Before discussing this question it is desirable clearly to distinguish
between the procedures which are included under this term. These are--
(1.) The supply of drugs and appliances which are made available
for use by the individual before exposure to infection. This may be
described as "anticipatory prophylaxis," and has commonly been
designated the "packet system."
The Committee condemn this procedure, for these reasons: (i) That
the system suggests a moral sanction to vice; (ii) that the
individual is lulled into a false sense of security, and may
thereby be encouraged repeatedly to expose himself to infection;
(iii) that the individual may be thereby deterred from seeking
early advice or treatment; (iv) that the drugs supplied may be used
for treating disease should it arise, and so delay may result in
seeking skilled treatment in the early stages when it is likely to
be most effective.
(2.) Treatment applied after exposure to infection. This is called
"early treatment." This term is inapplicable, as a disease cannot
be treated before it exists. It is also likely to be confused with
"abortive treatment," which implies treatment immediately on the
appearance of symptoms.
The evidence before the Committee shows that this form of
prophylaxis, if applied by skilled persons and within a few hours
of exposure, is effective in preventing disease in a great majority
of the cases in which it is used.
The Inter-departmental Committee on Infectious Diseases set up by the
Ministry of Health in 1919 in connection with demobilization, in a note
on "Prophylaxis against venereal disease," reported among its
conclusions based on service experience, "That where preventive
treatment is provided by a skilled attendant after exposure to infection
the results are better than when the same measures are taken by the
individual affected, even after the most careful instruction." After
exposure to infection there appears no reason why these diseases should
not be regarded in precisely the same manner as other infectious
diseases, and precautions taken to sterilize the parts which have been
exposed to infection.
It is to be noted that it is recommended that the prophylactic treatment
is to be carried out by some properly instructed person. This need not
necessarily be a medical man. It is suggested that this form of
prophylaxis might be carried out by an orderly at the venereal-disease
clinics. The notices posted in the public conveniences and other
suitable places indicating the existence of the clinics and the
necessity for treatment might include a guarded reference to their use
for this purpose.
This form of prophylaxis applies to males. In the case of females the
methods adopted would be also contraceptive, and the Committee do not
recommend that facilities should be provided for this.
The Committee must not be supposed to advocate prophylaxis as in any way
a substitute for continence and the cultivation of that high moral tone
that repels any suggestion of promiscuous sexual relationships, but they
feel that they could not properly ignore reference to a method of
prevention of these diseases which has proved very efficient in the
services, to which there appears no reasonable ethical objection, and
which brings their prophylaxis into line with that of other infectious
diseases.