoke similar response or sensation among the staff. To them retention of their own hold on the subject means everything. The effect of this antiquated concept is that venereology is relegated to the background and venereological work suffers a total eclipse. Take the example of the best known V.D. Clinic in the world, directed by John Stokes at Philadelphia. No sooner its director was succeeded by an able dermatologist than the subject of venereology was eliminated and venereological work suffered a total extinction. Another equally famous clinic at John Hopkins Hospital met with a similar fate. The subject of venereology was swamped and a generation of high- powered dermatologists emerged to the detriment of education and training in venereology and medical services to venereal patients. But the authorities seem to learn nothing from those examples.
ESTABLISHMENT OF UNIVERSITY CHAIR OVERDUE
Take the question of establishment a university chair in venereology. It is overdue and one supposes it will not be long delayed in the view of the direction by the Conference of the deans of medical faculties of all universities in India. This will offer true guidance and inspiration and the subject will derive greater attention than at present. Emphasis will continue on scientific diagnosis, treatment and control of V.D. To trace and examine potentially infected contacts and thus to reduce morbidity rate are sufficient justification for making this a separate and independent specialty and keeping it so. Those who advocate or persist in the concept of dermato-venereology must look more deeply into the matter to realize the mistake. But authorities seem to be deaf and blind to the problem.
A routine blood test for syphilis in pregnant women to prevent congenital syphilis has to be applied in all antenatal clinics in the city.
There is perhaps no other branch of medicine as that of venereology which is so deeply interwoven with public health so as to be inseparable from it. However, venereal diseases rarely constitute an important part of activity of the public authorities. Most of the departments of Preventive and Social Medicine are without persons interested in venereology, and hence unable to extend any facilities for special studies relating to epidemiological, social and preventive aspects of venereal diseases. Even many venereologists themselves are not aware of their dual academic role for the public health. Preventive, Social and Public Health Medicine ought to include the course of training in public health aspects of venereology.
In the United Kingdom, venereology is recognized as a separate and distinct entity and venereologists work exclusively in their own field. This has resulted in an ideal comprehensive venereal diseases service. Their’s is an ideal example to follow. This is what being done in the Grant Medical College and its attached J.J. Hospital, Bombay for over last thirty or more years. But no one else wants to follow that example.
Despite constant threat and epidemics, venereal diseases have failed to obtain recognition for propaganda and increasing general awareness. Increased incidence of sexually transmitted diseases has proved that venereal diseases have retained their ugly face and remained as a social menace. This due to the lack of sensible national policy, unwillingness to learn from past mistakes, changing behaviour of micro-organisms, lack of health and sex education, and increasing promiscuity. It is, therefore, necessary to make serious efforts to remove drawbacks in the control and prevention of V.D., as well as hindrances in the smooth running of venereal institutions.
This state of affairs, very common in Municipal hospitals, colleges does not speak too well of the medical service and education in venereology. It should be a concern of all city fathers, not merely to improve but also to preserve the speciality in the interest of humanity.